Monday, March 19, 2012

Dealing with online patient complaints - a guide for doctors from Dr Malpani

The internet has become the primary source of medical information for patients and it’s high time doctors acknowledged this. It’s available 24/7, and provides lots of information on all possible topics – some of which is very high quality. Since so many patients are going online, it’s only logical that doctors will follow and lots of doctors have their own websites, where they inform patients about the services they provide.

With so many doctors and patients on the internet, it’s only natural that lots of interesting changes are going to occur in the way medicine in practiced. Some of these changes are very positive – for example, the growth of expert e-patients, who educate other patients; and the development of the Health 2.0 movement, which uses technology to encourage participatory medicine, to empower patients.

However, as with everything else, the internet can be a mixed blessing – and one of the problem areas is the mushrooming of doctor rating sites. After seeing the success of restaurant rating sites, it’s hardly surprising that entrepreneurs want to exploit this area and the past few years have seen an explosion in the growth of websites which allow patients to review/rate (usually rant or rave ) about their doctors.

Patients have always had opinions about their doctor - after all, this is how a doctor’s reputation develops . Traditionally, this was by word of mouth, which was a slow process; and it could take doctors a lifetime to build a reputation. However, while many patients will swear by their doctor, there will be others who will swear at them !

This is hardly surprising. Medicine is a service profession; and outcomes are uncertain. Complaints are common , especially when patients don’t do well. It is impossible for a doctor to have a 100% happy patient record, especially when money is involved. In my experience, the major reason patients have been unhappy with me, sometimes long after having left my clinic, is about having to pay for my services. In most cases , these patients anger has been misdirected, unfair and unrealistic ( though I am naturally biased in my viewpoint !)

The good news is that most reviews on doctor rating sites are positive. However, the fact remains that some will be negative. How do we deal with this, to ensure that these sites are ethical; and offer a fair deal for both doctors and patients ?

Sadly, doctors are easy targets. They have fragile reputations ; and it’s not easy to protect these. This is why some doctors ( belonging to a group called Medical Justice) have taken an aggressive approach; and take a signed consent form from their patients that they will not post negative reviews ! Some doctors are worried that it is not ethical to censor patient’s opinions; but while words like patient autonomy and patient welfare sound very grand in the abstract , when patients bring you printouts of false and unfair things which patients have said about you online, you are likely to respond far more viscerally !

While it’s all very well to take the moral high ground when talking about the right of patients to freely express their opinion about a doctor, I can vouch from personal experience that reading a negative review about you can raise your hackles very quickly. While some of them maybe well-deserved; others are unfair because it’s obviously pended by a disgruntled patient , venting his bile . Others may even be planted by the competition !

Can we censor these sites ? Let’s not fool ourselves – the horse has left the stable . It’s a fact that we will need to learn with patient complaints – including the ones posted online on doctor rating sites, for all to see !

Prevention is better than cure, and you can try to prevent negative reviews by managing patient’s complaints proactively . Sadly, we don’t like dealing with patient complaints , which is why they are often ignored . Even worse, many patients with complaints are belittled or patronised, as a result of which a festering problem just becomes worse.

It’s best to treat every complaint as a gift ! Remember that the fact that the patient has taken the time and trouble to complain means that the patient is not planning to desert you and walk off to the doctor next door ! Complaints are actually the best opportunity doctors have to understand the patient’s experience , so that they can help to improve it.

In our practice, we actively encourage our patients to provide us with feedback – and both compliments and complaints are welcome . Compliments give us a high and tell us we are doing a good job. Complaints remind us that we can do better . I always tell my patients – If you are happy with us, please tell the world . If you are not happy with us, please tell us, so we can fix the problem ! Patient satisfaction surveys are useful tool which allow you to identify problems and fix them before they get out of hand !

So why do unhappy patients go online to complain ? Most patients are quite reluctant to complain to their doctor face to face . They are worried that if they complain, the doctor may get upset and may not provide them with good medical care. This is why most patients are docile and compliant in the clinic. However, when they leave the clinic, they will then openly criticize the doctor – an unhelpful approach , which does not help either the doctor or the patient !

Ideally, webmasters of these sites should realise how fragile a doctor’s reputation is and how much it means to him. This can actually help them create a high quality site for their users. Firstly, they should ban all anonymous complaints. All complaints need to be sent by person who is willing to identify themselves publicly. Ratings accountability allows doctors to use real patient feedback to constructively improve their practice. Second, when the doctor rating site receives a complaint against a doctor , this should first be emailed to the doctor, who should be given a chance to provide an rebuttal. This is a basic principle of natural justice ! Only when this is done, should the complaint be published, if it still deserves to see the light of day. If not, then unethical doctors can post ( or get their cronies to post) false complaints about other clinics who are in competition with them – and this can set off a slinging match which harms everyone.

Allowing the online publication of unmoderated complaints about doctors without giving a doctor a chance to protect himself is a low blow against doctors and will strike another nail in the fragile doctor-patient relationship. Doctors will start seeing all patients as possible complainers – leading to an unhappy and adversarial relationship, and hurting both doctors and patients !

Unfortunately, not all websites bother to check the authenticity or reliability of these complaints , which means that even if I have 999 happy patients, 1 unhappy patient can spoil my digital reputation.

Many online doctor rating sites are of poor quality, and this is hardly surprising. After all, the primary purpose of these sites is to make money for their owners , not to educate patients ! For example, it’s obvious that the purpose behind is to get users to provide only negative reviews about doctors. After all, happy patients will never take the time to visit such a site– it’s only the unhappy and angry ones who will ! This is a problem, because most patients are not sophisticated enough to differentiate between reliable rating sites and unreliable ones.

There are many solutions webmasters can implement proactively to help them provide their reader with a better service. Patients need to provide feedback about their doctors – both good and bad ! However, this should be done in a healthy fashion, so that everyone benefits from this feedback !

Firstly, all reviewers have to be identifiable . Not only will this help to stop abusive anonymous complaints from angry patients , it will also prevent doctors from gaming the system by stuffing the sites with false positive reviews. Peer review can be very helpful in sorting sensible complaints from rants – and should be implemented before a negative review is published. Also, webmasters should allow doctors to respond to complaints and provide their point of view, so that the negative reviews are not one-sided and unfair. This is a basic principle of natural justice, which sadly most rating sites still flout.

It’s all very well to talk about theory, but we still need to get down to brass tacks. What can you do if you have a negative review on one of these sites ? Don’t take an ostrich in the sand attitude and pretend there’s no problem ! Ignorance is not bliss – and what you don’t know can hurt you because prospective patients are reading all about you .

Don’t panic – and don’t get angry either. Your first response is going to be one of outrage and you will want to sue the person who posted the review – or the website publisher. I am a good doctor who works hard – how dare he write this about me ! This is not a good idea and will just make a bad situation worse . Remember that every patient is entitled to their own opinion – and it’s humanly impossible for a doctor to keep all his patients happy !

Swallow your pride and read the review carefully. Is there some truth in it ? If so, please respond to the review by thanking the reviewer for bringing this problem to your attention; and then described how you’ve fixed it. Patients are not naïve – and others who read the negative review and then your thoughtful comment will be pleased that you are responsive and responsible !

If there’s no truth in the claim, please point this out in your response; and explain why.
It’s also a good idea to ask some of your net- savvy patients who are happy with you to post positive reviews. These can often help provide a more balanced perspective; and undo some of the damage. You can provide your patients with clear, written instructions and request them to rate you online. This will help to dilute the impact of the few negative reviews you may have. Encouraging satisfied patients to post positive reviews about you and your practice should easily drown out the occasional dissenting comment. A recent study from the Journal of General Internal Medicine last year that showed that close to 90% of online physician ratings were, in fact, positive.

There are still very few India-specific sites as yet. However, this will change quickly as more Indians get online – and sites like do allow user reviews even now.

The good news is that these doctor rating sites can actually help doctors to become more patient-centric ! Hopefully, we will start treating our patients better, because we know they can harm our reputation by going online and posting negative reviews.

Reading the patient feedback stories at doctor rating sites is a good idea for all doctors , because it will educate you as to what patients want from their doctors ! The good news is that what patients want from their physicians is not all that different from what good physicians want to offer their patients. Patients are generally not unreasonable, high-maintenance consumers; they simply want doctors who care, will listen, and know what they're doing. By reading the positive ratings, you’ll have role models of good physicians you can try to emulate; and by reading the negative ratings, you’ll learn what to avoid. Smart people learn from other’s mistakes – and you can learn a lot about what a medical encounter feels like from the patient’s perspective by browsing through these websites. They’ll help you become a more empathetic doctor if you are mature enough not to take the negative ratings about you too personally !

In the big picture, these rating sites are a great opportunity for the medical profession. We should embrace this opportunity to be open and transparent with our patients . Medical associations should set up doctor rating sites – this will ensure that the basic information which patients need about a doctor ( clinic location; credentials; professional qualifications and so on) is available. Also, these sites will be comprehensive because they will provide information on all doctors . If these are seen to be fair and frank, patients will be happy to refer to these as an authoritative source of information on doctors, because they can trust them, rather than having to waste hours scouring dozens of unreliable and incomplete sites, which may be biased and unreliable . It’s also a good way of identifying the bad eggs In our profession. The few black sheep in our profession end up giving us all of us a bad name, causing everyone a lot of harm. Even though we know who they are, we often prefer to participate in a conspiracy of silence and to turn a blind eye to their cahoots. Rating systems will allow the truth about these bad apples to come out in the open more quickly, helping with self-regulation of the profession. Thus, the Medical Council could take cognizance of repeated complaints about a doctor, and take action, to prevent problems from flaring up.

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  1. Excellent article posted here. Its really appreciable for sharing such a useful information. Six Sigma

  2. Anonymous3:34 PM

    I am sure the online complaints about you in a consumer forum might have caused lots of pain. I read those complaints when I decided to come to you for treatment. But by the time I read those complaints I am also in touch with you through e-mail and I felt very safe when my medical queries and concerns were appropriately addressed. The next thing which made me to feel secure is the way you came forward to give an explanation for the complaints said about you in that forum. When I came to you in person I tried my level best to come with a clean slate of mind. I did not want to have a predetermined notion because of the complaints I read and to look at everything with suspicion. That will make my life hell. I just wanted to believe that we have come to a doctor whom we can trust 100% and we will be taken care of well. When we are waiting for the ultrasound you came into the waiting room and you were nervous to see us waiting there for sometime (although it is only a very short period). I did realize that those complaints have made you to panic about each and every patient’s mindset you meet (what will this person go and complain?!). Although complaints have the power to change things it also adds enormous pressure on the person concerned. Should I be happy for the fact that my ultrasound will be finished in time or be sad for the fact that doctor-patient relationship can never be pleasant enough without eyeing each other with doubts? Compliments and not complaints will help a person to perform better. Complain about a bad doctor, it is hardly going to change anything. Complain about a good doctor, for sure you will kill his enthusiasm he has for his profession.

    But on the other hand, patients especially IVF patients are emotionally vulnerable. You have correctly guessed that it is the money that plays a major role for the dissatisfaction that arises between an IVF patient and doctor. IVF is like gambling. You never know whether you will win a jackpot. But the amount of money patients spend is enormous. Unfortunately not everyone is well-off. The social pressure is already too much for an infertile couple. Financial burden combined with such enormous mental pressure will make their condition like an inflated balloon. Just a petty incident is enough to trigger their emotions in the wrong way. I think when an IVF patient comes with a query regarding the money they spent (even if it is wrong or unreasonable), doctors should give a proper explanation and try to make them comfortable. Explanations like ‘IVF is costly but a baby is priceless’ can only trigger their pain more! If a doctor fails to give a proper answer then that is the starting point for many more haunting questions in patient’s mind. Does this doctor just work for the money I give him? If he just works for money what else he will do for money? Unfortunately all the IVF procedures (from egg pickup, fertilization, loading the embryos in the catheter and transfer) cannot be shown to each and every patient. This combined with the uncertainity of the outcome creates a lot of suspicion in their mind; afterall they are humans in a very painful condition (they have to spend so much money to get a baby while it happens as an accident for most their friends and relatives!). Another truth which patients will never tell their doctor is, they secretly desire within their heart that their doctor will say that money is not important to him and doing service is important. If a doctor says so then the patient feels very secure. Money and morality can never go together- this is the thought with which most of us are brought up.

  3. Anonymous3:35 PM

    In short patients should understand the limitations a doctor has and consider him as a human too. A doctor inturn should leave his ego and ask each and every patient who leaves the hospital about the quality of care they received and whether they have any complaints. Giving a notebook in hand and asking the patients to leave their complaints or compliments will not help. A face to face conversation is several times better but a doctor should be prepared to handle the situation (if there are unreasonable complaints!) in a diplomatc way and not to carry a grudge about the patient. Ultimately the nature of doctor-patient relationship determines the ease with which such talks could be initiated.

    Dr, as you have rightly said it is impossible to keep everyone happy. It is better to understand the limitations and to do your best to keep your conscience happy. You will always have some unhappy patients and some patients like me who will adore you :)

  4. Although each individual has his or her own specific reason, most patients become angry because we have failed to meet their expectations.

  5. I can't thank you enough for pointing out the importance of dealing with online patient complaints. I had a sudden ear ache one time and referred to this one site that offers free virtual doctor but for some reason, the recommendation I got only made my condition worse and there was no way I could complain.


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