n oft-used maxim in U.S. health care is that patients ought to be treated more like consumers. Their feedback about medical services should be valued, and they should be given a chance to express their concerns.
But with more patients speaking up — via hospital surveys and third-party rating websites — inevitable tensions are emerging. Negative comments sting. Doctors targeted by them get angry. And in some cases, the feedback from patients gets labeled something else entirely: defamation.
A steady drip of legal disputes over online reviews is putting those tensions on display. In Texas, a pair of freestanding emergency rooms recently filed a legal petition seeking to force Google to share the identities behind 22 screen names connected to negative comments about the providers’ services.
In another closely watched lawsuit, a plastic surgeon in Cleveland is suing a patient over negative reviews she posted on RealSelf and other sites. The dispute is unusual in that it may actually proceed to trial (most get settled), potentially leading to an influential precedent.
Participants in the doctor rating business say those cases are flashpoints in an inevitable, if messy, transition to a more open marketplace. And while some providers are balking at unfavorable reviews, other hospitals are taking a counterintuitive approach to the problem — calling for more reviews, and posting them on the hospital’s own site. That effort aims in part to put negative ratings in context. It’s also a way to deliver a more straightforward message to physicians: If you don’t want negative comments, do your job better.
“The big impact [of reviews] is on the people being measured, not so much on the consumer,” said Dr. Thomas Lee, chief medical officer for the patient survey company Press Ganey. “It makes people raise their game.”
University of Utah was the first hospital to begin posting unedited patient comments online in late 2012. Since then, dozens of hospitals have followed suit, including Cleveland Clinic, Duke, Geisinger of Pennsylvania, and Brigham and Women’s Hospital in Boston.
Some critics of publicly airing patient comments argue that they put doctors in an untenable position. Due to federal privacy laws, doctors cannot respond in a way that would compromise patient confidentiality, leaving them with limited ability to rebut complaints. Physicians are also uniquely vulnerable to public criticism, given the deliberateness most people take in choosing where to get health care.
So, many providers, including the University of Utah, give physicians an opportunity to review their comments — and to appeal to an internal committee to get them tossed out if a doctor can show a comment is particularly unfair or untruthful.
In some ways, hospitals’ decision to post more reviews is an act of self-preservation amid a dawning reality: Their doctors were already getting publicly rated on third-party sites like Healthgrades, Vitals, RateMDs and others. In many cases, such sites only feature a handful of comments on a given doctor. If one or two are negative, it’s easy for doctors to feel they are being presented unfairly.
Although third-party sites themselves are shielded from liability, the individual commenters are not. Libel lawsuits remain rare. More common are threatening letters from doctors and their attorneys seeking to pressure commenters into removing or retracting their statements. Last year, Aaron Schur, senior director of litigation at Yelp, testified before Congress that the company regularly receives supboenas from plaintiffs involved in an array industries who want to get Yelp users’ personal information to press their legal claims.
In testifying for greater protections for consumers, Schur cited a letter from one Yelp user who said he removed his comment — even though he maintained its truthfulness — after a dentist sued him for $100,000.
Though effective in some instances, such tactics are often expensive and risky, especially if they lead to litigation. Dr. Jeffrey Segal said there are more effective ways to respond. Instead of fighting negative comments, he said, providers ought to solicit more of them.
“I call it the denominator problem,” said Segal, chief executive of eMerit, which helps doctors collect and post reviews from patients. He said doctors who feel their reputation is being harmed by a few negative comments can combat the problem by opening the floodgates to all commenters.
It’s a tack that a wide variety of businesses — from hair salons to laundromats — have taken in the online era of “reputation management”: hiring firms to help solicit good reviews or respond to consumers who leave negative ones. As the health profession belatedly embraces online reviews, a number of firms have sprouted up specializing in just this kind of digital spruce-up.
Segal said his company does not screen patient comments or advise that only positive reviews be posted. He said that would quickly undermine their credibility, causing consumers to pass them off as marketing puffery.
Segal, who also founded Medical Justice, a firm that helps doctors deter frivolous malpractice suits, is among many doctors who have done an about-face on the value of patient comments. He said he initially thought they offered limited value in improving quality, while giving disgruntled patients a chance to take potshots.
Then he started to look into it more deeply. Examining data from insurance carriers on specific procedures, he found a high correlation between the outcomes data and what patients were saying about the doctors online. “I went from being opposed to it, to figuring out how to do it better,” Segal said of online reviews.
He acknowledged lawsuits will continue. But he cautions doctors not to file the kind of frivolous claims he spent so much energy trying to protect them from. “Litigation is probably something that should be used sparingly, infrequently, and with full eyes open,” Segal said. “There probably are occasional circumstances where it probably is [warranted], particularly if your practice is clearly damaged. But those are the exception. They’re not the rule.”