By Wendy Lewis

Like it or loathe it, consumers have become programmed to check reviews before they go, buy, or choose products and services. As more consumers rely on ratings and reviews to select their doctors, and to rule out the ones they do not want to go to, negative content posted about health care practitioners can directly affect the success of their practices. In the digital world, consumers are inclined to speak their minds and share their opinions about your practice, whether they are fair or not. Historically, unhappy patients tend to be the most vocal.

“Doctors have always been the beneficiary or victim of ratings; they just were not online and in your face. We have always had positive and negative comments, but the forum has grown from the bridge club and locker room to the universe, due to the Internet,” says Joe Niamtu III, DMD, a cosmetic surgeon in Midlothian, Va.

Without a doubt, the stakes are higher now. Aesthetic practitioners need to market themselves, which makes them more vulnerable to attacks. Every patient counts.

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In reality, it is almost impossible to have 100% happy patients despite your best efforts. Regrettably, ratings sites and social media platforms have become the logical places for patients and customers to vent and air their grievances. They are the first port of call for spite-based attacks on your professional reputation, and it’s unfortunate that some patients use these platforms as a weapon.

According to Niamtu, “Smart and conscientious doctors have always been concerned with their reputation. Only shallow doctors don’t care about what people think about them or what is said. We are all human, and we all want to hear good things.”

No matter how good you are as a physician, you are bound to get some snide remarks about your fees, or complaints about your approach or attitude at some point. The more patients you treat, the higher the odds of having some unhappy campers in the bunch.

It can be difficult to stay calm when you read what people are writing about you online. The worst thing you can do is to react in a defensive or aggressive manner. It is important to try to maintain a calm, rational, and reasonable approach at all times, even when the patient is completely unreasonable. Whenever possible, keep emotions out of it. As a physician, you do not share the privilege of over-reacting with your patients.

“When negative posts show up, doctors tend to take it very personally. If you do, the patient has won,” says Robert Aicher, Esq, general counsel for the American Society for Aesthetic Plastic Surgery.


By now, you should be keeping tabs of online critiques leveled against your reputation. Set alerts on Google, Yahoo!, and Bing, and assign a staff member to watch what is being posted on all relevant sites and social networking platforms. Using an external monitoring service can also help alert you to any new developments, such as reposts of negative content and any attacks that appear in response, so you can be proactive. For example, sites like offer a monthly analysis of your online reputation.

Physician management of negative online content can take many forms. Some approaches help distill an unflattering or defamatory post, while others can backfire significantly and escalate a situation. The last thing you want to do is to stimulate one comment and have it spread into a chain of like-minded comments.

3 Ways to Deal with Negative Content
1) Take good care of patients and resolve conflicts early.
2) Keep monitoring the web for uncomplimentary posts and mentions.
3) And if/when they arise, try to bury them with positive content.

According to Aicher, “Consumers are skeptical of reviews, and they look for red flags. Don’t feed the animals. You can make it worse by opening up a dialogue and engaging with them in a public forum. If you feel compelled to reply, remember that you are the professional. Anyone who is reading these reviews is judging whether you are the doctor they want to go to. Write something very innocuous that can’t get you into trouble.”

If you are going to respond, it should be something straightforward like this, Aicher says: “Thank you for expressing your concerns. If you would be so kind as to contact my office, I would be happy to discuss this with you further. Patient satisfaction is our number one goal.”

For example, common complaints on rating sites often center on long waiting times, a rushed staff, the doctor didn’t spend enough time, the feeling that the practice was too busy, and the ubiquitous bedside manner. You could try to distill the commentary about long waits and short visits with a statement such as, “We are among only a few aesthetic plastic surgery practices in the area, and we pride ourselves on providing quality care to all of our patients.”

Specifically, consumers who post negative reviews on doctor rating websites most commonly complain about a health care provider’s bedside manner (43%) and customer service (35.3%), according to a survey by Vanguard Communications. Of the online reviews analyzed, 53% gave doctors two stars or fewer out of a maximum of four or five stars.

Whenever possible and appropriate, the best tactic is to respond with factual information. Don’t be defensive, which can be misconstrued by readers as arrogance. If you wish, try to respond to the poster with some form of an offer to continue the dialogue. The next step is to take the matter offline. In this way, you have demonstrated that you stand behind your reputation and pay attention to situations flagged in public forums. You can then privately try to resolve the conflict (assuming that the post is actually a real patient with a valid issue).

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If you are the victim of negative comments, read the Terms of Service on the site with a fine-toothed comb. If the poster has violated the terms even slightly, you may have recourse to get the post removed.

As Aicher says, “Website hosts have significant latitude to keep or pull a thread.” There are circumstances where they are more likely to do so, he says. An example is a doctor who refused someone as a patient. The patient went on Yelp and trashed his photo gallery, and stated that she would never go to him. So the doctor contacted Yelp directly. In their terms of service, Yelp states that you MUST be a customer to post a comment, so this was a clear violation of its terms of service, Aicher explains.

If the poster is going over the top, you can try to get it taken down if it is not merely an opinion. Your chances are better if they are stating something as fact that can be perceived as defamatory. An example, Aicher says, is, “While I was under anesthesia, the doctor kissed me.” That is an allegation of criminal conduct, and would be considered automatically defamatory in most states.


Don’t Get SLAPPed

When you go online, you leave electronic footprints almost everywhere. So if you want to track down someone who has posted about you, you may be able to get the personal information they gave an Internet service provider (ISP) or message board when they signed up (name, address, phone number, e-mail, etc). Some sites might only have required an e-mail address to register. In this case, a subpoena to the ISP that hosts that address will be necessary to obtain the individual’s true identity.

Some physicians have tried to file lawsuits against patients or doctor rating sites over negative reviews, but they often lose. “Doctors feel angry when patients voice negative comments and want to get back. It is unwise to do so. It is better to address what could be complaints in the office, and stress proper patient selection and appropriate procedures,” says plastic surgeon Neil Reisman, MD, JD, who practices in Houston.

You could also be shooting yourself in the proverbial foot by taking legal action. SLAPP, the acronym for Strategic Lawsuit Against Public Participation, basically means that if you sue and you lose, you pay their legal fees. According to Reisman,

“Patients (prospective or actual) are entitled to their opinion as long as it is factual and NOT defamatory per se (citing untrue ‘conviction moral turpitude,’ ‘sexual transmitted disease,’ ‘untrue comments regarding sexual promiscuity,’ and ‘untrue comments against their business reputation.’)

“The SLAPP laws provide a defense against litigation to stop voicing their legally valid opinion. A patient voices an honest opinion against a surgeon. The surgeon sues in essence to stop the comments, actually knowing the opinions are protected speech. Yet the patient must hire an attorney and defend such statements. The SLAPP legislation protects the opinion, and when applicable in their jurisdiction, the court will dismiss the lawsuit against the patient and award legal fees for the defense against the surgeon bringing the lawsuit,” Reisman says.

Yelp is usually named as the most notorious site for filtering out positive reviews. The criteria it uses are not disclosed publicly, and physicians are far from the only business owners or professionals who lament that legitimate positive reviews from satisfied customers are often unfairly buried. Many physicians complain that their practices are taking a big hit because of this. The challenge is that users, called “Yelpers,” have a lot of clout.

Yelp survived a lawsuit attempting to stop them from filtering positive reviews, and the Court ruled that they could manage their database of reviews as they see fit.

Does Yelp play fair? Hopefully, consumers are getting wise to this practice and more will take the time to read both the “accepted” *and* filtered reviews. But those who are unaware of how this works can easily overlook the link to positive reviews. To level the playing field, many doctors are taking matters into their own hands. Aicher says, “If you scroll down to FILTERED RESULTS and click, all posts show up. Some doctors are stating in their own Yelp posting, SEE MY FILTERED RESULTS BELOW.”

Reviews on Yelp are more positive than negative, “except that they filter out positive reviews and they appear on Page two,” Aicher adds. But they also tend to keep negative reviews even if they are several years old.

Even if you become a Yelp advertiser, the only way to get rid of bad reviews is to have them flagged as inappropriate and try to get them reviewed by Yelp. This process takes time and is not always successful. You need to have grounds to get reviews taken down.

Furthermore, just having someone write a glowing review on Yelp also doesn’t mean that it is going to show up. “They give preference to regular Yelpers who have a 6-month history on Yelp. Even if a patient goes online and instantly reviews six other places, including your practice, it won’t work, either,” Aicher says.

According to plastic surgeon Brian M. Kinney, MD, FACS, who practices in Los Angeles, “Having patients write reviews while they are in your office will not work because they will come from the same Internet service provider address and will not be considered legitimate.”


The best way to avoid negativity is to not create any reason for having it in the first place. The second best way to counter negative ratings is to make sure they are buried under a slew of positive ratings from real satisfied patients who are your advocates.

So, how do you get patients to post good reviews? “Sometimes you have to ask,” Niamtu says. “It is much easier for staff to ask than for the doctor. When a patient compliments the result, office, or staff, it is very easy for the staff to say to the patient, ‘You will make our day if you give us a positive review.’ There is no shame in that. The doctor can do the same. Just asking a patient may not be enough as the thought passes out of their mind immediately after they leave your office. Giving them a card with various rating sites on it to simplify the process can be a great impetus,” he says.

Kinney suggests that physicians have to start early in the relationship and be proactive. “Start from the initial consultation when they are sitting in the waiting room. Use patient-satisfaction surveys so you show them that you value their opinion and get them to participate,” he says.

Encouraging patients to post good reviews about your practice is a constant battle, but the rewards will pay off. “Be consistent,” Niamtu says. “Do all you can, every day, to garner positive ratings. If you don’t, you will fall into the rut of getting a negative rating and then suddenly scrambling for some good reviews, which will be very apparent when someone looks at the site.”


Honest doctors may admit that this threat of negative reviews has made them a little more caring and humble as they know that there are more consequences to bad behavior than in the past. “No doctor should ever be arrogant, but those that have been may have to pay the piper,” Niamtu says. “We will all get some negative reviews, some unwarranted, some deserved. No one likes it. When it happens, first look in the mirror and ask, ‘Hey, is there some truth in this critique?’ If so, make your practice better.”

When you do find content that addresses a genuine shortcoming in your practice, you can use it to improve. If you are consistently getting three stars or less, there are probably some things that need immediate attention. For example, develop an approach that instills trust and confidence with each patient visit. If you have to rush to get through a busy day of patients, apologize to anyone who has been kept waiting and explain why. Get the staff involved in answering questions and moving patients through more quickly. Make an extra effort to avoid scheduling mishaps and billing snafus that are sure to cause patients to become irate. Another patient pet peeve is promising to do something and letting it slip through the cracks—such as calling back, contacting their insurance company, sending a receipt, making a copy of a chart, and calling in a prescription.

A collection of sincerely favorable reviews by real patients will outweigh a few negative ones, so being vigilant about garnering good will with patients is even more critical now. Persuade patients to write good reviews about your practice by showing that it matters to you. Include some of your positive reviews on your website and in your brochures. Post a sign at the reception desk stating that you value patient feedback by any means, including in person, by phone or e-mail, or via online forums.

The ongoing mission is to create a large body of positive content to outweigh any negative posts that may arise.

WendyLewis300dpi opt Wendy Lewis is president of Wendy Lewis and Co Ltd, Global Aesthetics Consultancy,, author of 11 books, founder/editor in chief of, and contributing editor of PSP. [email protected].