Should you respond?
Your decision to respond will depend on several factors. Are the patient reviews on a website to which you pay a fee to refute these allegations or remove negative comments? That situation is tantamount to blackmail. I would ethically decline to participate in such a scheme.
Michael W. Davis, DDS.
In some cases, patients create a website to specifically address the alleged abuses of a particular doctor, clinic, or chain of clinics. We have precedence in case law, in which individual doctors and even large corporate dental chains have sought legal remedy, to remove such commentary from the internet. The right of free speech in the U.S. Constitution has generally supported patients' rights to make open commentary on their healthcare providers. As unfair as some of this disgruntled reviewing may seem, there is little the provider can do.
If you elect to respond on an open forum, elements of patient protection may be afforded under the U.S. Health Insurance Portability and Accountability Act (HIPAA) statutes. A patient may certainly breach doctor/patient confidentiality, but a doctor is not allowed to do the same.
The penalties for HIPAA violations may be quite severe. Commentary may be distorted, unreasonable, and very hurtful. Regardless of the professional pain, you might be best advised to remain silent.
Some dentists and dental chains may generate an online response. Too often, these rebuttals seem trite, vague (to protect patient confidentiality), and generic. They may also serve to draw additional attention to the complaints. Rarely will such rebuttal of negative patient commentary change minds.
The best action to take is to counterbalance a negative patient review with multiple positive reviews. Generate the very best dental service for patients that you possibly can. Keep reception rooms and restrooms clean and orderly. See patients on time. Explain dental services, and obtain a complete informed consent from patients prior to delivery of care. If patients seem pleased with your dental services, it's great to request online reviews.
“The doctor must always lawfully and ethically meet the standard of care for care delivered.”
Dental consumers are savvy. They respond more favorably to a dental practice with more than 90% positive reviews and a few negative reviews. Those practices with 100% positive reviews may appear suspect to a discerning consumer. Why?
One example is that some practices offer patients gifts or incentives in exchange for positive online reviews. More tuned-in patients can often detect such behavior. Certain reviewing websites that detect incentives in exchange for positive reviews will negatively categorize such dental clinics.
Some dentists and larger corporate practices will go to the extent of peppering patient review websites, and even employment review websites, with artificially created positive reviews. This activity could eventually come back to bite the practice. A variety of methods may be employed to track such activity, ranging from reports (or affidavits) of former disgruntled employees to systems in tracking computer addresses.
I specifically know one case in which this bogus activity was addressed in a dental malpractice/fraud legal case. The defense attorney objected to deposition questioning, claiming that possible misrepresentations with online reviews were immaterial to the case. The plaintiffs' attorney argued that such misrepresentations were part of a larger pattern of public deceptions in violation of unfair trade practice acts and false claims acts.
This case was settled before trial, but deposition questions relating to generating bogus online reviews were not favorable to the defense.
If you can discern who the unhappy patient is, you may elect to address the matter with the patient personally. This takes the discourse offline into a private realm, which protects patient privacy and avoids potential HIPAA violations. Sometimes a favorable resolution can be reached. Such patients may retract their negative review and insert positive commentary.
There are also times you may reach a stone wall. For example, in one case, a patient generated a very negative online review. When the patient was contacted privately, the person's true objection turned out to be that the practice would not alter dates of dental services for an insurance claim, which would have lessened the patient's out-of-pocket expenses. It was explained to the patient that such activity would expose the dentist and dental clinic to liability risks for insurance fraud.
However, in cases like this, if the patient responds, "I don't care. That's what my last dentist would do for me," there may not be much you can do.
Other times, a patient may demand that a doctor provide services below the standard of care, usually to save money and cut corners. A patient cannot legally sign a waiver that absolves a doctor from meeting patient protections of standard of care.
The doctor must always lawfully and ethically meet the standard of care for care delivered. In reaction or retaliation, a patient may place a negative online review, despite the very best explanations of dental ethics and law. The doctor is most likely at an impasse in these instances.
I offer these six tips when I am asked about how to handle negative reviews:
- You should always provide patients with the very best care possible.
- You should never pay an incentive for positive online reviews.
- You should not be overly concerned about a few negative reviews. These are to be anticipated and can be countered with many more positive reviews. This gives authenticity to the review site.
- You should never offer incentives or gifts for online reviews.
- You should never get into an online "discussion" with a disgruntled patient. You can't win.
- You should never submit bogus positive online reviews. Savvy patients will pick up on this, and this could also cause legal damage in the future.
Michael W. Davis, DDS, practices general dentistry in Santa Fe, NM. He also provides attorney clients with legal expert witness work and consultation. Dr. Davis also serves as chairperson for the Santa Fe District Dental Society Peer Review. He may be contacted at MWDavisDDS@Comcast.net or www.SmilesofSantaFe.com.
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