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Bad online review?

Dermatology World explains why bad online reviews may not be so bad after all


Bad online review?

Dermatology World explains why bad online reviews may not be so bad after all


By Ruth Carol, contributing writer

Patients are increasingly using online reviews to choose a physician. That can translate into more positive reviews, higher ratings, and new patients for dermatologists who are savvy about managing their online reputation.

According to a study published by Software Advice, 72% of patients used online reviews as a first step in choosing a doctor in 2019. That’s up from 25% in 2013.

That number doesn’t surprise Tony Davis, president of the Association of Dermatology Administrators and Managers (ADAM at www.ada-m.org), and director of Vision and Strategy at Dermatology Specialists, PA, in Edina, Minnesota. “Patients are using online reviews to find and review doctors just like they do for hotels and restaurants,” he said. More and more, patients — especially younger ones — are used to getting services and products on demand and with a high level of customer service, added Rachna Chaudhari, MPH, the Academy’s director of practice management.

By all accounts, most online physician reviews are positive. Data from DrScore.com, an online doctor rating website that Steven R. Feldman, MD, PhD, started 15 years ago, show that physicians get, on average, a rating of 9.5 stars out of 10. “It’s true that people who are unhappy are more likely to write a negative review,” he said, “but the average patients love their doctors.” A whopping 72% of patients provide “very positive” or “somewhat positive” feedback on review sites; only 2% leave “very negative” feedback, according to Software Advice. 

Responding to negative reviews

First, determine if the negative review is opinion or fact. “If it’s opinion, the patient has a right to express it no matter how offensive it may be,” noted Clifford Warren Lober, MD, JD, a dermatologist practicing in Florida and partner in the law firm, Lober, Brown, and Lober.

If the facts in the review are incorrect, such as the patient did not see you as indicated in the review, then it’s a question of whether it’s worth responding to, Dr. Lober said. Responding could result in the Streisand effect, which refers to the singer Barbra Streisand who made such a big deal about someone taking pictures of her house and posting them online that she drew more attention to where she lived than had she not acknowledged it.

Any response should be done in a caring, compassionate, and concerned way, Dr. Lober said. Ask the reviewer to contact the office to address the concerns together. Hopefully, that’s the end of the situation. Take the discussion offline. “You never want to debate the issue online because it looks like you’re argumentative, even if you’re right,” he added.

Revealing anything about the patient’s medical condition may put you at risk for violating HIPAA. “Even if the patient mentions his or her medical condition in the review, you should not repeat it,” Dr. Lober said. “But you can address the issue without mentioning any medical facts.”

The response should be done in a polite and caring manner, but kept generic, Dr. Feldman reiterated. “It could say something like: ‘We aim to provide great service. We’re disappointed that you feel this way. Please contact us, so that we can help you.’”

Academy resources

For more resources on how to manage negative online reviews, visit staging.aad.org/member/career/burnout/challenges/negative.

Robin Sigismondi, CMPE, practice administrator at Central Dermatology Center in North Carolina, doesn’t apologize for what happened, but rather apologizes that the patient didn’t have a good experience. She encourages the patient to call her at the office to resolve the situation. “I don’t hear back from them about 95% of the time,” Sigismondi said. If she recognizes the name or can identify who the patient is, she will contact them. Sometimes they call back, sometimes they don’t. In one case, the patient changed her review because she felt differently about the practice after Sigismondi reached out to her. As a general rule, she doesn’t ask patients to remove a review. “I didn’t ask her to change her review, but it was nice to see that she did,” Sigismondi said. Depending on the circumstance, she will ask if the patient would like to have a consult with another doctor.

Many of these reviews are anonymous and it’s not easy to figure out who wrote them, Davis said. When he can identify and contact the person, Davis asks the patient to walk him through the scenario. This helps build a level of trust, he said. In the case of a staff issue, Davis explains that all the phone calls are recorded, so with some additional information, he can figure out with whom the patient spoke. “As soon as I say that, they either stick to their story or back off a bit,” Davis said. He tells the patient that he will use this as a learning opportunity for staff and offers to follow up with the patient, most of whom say it’s not necessary. If the complaint is about a physician, the dermatologist will often contact the patient directly.

Davis will attempt to retain the patient by offering an opportunity to see another provider. “It’s a judgment call,” he said. “If it’s a legitimate concern, we will try to resolve it.” Most patients appreciate getting the phone call. “They like the fact that we go out of our way to contact them,” Davis noted. Like Sigismondi, Davis never asks the patient to remove a negative review. If they suggest it, he will thank them for doing so. A few people have removed a negative review or responded with a positive follow-up review.

It’s important to remember that there are two audiences reading the response: the person who wrote the negative review and everyone who reads it, Dr. Feldman said. “By taking the high road, and not arguing or denigrating the reviewer, the public will see how much you care about your patients,” he added. Patient satisfaction is not determined by how long a physician spends with patients or how long they are kept waiting, it’s whether patients think the physician cares about them, Dr. Feldman said. About 70% of patients believe that it’s “very important” or “moderately important” for physicians to respond to online reviews, the Software Advice survey found, because it shows empathy and responsiveness. Moreover, 65% of patients tend to ignore negative reviews that seem unreasonable or exaggerated, and 19% overlook negative reviews if the provider responds thoughtfully, according to Software Advice. 

Increasing online reviews

“The best way to address negative reviews is to actively seek online reviews,” Dr. Feldman said. “Increasing the number of positive reviews will drown out the occasional negative one.” But don’t delete those negative reviews because having a few negative ones among a sea of positive reviews is more believable, he added.

Have the receptionist ask patients when leaving the office to write an online review. “Your patients already have a good opinion of you, or they wouldn’t return,” Dr. Lober said.

Davis works with a vendor that automatically sends a text or email to new patients seeking feedback. “If you don’t prompt people, they won’t put a positive review out there,” he said. Since beginning this service three years ago, positive reviews have grown exponentially. Additionally, they significantly outweigh the negative reviews. Another advantage is that Davis has control of the review. If it’s negative, it won’t appear on the practice’s website. Instead, Davis will contact the patient to address their concerns.

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Similarly, Sigismondi works with a vendor that automatically posts five-star reviews to the practice’s Google page. When she started using the service in March 2019, the practice had 100 online reviews. Ten months later, it has 500. The practice’s physicians had an average star rating around 4 out of 5; now it’s 4.8. “We struggled for a long time to figure out how to get people to post reviews for us,” she said.

Before hiring the vendor, Sigismondi tried increasing the number of reviews by putting a page on the practice’s website for patient feedback. If the patient indicates that the experience was great, the review links to a positive Google review. If the patient indicates that it could have been better or was unsatisfactory, Sigismondi receives an email. Providing feedback on this page allows her to address the problem and potentially avoid a negative review being posted, she said. But the link generates only one or two emails a month, and most comments are anonymous. Reviewers who include their contact information rarely respond to Sigismondi’s email.

Online reviews should be monitored by a designated staff person, Chaudhari said. This person should be comfortable with finding and navigating physician rating websites. It could be the practice’s marketing person or an outside vendor. She recommends searching the physician rating websites at least once a week. Spending as little as 10 minutes a week cultivating the practice’s online presence and addressing feedback publicly reduces the impact of negative reviews by up to 70%, Software Advice reports.

Turning complaints into improvements

Negative patient experiences in dermatology practices were frequently affected by considerations outside of the physician-patient interaction, according to an analysis of 518 Yelp and 4,921 ZocDoc reviews of 45 dermatology practices in three cities (JAMA Dermatol. 2016;152(2):153-7). These include curt interactions with staff, difficulty with scheduling, practice cleanliness, and insurance problems.

“These things provoke a negative review,” Dr. Lober said. And for every negative comment posted online, there may be another patient who felt the same way, but didn’t return, he added. In contrast, 48% of patients would go out-of-network to see a provider with favorable reviews, Software Advice reports.

“If the patient has what they consider a disappointing experience, our natural recourse is to blame the patient,” Dr. Feldman said. “Instead of trying to convince yourself the patient was wrong, listen carefully because maybe the patient has identified something you could do to improve your practice.” For example, if the patient complained that the office is messy and uninviting, make sure the walls are freshly painted, the floors are clean, and the magazines are current. “People’s perceptions are determined by the context in which they see things,” he added.

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Sometimes the complaints are legitimate, said Davis, who coaches the dermatologists based on patient feedback. With one physician who received a lot of complaints about being late, Davis discussed options for adjusting the physician’s schedule, which resolved the problem. In some cases, Davis uses a complaint to educate patients. As an example, a common complaint in dermatology is that the appointment isn’t long enough to answer all the patient’s questions. When the patient makes an appointment to have an odd-looking spot checked, but then wants a full body scan, which takes much more time, Davis has explained that appointment lengths vary depending on the reason for the visit. He then offers to schedule a longer appointment to accommodate a full body scan.

At Central Dermatology Center, a sign in the waiting room states: If you are waiting more than 20 minutes, come to the front desk. Staff will then find out the reason for the delay, Sigismondi said. Additionally, the practice implemented a system requiring any doctor who is 30 minutes behind schedule to notify the front desk staff. When the patient arrives, the patient is given the choice to wait, see someone else if possible, reschedule, or run an errand and return. “As a manager, you have to be proactive,” she said. “Patients have other choices, and there are a lot of dermatology practices nearby.”

The office is currently being renovated to keep it looking clean and contemporary, Sigismondi noted. Based on survey feedback, changing tables are being added in the rest rooms. “It’s all about the patients’ experience, and how they’re treated from beginning to end,” she said.

If the online reviews repeat the same complaint, consider that it may be true, Chaudhari said. If the review cites difficulty in scheduling an appointment, consider offering a way to schedule appointments via the Internet or text. If the complaints are about long wait times for new patients, consider carving out time to see new patients in the schedule. If the reviews are about rude staff, send staff members for customer service training. If Sigismondi identifies repeated comments about a specific staff member, she will speak with the individual’s supervisor and may suggest additional customer service training.

Incorporating questions into a patient survey to address issues raised in negative reviews is a good way to gauge if other patients feel the same way, Chaudhari said. The individual managing social media and the office manager should work together to identify these issues and solutions to address them as both individuals are in tune with what patients are saying, she added.

“Online reputation management is just another avenue that dermatology practices need to invest in to ensure that their practices are a cut above the rest,” Chaudhari said. Sigismondi concurs. “Every dermatology practice has to be paying attention to this. If they don’t, they do it at their own peril because we live in a social media world.”