Build and Defend Your Online Reputation

Jeanine B. Downie, MD, FAAD is Director, image Dermatology® PC in Montclair, NJ and Assistant Attending at Mountainside and Overlook Hospitals.

Dr. Downie has no relevant disclosures.

Online review websites are a fact of life for many Americans. There are individuals who will not go to a restaurant, shop, hotel, or salon without first researching its ratings on the web. Sometimes the same holds for healthcare providers, especially when patients are considering elective procedures. Patient/ consumers may research potential providers and read web reviews before they even book a consultation.

A Wall Street Journal poll indicates that more than 90 percent of patients value doctor rating sites.¹ Recently released survey results from the healthcare technology company Digital Assent show that eight out of 10 respondents say online reviews influence their willingness to be treated by a doctor. Fifty percent of respondents believe that a doctor's online reputation is worth considering if they have at least 10 reviews. The survey sample was small at 341, but the findings reflect trends in patients' use of rating sites.

The Pew Internet and American Life project reported earlier this year that 30 percent of Internet users have consulted online reviews or rankings of healthcare services or treatments.² It may be worth noting that the survey was slanted toward use of the Internet for disease diagnosis or general medical information, and it stands to reason that the use of review sites may be higher among cosmetic patients.

Aesthetic physicians must be prepared for the “online review” reality and know how to effectively manage their reputations. As discussed ahead, a proactive strategy is integral to success and far more effective than reacting to negative reviews.

RATINGS SITES: SOME BASICS

Ratings websites are big business. One of the best known sites, Yelp reportedly rejected a $550 million buyout offer from Google in 2011.³ Though details were not disclosed, the decision suggests that Yelp is in a rather comfortable financial position. Yelp has an estimated 50 million visitors per month—possibly more—and hosts more than 17 million reviews.

Rating sites run the gamut from focusing on very specific services or industries (such as RateMD for physicians or Angie's List for contractors) to general sites that rate everything from car washes to neurosurgeons. Some sites are subscription-based and generate revenues from user fees as well as the sale of advertising to related vendors.

Open sites generate revenue from the sale of broad-interest web advertisements (such as for wireless telephone carriers or national chain stores). But the bulk of their revenue derive from the sale of various promotional opportunities and advertising positions to local businesses. These may include traditional web advertising opportunities, or sites may highlight a sponsored business when a user enters a search in their category—these are, on transparent sites, labeled as sponsored links.

Controversy exists regarding questionable alleged revenue generating tactics that some review sites are said to use. In one publicized lawsuit, a law firm alleged that Yelp staff coerced it into advertising in order to receive favorable reviews. Although a court sided with the firm and ordered Yelp to pay damages, Yelp appealed, and the case has been sent to arbitration. Of interest, Yelp subsequently has filed suit against the law firm, alleging that the firm had its employees post misleading, positive reviews on the site.⁴ Anecdotally, businesses have charged review sites with offering to remove inaccurate negative comments only in exchange for advertising or with offering to keep positive reviews at the top of results for contracted advertisers.⁵

Bottom Line

More important and likely more effective than countering individual reviews is to focus on building your reputation and “managing the message.” Don't wait for random patients to post comments on rating sites. Instead, recruit patients that are willing to post positive comments about you.

Of course, businesses can abuse rating sites. The New York Attorney General's Office this fall settled an agreement with 19 businesses that will pay more than $350,000 in total fines after being accused of posting fake positive reviews.⁶

PROBLEMS WITH REVIEW SITES

One problem with physician rating sites, and rating sites for any professionals for that matter, is the lack of objectivity in most ratings and the challenge of an untrained individual objectively assessing a medical professional. Most people can agree on what constitutes good restaurant service or a clean hotel room. But are patients always prepared to offer a fair assessment of medical care? If the patient goes to another physician and receives a different treatment, does that mean the first physician was “wrong”? Does refusing to provide a particular cosmetic therapy make the physician a responsible provider or an overbearing know-it-all? If the patient neglected to follow post-procedure instructions—which they may conveniently forget to mention in their review—is the poor outcome the physician's fault?

Many sites still allow anonymous reviews. With anonymous posting, there is no way to know whether the individual posting is actually a patient. A competitor could post comments on a site in efforts to deter patients from your practice. Worse, a disgruntled ex-employee, family member, or former friend could post negative comments, posing as a dissatisfied patient. Sometimes negative comments are personal and have little to do with the physician's professional skill. One doctor had a disgruntled family member who wanted money and posted complaints online. There are also anecdotal reports of medical professionals using anonymous posts to make wild accusations against competitors, including claims of sexual impropriety.

It appears generally that disgruntled patients are more likely to write negative ratings than contented patients are to post a positive review, though this is not always the case. It may also be true that negative reviews seem more “dramatic” and therefore attract more of a review site visitor's attention than a positive comment, though this is not proven.

Unfortunately, it may be impossible to remove a negative review—no matter how unfair it is. Even for factually inaccurate or libelous postings it can be difficult if not impossible for a physician to contact a cooperative human being at the site. Gaining access to a customer service professional does not guarantee that problems will be addressed.

Reputation Management Companies

Third-party companies can be contracted to assist with reputation defense. Some companies promise to monitor postings and work to remove any negative or inaccurate posts about you. This kind of service can be costly, ranging from hundreds to more than a thousand dollars per month. If going this route, consider seeking a by-the-hour contract so that the company will make an accounting for the work they do on your behalf.

A marketing consultancy company like Infogroup (infogroup. com) can assist with all social media implementation and help establish that important baseline positive message. They can help create a consistent image for you and your practice across multiple platforms (website, social media, print and web ads, etc.).

You may not need a reputation defender, but you do need to monitor the chatter. There are free tools that can help. At a minimum, set up a Google alert for you, your practice, your industry, and locality. You can set alerts to be sent daily or weekly, and you'll be notified when your name appears online.

Computer dual verification technology is forthcoming that will level the playing field and ensure that your competitors are kept out of your online assessments.²

BUILD A POSITIVE REPUTATION

Despite these very real challenges, you can defend your reputation online. It is not necessarily difficult to do, but it does require effort and know-how.

Responding directly to negative comments is really just a minor aspect of the strategy, but it's a reasonable starting point for discussion. The first step is to try to identify the source of negative comments if you can. Most sites are anonymous, but certain details may be specific to an incident or case you easily recognize. Some patients give their initials or their names on the sites. For example, one of my patients posted her unusual first name and first letter of her surname on the complaint on a doctor site. When called and confronted, she initially denied posting but then agreed that I could ask Google to take the comments down. Because I affirmed to Google that I had no other patients with this first name, they accepted her consent to retract the comments.

A patient in collections for failure to pay may purposefully tip his/her hand in a negative comment, thinking that you'll ask them to retract their comments in exchange for cancelling their debt. Do not allow yourself to be bullied. If you can identify the source of inaccurate or unfair posts, contact them, but don't feel pressured to offer anything to the patient for retracting false information.

Generally, answering a negative posting online is not advised. If you respond, be courteous and non-specific. Try something like, “Please contact our office so that we may address any concerns with you directly.” Even though the patient initiated the post, making any specific response to refute the patient's post could lead to an inadvertent HIPAA violation.

THE BIGGER PICTURE

More important and likely more effective than countering individual reviews is to focus on building your reputation and “managing the message.” When patients send you fabulous letters about how great you and your practice are, call them and ask if you can post their letter on your website with their initials. Using initials helps lend legitimacy, and viewers are less likely to think the letters are contrived.

Put a scrap book (photo album) in your waiting room with any hand-written letters from your satisfied patient base. Simply redact any personally identifying information from the letter author, unless, of course, they give specific consent for you to share the letter.

Don't wait for random patients to post comments on rating sites. Instead, recruit patients who are willing to post positive comments about you on any of the aforementioned websites. You don't have to fish for compliments. When a patient offers praise, simply say, “Thank you. Would you be willing to post your comments on RateMD?” or “We are trying to build up our comments on RateMD. Would you mind posting that?” You need not feel uncomfortable asking patients to post a positive comment they voluntarily shared with you. If you do feel awkward, perhaps staff members can be prepared to step in and ask patients to post. A less effective but possibly more comfortable approach is an indirect one. Simply say, “Thank you! That's the kind of comment I'd love to read online.” Follow up with patients two days later to make sure they actually posted the positive comments.

Every positive comment you and your practice receive pushes any negative comment farther down the page (or better yet, to the next page). Strive to receive 25 positive postings for each doctor and 10 for each PA or NP in your practice every two to three months.

Some practices have set up computers in the office and encourage patients to post reviews on the spot. This is problematic because the site will see multiple reviews coming from the same IP address and dismiss them as fraud. Additionally, the sites or the patients themselves could argue that reviews were “coerced.”

When you have achieved a high reviewer rating, be sure to publicize it. For example, you could post signs in the office: “Check us out on ReviewSite.com. We have a 5-Star rating!”

SEO IS KEY

Review sites are not the beginning and end of patients' online research—literally. Despite the growing popularity of these sites, most patients still begin their physician search with a basic web search. If your site is at the top of the first results page and you make a good impression on the patient, you may not have to worry about your reviews. Similarly, patients using review sites may select two or three potential providers that they will further investigate through web searches. Be sure that potential patients will find your website quickly and easily any time they search for you.

Search Engine Optimization or SEO is essential to drive your site to the top of search results pages. In simplest terms, SEO means designing your website so that search engine algorithms will recognize it as relevant, authoritative, and compelling and therefore present it high on the results list.

The most important ingredient of good SEO is new and unique content. As the physician, you have to assure the quality and accuracy of all posted content. Ideally you will write the content; if you hire a writer, review and approve all items prior to posting. You can give responsibility for posting new content and managing the content to someone else, but it's your responsibility to confirm that it gets done.

In addition to authoritative articles on specific cosmetic concerns and treatments (adding new content as you expand your menu), consider a blog where you can make regular, brief content posts on hot topics or topics of interest.

High website traffic leads to higher search rankings. Promote any new content on social media sites like Facebook or Twitter with direct links and brief descriptions that can drive traffic back to your site. Content is king in the world of SEO, but linking is nearly as important. Inbound links drive traffic from other websites to yours. Any inbound link is beneficial, but the better the linking-from site, the more valuable that link is. Three easy (and usually free) sources for inbound links for medical professionals include professional directories (such as specialty association rosters), academic websites (ask that the faculty or staff listing for the university or hospital include a link to your practice site), and websites for local businesses with which you have affiliations (for example, if you volunteer for a local charity).

If you have or plan to develop video content, consider creating a channel on YouTube, which would link back to your site. You may also want to write articles for or blog for other sites that can gain you exposure—and links. Consider writing for local or national news, lifestyle, or health publications, beauty blogs, etc.

In addition to Facebook and Twitter, mentioned above, consider establishing a presence on LinkedIN, Instagram, Google+, and now Pinterest. Each offers opportunity for inbound linking and may help you gain more publicity. Set up a Google Profile for your practice so that you can more fully engage via Google+.

Wikipedia mentions are great for SEO. Developing an entry can be tough and probably worthy of a full article, but it's a pearl to keep in mind.

As online video viewing becomes increasingly easy and popular, search engines are assigning greater value to video content on sites. Consider posting on your site at least a welcome video and perhaps some educational videos demonstrating popular procedures. If you are more ambitious and want to post videos on a regular basis, create a video blog (vlog) page.

Consider asking some loyal, satisfied customers if they would be willing to record video testimonials to be posted to your site. It may be wise to have a lawyer review any such testimonials prior to posting.

Outbound linking is also important for SEO. This seems counterintuitive, and some practices are reluctant to include links that would direct users away from their sites. However, quality outbound links—reciprocate those inbound links from hospitals and universities and charities, and consider some more links to key product or device pages—help establish the authority and value of your site for search algorithms.

This entire discussion assumes, of course, that you have a good website. If you don't have a site or don't have a good one, don't delay. If there's any upside to your delay it's that you can build your new site working with SEO professionals to optimize your investment.

Be sure to register your name as a domain (such as JeanineDownie.com), even if you don't intend to launch a site there. You can just have it redirect to your actual site, if you wish. But this way, no one else can purchase the domain and establish the site in your name.

A WELL-ROUNDED APPROACH

Implementing the steps above puts you well on the way to establishing a favorable online reputation. A few extra steps can make it stellar.

Develop a “Meet the Doctor” section on your website with a smiling, not-too-serious picture of yourself in something other than a white coat. List your hobbies and details that humanize you. Include information about charities you support and your community involvement.

Hone your sensitivity to potentially troublesome patients and keep an eye out for difficult personalities. The person who demands free services or is seductive is the one with whom you need to be particularly cautious. If you cannot avoid initiating a patient-doctor relationship, tread carefully throughout the course of care.

Make Satisfaction a Goal

Every aesthetic practice must establish and publicize a patient satisfaction policy that

• explains your philosophy of patient care,
• highlights patients' rights and expectations, and
• provides specific and direct contact information for patients who are not satisfied with service.

Such a policy may be particularly apropos for cosmetic procedures but can apply to medical patients, as well. Importantly, the contact information provided must allow for rapid response (have a designated voicemail box for after-hours or busy time complaint calls and return these as quickly as possible). Assign a staff member to handle patient complaints and be sure that they follow through on every complaint or question.

Establish internal policies for addressing various types of complaints and concerns. Many problems can probably be managed without your direct involvement. Determine in advance which types of complaints will require your oversight and those you always want to be made aware of. Think about costs in context. It is often much less costly to provide a filler patient a “touch-up” than to counter negative publicity.

Take before and after photos of every patient. For filler and toxin patients, get pictures from different angles, both animated and in repose. This way, at the follow up visit you can show the before pictures and discuss their outcomes. Many times, before photos help to quiet and calm a disruptive patient before they make an online outburst!

Of course, some patients simply cannot be satisfied. If the patient does not have a legitimate complaint, do not be bullied into providing free services in efforts to make them happy.

You might also consider in-office or post-appointment surveys of your own. These can be done electronically, and your overall satisfaction score can be publicized on your website. A patient who feels that he or she had the opportunity to tell you that he/ she is unhappy may not feel the need to publish their dissatisfaction online for the world to see. Again, if you distribute a survey, it is essential to follow-through. Any complaint or concern requires follow-up.

Be polite, non-threatening and professional at all times. Never yell at a patient or anyone in your practice; a patient could be recording you and footage of your outburst could appear on the Internet without context.

If you receive any awards or recognition, highlight these accolades on your website, as well. Similarly, if you've received special training, advertise this. Also, highlight any work that you do educating peers and any press appearances you do, including TV spots or publication interviews.

It goes without saying: Do not enter into inappropriate romantic or sexual relationships with a patient.

Never, ever go after a competitor by posting negative comments about them on the Internet. Posting lies is unethical. Legitimate concerns are better handled via professional channels, rather than on the Internet.

MOVE FORWARD PROACTIVELY

Yelp and other review sites are here to stay. As much as possible, physicians should hold these sites accountable for their content and seek to remove any false or misleading information. However, a more effective and less frustrating approach to reputation management is to reflect your positive, professional self online. Start with a well-designed website and an efficient SEO plan that will ensure the site is seen. Proper linking strategies and use of social media are important.

Use your digital presence to emphasize aspects of your practice that differentiate you from the competition. Use a blog to publicize some positive comments you've heard from patients. Consider discussing ways that you strive to meet patients' needs and/or have achieved patient satisfaction in your practice. For example, “A patient came to my practice who wanted to erase 10 years, but she didn't want any laser procedures, and she had a very tight budget…” Then describe how you worked with the patient to develop a therapeutic strategy that satisfied her needs.

These strategies create a baseline of positive content to counter any negative comment that comes up.⁷ Establish yourself as the competent, caring, and accomplished professional you are, and you can worry less about online reviews.

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4. http://about.bloomberglaw.com/law-reports/yelp-sues-firm-that-sued-it-for-coercion-alleging-posting-of-fakefavorable- reviews/
5. www.pcworld.com/article/242708/lawsuit_accusing_yelp_of_extorting_businesses_is_dismissed.html
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7. Jesitus J. Internet Savvy. Dermatology Times, February 2011
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9. http://www.skinandallergynews.com/views/managing-your-dermatology-practice-by-joseph-s-eastern/blog/ managing-your-dermatology-practice-defending-your-online-reputation/f15b136e921cef000f53e65b68109748.html