In the last few years, we’ve noticed a dramatic increase in the number of complaint web sites on the internet.  Any person who is mad about something can quickly and easily establish a site that is picked up by web browsers of others looking for information about the subject.  Moreover, new web sites soliciting complaints about anything from a bad meal to a bad romance are popping up every day.

Being the subject of a complaint blog on these sites can be very troublesome, and legally there is very little that can be done.  Laws protecting potential victims from defamation require a showing that the statement is false and designed to cause injury.  “Opinions” are especially protected forms of free speech.  Thus, even if the content of a web site damages the public reputation or business of the target, the libel and slander laws provide little protection if the site operates under the flag of “consumer advocacy” or  “public opinion.”  I have represented individuals who have been attacked professionally and personally on such blog sites, and fighting the battle is a lot like Brer Rabbit battling the Tar-Baby.  With each salvo more and more attention is drawn to exactly what you would like the world to forget.

The latest trend that should be of great concern to all doctors is large healthcare organizations, from hospitals to insurance companies, establishing customer feedback sections on their web sites.  This is a rapidly growing trend, and the companies aren’t just creating the sites, they are actively promoting them.  So what does this mean?

I defer to Dr. Jon Hultman on the exact statistics regarding how many people an upset patient complains to versus how many people a satisfied patients takes the time to share their good experiences with, but I feel very safe saying the upset patients are generally much more active in spreading the word than happy ones.  Psychologically the need to “vent” appears to be a strong drive in upset patients.  Now they have an easy forum in which to berate and complain about anyone that by misfortune has crossed their path on a bad day.

I get calls on these types of patients all of the time.  It is always a challenge to calm them down and satisfy their concerns, without compromising the doctors’ integrity or cash flow.  Often we have to just dismiss the patient from the practice.  While that may have worked in the past, now this type of patient can be like a bad cold that won’t go away.  Once the blogging starts, it is generally permanent.  And the vast majority of patients that are satisfied simply don’t join the on-line conversations.

So what can you do to avoid this incredibly distracting dilemma?  The only approach I’ve seen that works is hitting the problem head on.  Don’t avoid the problem patient and let them percolate until they explode.  If you see an emotional issue brewing, immediately intervene.  Don’t defer this type of problem to staff members.  Apologize for the patient not being satisfied or for not having a good experience or outcome.  “I’m sorry this hasn’t been a good experience for you” is not an admission of doing anything wrong.  It’s merely an expression of your concern over the happiness of the patient.  Let the patient know that you care about him or her, you tried your best, and that you want to help them with whatever is causing them difficulty.  If the patient doesn’t want your help, let them know that you will help them find another doctor and ask if there is anything you can do for them.

Unfortunately, what they may ask for next is their money back.  While in the past that is something we have aggressively denied, if there is a potential website involved, you will need to assess the risks and benefits of the refund.  If it is a small amount of money, and you believe that the patient will be appeased by the refund, returning the money with a short note stating that although you believe your care and treatment was appropriate, you are refunding your fees because patient satisfaction is your number one goal, may be a good decision.  If the refund does not appear likely to end the ordeal, then you should send a short letter simply stating that although patient satisfaction is very important to you, you believe you provided appropriate care and did you best, and that you feel it is only fair that you be paid for your professional services.

If the patient still resorts to complaining in the on-line forum, you will generally be able to respond.  The wording on the response can be tricky.  You need to start off by stating that patient satisfaction is very important to you and that you are confident you did you best for this patient.  A short comment regarding how everyone reacts and heals differently, and that all you can do is rely on your many years of experience and training to best help your patients, is also appropriate.  Never, ever, ever discuss particulars of the care and treatment.  The patient’s privacy rights aren’t waived just because they complained in public forum.

The axiom “the solution to pollution is dilution” also applies here.  Getting as many positive comments on the website as possible will help mitigate the negative impact of a rant-blog by one of your “special” patients. [How’s that for political correctness?]  When patients thank you for a great experience, ask them to share their experience on the website.  I’ve even had doctors call ex-patient they haven’t seen in a while and ask them to make comments on the website to offset comments posted by a particularly bizarre patient.  Patients that like you, and had a good experience, will often rally around to help you from being unfairly characterized as a bad doctor.

Another impact these web sites will have on your practice is that you can no longer leave things to chance.  Every patient should be asked to comment on their experience, including what they liked, what they disliked and what they believe can be done to make their experience better in the future.  By providing patients with aftercare questionnaires, you can identify those patients that had good experiences and encourage them to share them on the website.  You can also identify those having less than optimal experiences and take action to resolve their concerns.

By giving patients an avenue to communicate their concerns directly to you, you will avoid being blindsided by the upset patient that slipped through the cracks.  What you say and how you say it can make all the difference.