Take charge of your online reputation

Love them or hate them, online reviews are reality and powerful decision-making tools for patients searching for urologists and other physicians online. Managing or mismanaging a doctor’s online reputation can make-even threaten to break-a ­ practice.

A recent survey of more than 1,400 U.S. patients found that 84% claimed to consult a review website with some frequency to view or post health care provider and staff comments and ratings. For most, online review resources are a determining factor for choosing a new doctor, according to the survey by software buyer resource Software Advice.

Dr. Ellimoottil“There is a lot of data that shows that patients review these ratings before seeing their physician. It is not clear whether they use these ratings to decide whether or not to see a particular physician. However, the ratings do affect how the patients perceive the physicians that they are actively seeing,” said Chad Ellimoottil, MD, MS, assistant professor of urology at the University of Michigan, Ann Arbor, who has been published on the topic of reviews in urology (J Urol 2013; 189:2269-73).

While some practices cringe at the thought of becoming involved in online chatter about how patients perceive them, others embrace online reviews and make them part of process improvement.

Also see: Dr. Stacy Loeb’s Twitter advice for urology residents

University of Utah in Salt Lake City pioneered taking a proactive approach with online review management in the U.S. The university posts all of its online reviews as part of its process improvement, according to James M. Hotaling, MD, MS, assistant professor of surgery (urology) at the University of Utah’s Center for Reconstructive Urology and Men’s Health.

“Anybody can go online and look up the reviews and comments on physicians at the University of Utah. The reviews are tracked, and [the physicians] get monthly reports of what percentile we’re in,” Dr. Hotaling said.

Dr. HotalingBy learning to better manage physician and practice online reputations and putting processes in place to address patients’ online concerns, the Center for Reconstructive Urology and Men’s Health has gone from the 38th percentile to the 75th percentile in patient satisfaction in 9 months, Dr. Hotaling said.

Based on patient feedback, the University of Utah men’s health center has changed its patient through-put process, so patients have a better experience.

“One example is patients complained a lot about getting a person on the phone. So, we switched to a different phone tree, where a patient can always get a live human being and have a warm transfer on the phone,” Dr. Hotaling said.

Next: Anatomy of an online review

Anatomy of an online review

There are about 60 review websites focused on health care in the U.S. where patients can search for physicians and learn more about them or review or rate them, according to Software Advice.

Read - Men’s health: A forgotten topic

Whereas word of mouth used to be king, online reviews are today’s most efficient and effective way for patients to learn about doctors’ reputations, according to Parham Javaherian, CEO of Practice Builders, a company that provides expertise in online marketing and reputation management for health care providers.

Mr. Javaherian“Although the traditional referral patterns still exist with word of mouth and general practitioners’ recommendations, patients also cross-check those names on the Internet and figure out if that doctor is a good one to visit or not,” Javaherian said.

In the past, consumers might have talked with a few people about which urologist to see. Now, they go online, where they’re connected to thousands of patients giving their opinions about doctors on major review sites, from Yelp and Healthgrades to Vitals and others, according to Javaherian.

Urology patients might be even more likely than other patients to go online for information, he said.

“There are certain specialties, like urology, that become more sensitive and more personal and you don’t ask around as much because it’s more of a private issue. Therefore, you even put more weight and more trust in online reviews, where you can search for a urologist in privacy and not everyone in your world or in your network needs to know that you’re looking for a urologist,” Javaherian said.

It’s a misconception that online reviews tend to be negative, according to Dr. Ellimoottil.

“While there is no recent data about this that I am aware of, all studies that I’ve seen from different specialties have shown that most reviews are positive. Most patients are happy with the service they receive,” Dr. Ellimoottil said.

In fact, most urologists are rated positively but will have relatively few reviews compared to other types of physicians, he said.

“Based on our study, we found that 80% or more of urologists will be rated on at least one website. It is a function of how those websites are created. The websites usually use large databases to collect names of physicians. So, most likely, you will be listed on the site, but may not have many reviews,” Dr. Ellimoottil said.

Patients’ hesitance to post about their urologists could be because they don’t necessarily want people to know they’ve been to a urologist, according to Javaherian.

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“Another aspect is most urologist patients are male and the male population statistically write fewer reviews. So, an ob/gyn gets many more reviews than a urologist,” Javaherian said.

Next: Tips for managing your online reputation

Tips for managing your online reputation

Physicians and practices can’t manage what they don’t monitor. Urologists need to do three things to effectively manage their online reputations, Javaherian says.

Have you read: How to command patient trust while building experience

“One is that they need to monitor reviews at all times. Two, they need to capture reviews from patients (happy and unhappy) to better understand. And three, they need to make sure they only publish the positive reviews and manage the negative reviews internally,” Javaherian said.

It’s time-consuming to monitor and respond to mentions on all review sites, so practices should choose the most popular review sites in their local areas and focus on those. Practices should consider asking patients how they heard of the doctor or practice. Another way to investigate what patients see when they search a doctor’s or practice’s name is to Google those names.

“The domains that appear at the top of those search results are the big things [and worth monitoring],” Dr. Hotaling said.

According to an AUA Health Policy Brief article, practices can enter search queries on Google Alerts, which monitors the Internet for those key terms and sends the practice or physician an email when relevant information matches their search terms. There are also reputation management and reputation repair programs, according to the AUA, that help monitor physicians’ online reputations-some even respond to patient feedback, address problems, and help encourage positive reviews. PracticeBuilders has such a program, myPracticeReputation.

Review monitoring should be done daily, if possible, according to Javaherian. For every day that a doctor has a bad review lingering in cyberspace, he or she might lose patients because of it.

Javaherian also encourages practices to respond to positive and negative feedback. In fact, practices should respond as soon as they see the reviews, hopefully using an established practice protocol for how to respond. When responding, practices and doctors need to be professional, abide by privacy laws, and take emotion out of the equation.

“Many doctors have gotten themselves into trouble just because they get emotional. Sometimes they want to respond if they think the review was unfair, or even not true, and they may be right, but you cannot respond to any reviews with any personal information,” Javaherian said.

The solution, according to Javaherian, is to respond openly that the practice regrets that the patient had a negative experience and wants to make it right. Take the rest of the conversation offline by contacting the patient if the review is not anonymous or offering a phone number and contact at the practice for follow-up if it is anonymous. In some cases, patients will follow up with more positive feedback on the review site, indicating the problem has been solved.

In response to positive reviews, practices should consider thanking the patient on the review site.

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“You’re making a happy patient even happier by thanking them,” Javaherian said.

Next: Listen and act

Listen and act

Most importantly, don’t forget to listen to what people are saying about the practice and physicians and act on it.

Read: Scribes slash EMR burden

“On the operational side, the doctor should get with the staff and figure out why they have bad reviews. Bad reviews come in for a reason. And all the reviews on all the sites can be overwhelming, but for the first time in history, all businesses can get instant feedback and recognize what they need to work on,” Javaherian said.

In addition to monitoring and managing online reviews, it’s important to take a proactive approach to generating positive feedback from patients.

“The easiest and cheapest way to improve your online reviews is to encourage all your patients to submit reviews for you. The data shows that they will most likely rate you favorably,” Dr. Ellimoottil said.

Dr. SoteloOne way for physicians to help ensure a good patient experience and, ultimately, a positive review is to effectively communicate with their patients, according to urologist Rene Sotelo, MD, medical director of international medicine of Keck Medicine of University of Southern California, Los Angeles.

“It is critical to efficiently communicate with the patients and their families, so that there are no misunderstandings. It is the most demanding patients who, when treated properly, leave the best reviews and will be your best advisers,” Dr. Sotelo said. “Medicine is complex, so often reviews are made without enough knowledge of the situation. This is why we try to explain as we go-before the reviews are made. Sometimes there is only so much we can do, but it is important these days to communicate sufficiently with the patient.”

Part of good doctor-patient communication, according to Dr. Sotelo, is to ask patients if they understand what you’ve said or have any concerns.

Physicians and practice staff can and do ask patients to write reviews, according to Javaherian.

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Optimal asking takes some scripting and a plan. For example, one approach that Javaherian recommends is for a staff member to ask patients if it’s OK to send them a follow-up email or text for feedback about the patient’s experience, explaining that the doctor is interested in knowing what they think. If the patient agrees, the staff would send the email or text right after the appointment, with a check box option giving the doctor permission to share that review online once he or she receives it.

Next: When reviews get ugly

When reviews get ugly

Constructive criticism is one thing; slander or libel is another. Unfortunately, urologists and others have little recourse when they see reviews that competitors or unreasonably angry patients may have posted. Even blatantly false reviews are difficult or impossible to delete without going to the person who posted it and resolving the issue so that he or she removes it.

Read - The ‘post-truth’ world: How it’s drifting into medicine

Still, physicians should take legal action against reviews only as a last resort, according to the AUA.

“Lawsuits can be time-consuming and very expensive, and defamation and libel can be very difficult to prove in court. Therefore, taking legal action can prove futile and may end up damaging a physician’s reputation further. Your attorney is the best source of advice about how far down this pathway to proceed,” according to the Health Policy Brief article on the topic.

Balance is key

Urologists have a lot on their plates and putting online reputation management on the list could be the tipping point. The good news is that doctors can delegate the responsibilities of monitoring and addressing online reviews to staff, with limited involvement. Or they can hire consultants and purchase software programs to help manage the process.

Dr. Hotaling says he and his urologist colleagues do not respond to negative comments; rather, the university works with people who work to improve online review scores.

“If you get too caught up in it, you’ll get depressed and it can lead to physician burnout. But I think paying some attention to it is helpful,” Dr. Hotaling said.

The message to urologists is that regardless of how they choose to manage their online reputation, it’s no longer a good option to ignore what’s being said online about the practice or its doctors.

“No matter what stage of practice you are in-whether you’re a new practitioner, a couple of years in, or you’re almost getting ready to retire and are going to sell your practice-you need that good online reputation,” Javaherian said.

“In the beginning of your career, of course, you need it to get more patients. But if you’re almost getting ready to retire and want to sell your practice, you have to believe that in an apples-to-apples comparison, a practice that has two positive reviews and one negative one and a practice that has 100 positive reviews, the practice with 100 positive reviews has a higher valuation when you want to sell it.”

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