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2/20/2014
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Online Patient Reviews: 6 Strategies For Doctors

Healthcare practices can't control what patients write, but they can control how they respond to increasingly popular review sites like Yelp and RateMDs.

Surgical Robots: Look Who's Coming To The OR
Surgical Robots: Look Who's Coming To The OR
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Patients are starting to diagnose their doctors via online review sites, so it's important for healthcare practices to maintain their digital reputations. 

After all, a one-star drop in a rating can reduce a business's revenue by almost 10%, a Harvard Business School study has found. 

Twenty-three percent of those surveyed for the Journal of the American Medical Association use rating sites such as Healthgrades, Vitals, RateMDs, and ZocDoc. Of those, about one third either chose -- or shunned -- a physician because of these online ratings, the survey of 2,137 adults discovered. Since the poll was taken in September 2012, it's probably safe to assume the number of those using and relying on web reviews has only grown: In 2010, more than 112,000 individual doctors were reviewed, compared with 2,475 in 2005, according to RateMDs.

In addition, 19% considered a doctor's ratings "very important," versus 46% who deemed a physician's experience to be very important, the survey found. The majority (89%) said the office's acceptance of their insurance was very important.

[Are doctors too busy to fill out electronic health records? Read Do Doctors Need EHR 'Scribes'?]

These statistics indicate consumers are far less likely to visit a doctor-rating site than one that ranks hotels, restaurants, or movies. Yet the inclusion of practitioners on sites like Yelp, as well as medical-only sites, is likely to encourage an increasingly aware public to post opinions, often anonymously, about doctors.

Like other public-facing businesses, doctors will have to address angry comments, fake reviews, and other downsides of the digital age. Unlike many other industries, however, healthcare providers are constrained by HIPAA regulations. Fortunately, they do have some options available that allow them to leverage or control online reviews.

1. Ask for raves. When one patient writes a negative review, some offices ask favorite patients to combat that post with their own thoughts on the doctor's services, waiting room times, and courtesy. Because scores typically are based on averages, satisfied patients' reviews will balance out the lone malcontent.

2. Contact the complainer. If a patient posted negative feedback after a visit, contact him to see if the office can do anything to improve the situation. Many review sites allow a service provider to privately message a reviewer without revealing the identity of the person who complained. If the person doesn't respond or is unreachable, accept fault, apologize, or explain. An unusually long wait could have been because the doctor was called to the emergency room for a critical patient or for an early delivery, for example. 

3. Gag orders. Some practices have tried to contractually prevent patients from posting online comments or give doctors the right to veto any comments patients publish online. Turning to service providers like Medical Justice, they can take patients to court if consumers breach these contracts. Some review sites, such as Yelp, are ignoring these agreements, arguing they go against individuals' right to free speech. 

4. Reputation management. Several businesses specialize in providing reputation management services to healthcare organizations. Others, such as WebiMax, Brand.com, and Reputation Management LLC, generalize across markets. Reputation management firms monitor online posts; help build a brand; provide search engine management; deliver content management; and have online self-service tools for staff. Most of these services help medical providers repair bad online reputations caused by name confusion, ancient posts, or other problems. In addition to responding to malcontents, they improve practices' rankings, ratings, and standings across a slew of online sites.

5. Fake posts. Some reviews and comments are not the work of dissatisfied patients. They are fictional work by disgruntled ex- (or current) employees, competitors, or others with an agenda. In these cases, the best approach might be to hire an outside expert to find the source of the lie, then sue in court.

6. Learn and move on. If criticism was warranted -- many complaints are about wait times, brusque bedside manners, or rude office staff -- use what patients say to improve the practice. Consider new tools to cut waiting times. Brush up on office etiquette or go to bed a little earlier. Next time, patients might be pleasantly surprised at the improvements.

Medical data breaches seem to show up on the 6 o'clock news almost every week. If you think it won't happen to you -- or the financial impact will be minor -- think again. Download the Healthcare Data Breaches Cost More Than You Think report today. (Free registration required.)

Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel ... View Full Bio

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anon8549682611
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anon8549682611,
User Rank: Apprentice
5/5/2014 | 2:58:47 AM
ďFrom now until the end of time, Iíll be the jerk neurologist who was rude to a World War II veteran,Ē
 "The Streisand Effect." refers to the consequence of inviting even more negative attention by trying to remove negative attention. (The) inspiration was Barbra Streisand's objecting to a photo of her house in California being made part of a series documenting coastal erosion. Her complaints made the image far more pervasive online than it would have been had she simply ignored it.

 

David McKee, M.D., a Duluth, Minn., neurologist, was unaware of this phenomenon at the time he decided to sue Dennis Laurion. Laurion's father, Kenneth, had suffered a stroke in April 2010; McKee was called in to assess Kenneth's condition.

 

McKee asked if Kenneth felt like getting out of bed so he could make an assessment on mobility. He did, though his gown was partially undone in the back. According to the Laurions, McKee was oblivious to Kenneth's modesty. "His son was right there," McKee counters. "If he was concerned about the gown, he didn't get out of his chair to tie it."

 

The family exited the room while McKee conducted a brief examination. Laurion says he returned to find his father partially conscious. His head, Laurion asserts, was "pushed against the railing" of the hospital bed, appearing to be a victim of postural hypotension that resulted in a brief fainting spell.

 

Unaware of any resentment, McKee went to the nurse's station to dictate notes; an irritated Dennis Laurion consulted with his family to see if his impression of the arrogant doctor was real or imagined. At no point did he approach McKee to clear the air. Instead, he fired off a dozen or more letters to a variety of medical institutions, including the hospital's ombudsman, the Minnesota Board of Medical Practice, Medicare, and the American Medical Association.

 

McKee sued Laurion for defamation. A local Duluth newspaper picked up on the story, favoring Laurion's interpretation of events. McKee claims the writer called him shortly before close of business Friday to solicit a quote; the story ran the following day. "The article was written like I was being reviewed for misconduct," McKee says. In fact, no action had been taken against him by any of the organizations Laurion had written to.

 

Two events further demoralized McKee. In April 2011, the judge granted Laurion's motion for summary judgment, ruling his comments were protected free speech. Worse, a user on Reddit.com posted the newspaper story. Almost overnight, dozens of "reviews" popped up on RateMDs.com and other sites with outlandish commentary on McKee, who was referred to as "the dickface doctor of Duluth." Their software was apparently unable to determine that a surge of opinion over a matter of hours was highly unusual activity for a physician who normally received perhaps three comments in a year.

 

McKee found no easy way to exit the situation. "You get drawn in," he says, suggesting his lawyer nudged him into further action. "It's throwing good money after bad. ... I wanted out almost as soon as I got in, and it was always, 'Well, just one more step.'" McKee appealed, and the summary judgment was overturned. The case, and the measurable impact of being labeled a "real tool," was now headed for the Minnesota Supreme Court.

 

Law professor Eric Goldman, who says he feels physicians are "thin-skinned" when it comes to patient complaints, is confident that litigation is never the answer. "I imagine many lawyers saying that's not good idea," he says. "Good lawyers, anyway. McKee made a bad call. There are no winners in defamation lawsuits, and you should advise clients of that."

 

McKee was rated for several years as a top provider in Duluth Superior Magazine, a well-regarded lifestyle publication that recently folded. But his online reputation will outlive that. "From now until the end of time, I'll be the jerk neurologist who was rude to a World War II veteran," the physician says. "I'm stuck with it forever."

 

Full article:

http://www.buzzfeed.com/jakerossen/insult-and-injury-inside-the-webs-one-sided-war-on-doctors
anon2885669109
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anon2885669109,
User Rank: Apprentice
2/27/2014 | 1:59:04 AM
Re: Streisand Effect for litigious doctors
Other reaction to David McKee MD v. Dennis Laurion. There are several Dr. David McKee entities. This refers to Dr. David McKee of Integrity Health Network and Northland Neurology and Myology, practicing at St. Luke's Hospital in Duluth MN.

 

Jane Kirtley, a professor of media ethics and law at the University of Minnesota School of Journalism, told the Star Tribune that the ruling stems from "an elementary principle of libel law." She said that this isn't a blank check for people to make false factual statements. She said, rather, that it's "an endorsement that statements of opinion are protected under the First Amendment."

 

According to the Duluth News Tribune, Minnesota Newspaper Association attorney Mark Anfinson, who watched the oral arguments before the Supreme Court in September, said that the justices made the right decision. Anfinson also told the News Tribune, "What this case really exemplifies is not so much legal precepts in libel law, but the impact of the Internet on the ability to publish unflattering comments about people."

 

Anfinson was also interviewed by Minnesota Lawyer. He said, "Anyone who knew about the case, who observed the oral arguments, and who knows something about libel law is about as unsurprised with this result as they can be. It's about as perfunctory and routine as the Supreme Court ever gets. It was a completely straightforward application of long-settled libel-law rules."

 

Anfinson said the case is more significant for social commentary purposes than for its legal analysis, noting that perhaps the justices only accepted the case to fix an error of the Court of Appeals.

 

Laurion's attorney, John D. Kelly, said the fact that Laurion's speech was made online was inconsequential to the ruling, which treated it as a standard defamation case. "It's almost as if things were said around the water cooler or perhaps posted in a letter to the editor," he said. "I think the principles they worked with are applicable to statements made irrespective of the medium."

 

Commenting about this case on his own blog, February 8, 2013, Aaron Kelly, internet law & defamation law attorney, said "Thanks to the First Amendment, free speech is the law of that land, and that means being able to communicate our views publicly – no matter how offensive."

 

The Mankato Free Press  said in February 2013: "It's puzzling why McKee's defamation lawsuit — filed nearly four years ago — was still in court. It's long been established that people may spout any opinion they want without fear of being sued . . . It's unsettling that the Appeals Court earlier ruled to allow the suit to continue."

 

Mark A Fischer of Duane Morris LLP, a full-service law firm with more than 700 attorneys in 24 offices in the United States and internationally, said on February 11, 2013, "For those who are under criticism, one of the practical consequences of bringing a defamation action is that more publicity for the accused statements is almost an inevitable result, whether the statements are ultimately found libelous or not.  In other words, in weighing the pros and cons of initiating a lawsuit, all potential defamation and privacy claim plaintiffs should consider the rule of Hippocrates applicable to physicians, 'First do no harm.'"

                                        

In his Technology & Marketing Law Blog, Eric Goldman said on February 4, 2013, "I've been tracking doctor v. patient lawsuits for online reviews. . . doctors usually lose or voluntarily drop these lawsuits. Indeed, with surprising frequency, doctors end the lawsuit by writing a check to the defendant for the defendant's attorneys' fees where the state has a robust anti-SLAPP law. Doctors and other healthcare professionals thinking of suing over online reviews, take note: you're likely to lose in court, so legal proceedings should be an absolute last-resort option--and even then, they might not be worth pursuing."

 

Dan Hinmon, the principal of Hive Strategies, wrote for Health Care Communication, on March 21, 2013, "According to the Star Tribune, McKee is now ticked off at the people who posted hundreds more negative comments about him after the story went viral. Incredulously, the story reports that McKee 'hasn't ruled out a second lawsuit stemming from these posts.' Yes, you read that right. After spending 'at least $50,000 in legal fees and another $11,000 to clear his name online after the story went viral,' McKee is considering suing the rest of the people who, exercising their right of protected speech, chimed in. I'm speechless."
DennisLaurion
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DennisLaurion,
User Rank: Strategist
2/25/2014 | 6:15:10 PM
Re: Streisand Effect for litigious doctors
In  spite  of  Supreme  Court  disagreement  and  subsequent  peer  disagreement,  Marshall  Tanick  is  STILL  saying  about  David  McKee  MD  v.  Dennis  Laurion:  "The  thing  that's  often  misunderstood  is  that  THIS  WAS  NOT  JUST  ABOUT  FREE  SPEECH,  BUT  ABOUT  MAKING  ACTUAL  FALSE  STATEMENTS.  The  problem  is  today's  unfettered  opportunity  to  express  opinion,  whether  or  not  the  substance  of  what's  said  is  true  or  not.  We  need  some  boundaries."

From  the  American  Health  Lawyers  Association:  IN  THIS  CASE,  THE  COURT  FOUND  THE  SIX  ALLEGEDLY  DEFAMATORY  STATEMENTS  WERE  NOT  ACTIONABLE  BECAUSE  THE  "SUBSTANCE,  THE  GIST,  THE  STING"  OF  PLAINTIFF'S  VERSION  FOR  EACH  OF  THE  STATEMENTS  AS  PROVIDED  IN  DEPOSITION  AND  DEFENDANT'S  VERSION  ESSENTIALLY  CARRIED  THE  SAME  MEANING,  satisfied  the  standard  for  substantial  truth,  did  not  show  a  tendency  to  harm  the  plaintiff's  reputation  and  lower  his  estimation  in  the  community,  or  were  incapable  of  conveying  a  defamatory  meaning  (e.g.,  when  a  nurse  told  defendant  that  plaintiff  was  "a  real  tool")  based  on  "how  an  ordinary  person  understands  the  language  used  in  the  light  of  surrounding  circumstances." 

From  the  Business  Insurance  Blog:  THE  MINNESOTA  HIGH  COURT  SAID,  FOR  INSTANCE,  THAT  DR.  MCKEE'S  VERSION  OF  HIS  COMMENT  ABOUT  THE  INTENSIVE  CARE  UNIT  WAS  SUBSTANTIALLY  SIMILAR  TO  MR.  LAURION'S.  "In  other  words,  Dr.  McKee's  account  of  what  he  said  would  produce  the  same  effect  on  the  mind  of  the  reader,"  the  court  said.  "The  minor  inaccuracies  of  expression  (in  the  statement)  as  compared  to  Dr.  McKee's  version  of  what  he  said  do  not  give  rise  to  a  genuine  issue  as  to  falsity."

From  the  Duane  Morris  Media  Blog:  The  doctor  said  in  his  deposition  that  with  regard  to  finding  out  if  Mr.  Laurion  was  alive  or  dead,  "I  made  a  jocular  comment...  to  the  effect  of  I  had  looked  for  [Kenneth  Laurion]  up  there  in  the  intensive  care  unit  and  was  glad  to  find  that,  when  he  wasn't  there,  that  he  had  been  moved  to  a  regular  hospital  bed,  because  you  only  go  one  of  two  ways  when  you  leave  the  intensive  care  unit;  you  either  have  improved  to  the  point  where  you're  someplace  like  this  or  you  leave  because  you've  died."  THE  COURT  SAID  THE  DIFFERENCES  BETWEEN  THE  TWO  VERSIONS  OF  THE  STATEMENTS  ABOUT  DEATH  OR  TRANSFER  BY  BOTH  PLAINTIFF  AND  DEFENDANT  WERE  SO  MINOR  THAT  THERE  WAS  NO  FALSITY  IN  THE  WEBSITE  POSTINGS.  In  other  words,  the  court  indicated  that  the  allegation  about  the  statement  was  true.

Although  the  Minnesota  Supreme  Court  dismissed  David  McKee  MD  vs  Dennis  Laurion,  the  entire  experience  has  been  distressing  to  my  family.  We  were  initially  shocked  and  blindsided  by  "jocular"  comments  made  so  soon  after  my  father's  stroke  by  somebody  who  didn't  know  us.  We  were  overwhelmed  by  my  being  sued  after  posting  a  consumer  opinion,  and  we  were  shocked  by  the  rapidity  with  which  it  happened.  My  parents  would  be  88-year-old  witnesses.  My  mother  and  wife  prefer  no  discussion,  because  they  don't  want  to  think  about  it.  Conversation  with  my  father  only  reminds  him  of  his  anger  over  this  situation.  My  siblings  and  children  don't  often  bring  it  up,  because  they  don't  know  how  to  say  anything  helpful.  I  have  been  demoralized  by  three  years  of  being  called  "Defendant  Laurion"  in  public  documents.  While  being  sued  for  defamation,  I  have  been  called  a  passive  aggressive,  an  oddball,  a  liar,  a  coward,  a  bully,  a  malicious  person,  and  a  zealot  family  member.  I've  been  said  to  have  run  a  cottage  industry  vendetta,  posting  108  adverse  Internet  postings  in  person  or  through  proxies.  That's  not  correct.  In  reality,  I  posted  ratings  at  three  consumer  rating  sites,  deleted  them,  and  never  rewrote  them  again.

The  plaintiff's  first  contact  with  me  was  a  letter  that  said  in  part  that  he  had  the  means  and  motivation  to  pursue  me.  The  financial  impact  of  being  sued  three  years  to  date  has  been  burdensome,  a  game  of  financial  attrition  that  I  haven't  wanted  to  play.  The  suit  cost  me  the  equivalent  of  two  year's  net  income  -  the  same  as  48  of  my  car  payments  plus  48  of  my  house  payments.  My  family  members  had  to  dip  into  retirement  funds  to  help  me.

After  receipt  of  a  threat  letter,  I  deleted  my  rate-your-doctor  site  postings  and  sent  confirmation  emails  to  opposing  counsel.  Since  May  of  2010,  postings  on  the  Internet  by  others  include  newspaper  accounts  of  the  lawsuit;  readers'  remarks  about  the  newspaper  accounts;  and  blog  opinion  pieces  written  by  doctors,  lawyers,  public  relations  professionals,  patient  advocates,  and  information  technology  experts.  Dozens  of  websites  by  doctors,  lawyers,  patient  advocates,  medical  students,  law  schools,  consumer  advocates,  and  free  speech  monitors  posted  opinions  that  a  doctor  or  plumber  shouldn't  sue  the  family  of  a  customer  for  a  bad  rating.  These  authors  never  said  they  saw  my  deleted  ratings  –  only  the  news  coverage.

I've  learned  that  laws  about  slander  and  libel  do  not  conform  to  one's  expectations.  I've  read  that  online  complaints  are  safe  "if  you  stick  to  the  facts."  That's  exactly  the  wrong  advice.  I  did  not  want  to  merely  post  my  conclusions.  I  wanted  to  stick  to  my  recollection  of  what  I'd  heard.  I  don't  like  to  read  generalities  like  "I'm  upset.  He  did  not  treat  my  father  well.  He  was  insensitive.  He  didn't  spend  enough  time  in  my  opinion."  However,  such  generalities  are  excused  as  opinion,  hyperbole,  or  angry  utterances.  If  one  purports  to  say  what  happened,  factual  recitations  can  be  litigated.  The  plaintiff  must  prove  the  facts  are  willfully  misstated,  but  the  defendant  can  go  broke  while  waiting  through  the  effort.
McKeeVLaurion
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McKeeVLaurion,
User Rank: Apprentice
2/24/2014 | 4:14:59 AM
Streisand Effect for litigious doctors
Doctors who skip reputation repair for defamation lawsuits should be told by their lawyer(s) about the Streisand Effect.

 

This is extracted from:

 

TWIN CITIES BUSINESS

The Top Lawsuits Of 2013

by Steve Kaplan

December 20, 2013

 

Never Shout "He's a Tool!" On a Crowded Website?

 

Dr. David McKee, a Duluth neurologist at St. Luke's Hospital, was not laughing when he saw what one former client wrote about him on a doctor-rating website. The reviewer, Dennis Laurion, complained that McKee made statements that he interpreted as rude and quoted a nurse who had called the doctor "a real tool." As these statements echoed through the Internet, McKee felt his reputation was being tarnished. He sued, and so began a four-year journey that ended this year in the Minnesota Supreme Court.

 

Laurion was unhappy with the way McKee treated his father, who was brought to the doctor after he had a stroke. Laurion went to several rate-your-doctor sites to give his opinion. That's just free speech, isn't it?

 

It sure is, says Laurion's attorney, John D. Kelly of the Duluth firm Hanft Fride. "The court held that what my client was quoted as saying was not defamatory," he says. "I do think the Internet makes it much easier for persons exercising poor judgment to broadcast defamatory statements, however... a medium... doesn't change the quality of a statement from non-defamatory to defamatory."

 

But McKee's lawyer, Marshall Tanick, of Hellmuth & Johnson, says no matter where it was said, defamation is defamation. "The thing that's often misunderstood is that this was not just about free speech, but about making actual false statements," Tanick says. "The problem is today's unfettered opportunity to express opinion, whether or not the substance of what's said is true or not. We need some boundaries."

 

But boundaries were not on the minds of the Minnesota Supreme Court. Free speech was. Chief Justice Lorie Gildea wrote, "The point of the post is, 'This doctor did not treat my father well.' I can't grasp why that wouldn't be protected opinion." As to referring to the doctor as "a real tool," Justice Alan Page wrote that the insult "falls into the category of pure opinion because the term ... cannot be reasonably interpreted as a fact and it cannot be proven true or false."

 

The takeaway from this case might be the knowledge that behind any rating service lie real people with real feelings. McKee spent more than $60,000 in the effort to clear his name, as he saw it. Dennis Laurion told the Star Tribune he spent the equivalent of two years' income, some of which he had to borrow from relatives who supplied the money by raiding their retirement funds.

 

See rest of article: http://tcbmag.com/Industries/Law/2013-Lawsuits-Of-The-Year
Alison_Diana
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Alison_Diana,
User Rank: Author
2/20/2014 | 2:50:32 PM
Re: Embrace patient input
Interestingly, while there isn't a ton of research out there about healthcare-specific review sites, what there is points to reasons like you both mentioned, reasons that have little to nothing to do with the doctor or dentist's quality of care. You'd think things like waiting time, providing a bathroom for patients, and not allowing staff to smoke (or not hiring smokers) would be pretty easy to remedy -- but only if offices know those are why patients are moving on. Usually, practices don't know why patients leave. They only know they've gone when they get a request for files. 

It only makes sense patients will start using these sites more and more for doctors, dentists, and other healthcare providers. Whenever I've looked at them I've been disappointed at the parcity of comments, but have noticed improvement over the past year or two. Trying to block patients from using these systems only makes a provider suspect. Can you imagine going to any other service provider if they forced you to sign a "no ratings allowed" contract?! I don't think so!
Lorna Garey
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Lorna Garey,
User Rank: Author
2/20/2014 | 1:09:54 PM
Re: Embrace patient input
Exactly - how many patients just quietly up and leave a practice for reasons that the doctor or manager could have remedied. I bet we've all done it. I know I have, at least four times that I can think of offhand.

Millenials don't buy a cheeseburger without checking Yelp. You can bet these ratings will only grow in importance.

So, what's are some reasons you dumped a physician? For me, it was that one of his receptionists always smelled like smoke. Ick. Another had a bathroom only for staff - if patients needed to go while in waiting room, they sent you with a key to the one out in the hallway.
ChrisMurphy
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ChrisMurphy,
User Rank: Author
2/20/2014 | 11:17:42 AM
Embrace patient input
Medical practices need to embrace this discussion as a way to understand what's wrong. I've seen so many practices perform badly at the experience around the medical care -- pre-surgery communication, post-surgery follow-up, waiting room communication, and the like. Having spent 90 minutes waiting in my dentist office lobby Monday for an appointment, I'm plotting how i can switch practices, despite the big headaches involved. Wouldn't that practice rather know that and try to fix its considerable problems?
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