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Neurosurgery:
doi: 10.1227/01.neu.0000428419.97328.67
Science Times

Managing an Online Reputation

Zusman, Edie E.

Free Access

A physician's reputation has always been key to success or failure in medical practice. Good publicity helps build a physician's renown, patient base, loyalty and standing in the community. By the same token, public disclosures of unsafe care, disciplinary actions or other medical missteps can stain, or even ruin previously stellar reputations. With the digital age the pace of reputation development and destruction has accelerated. The reach of information has been vastly expanded and the control of the information that can damage or build a reputation has become infinitely broadened. Internet search engines, which can pull up any literary mention of a physician by name with a keystroke, provide computer users with vast amounts of information in seconds. Online physician rating Web sites allow patients to try to rate their quality of care provider based on limited information. Social media networks such as Facebook and Twitter promote casual conversations about health issues and clinicians today that would never have been present in a public domain.

This revolution has made reputation management for physicians more complex— and even more important. Physicians must either join and help manage the conversations that can affect their reputations or risk losing control of them altogether. Reputation management companies have emerged to help professionals, including physicians, protect their reputations, but physicians can and should do some basic things to participate in the reputation management process.

In an excellent article by Pamela Lewis Dolan published in American Medical News, Christian Olsen, vice president of Levick Strategic Communication's digital and social media practice, outlines some simple steps for physicians to take control of their online reputations. Olsen argues that because comments, ratings and even complaints will appear online with or without the physician's permission or even knowledge, physicians should Google themselves, correct mistakes and false information, create their own content, embrace constructive criticism and address actionable items.1

If this kind of effort on the part of individual physicians seems onerous, physicians would be wise to take stock of the statistics which show the increasing importance of the internet as a source of health information for the public: 74% of adults use the internet and of those, 80% have looked online for information about any of 15 health topics such as a specific disease or treatment. More specifically, 34% of users have read someone else's commentary or experience about health or medical issues on an online news group, Web site or blog. Sixteen percent have consulted online rankings of reviews of doctors or other providers and 4% of internet users have posted a review online of a doctor, according to the Pew Research Center's Internet & American Life Project, published in May, 2011.2

With the proliferation of information on the internet, driven heavily by blogs, and more recently, ‘social media’, a physician's reputation can become enhanced and/or dinged in a nanosecond, states Tobin Arthur, CEO and founder of iMedExchange. Arthur cautions that employed physicians are not immune from the impact of the internet. Not only does your institution gain or lose on the collective reputations of its physicians, but you may not always be in the same role. Ignoring your online reputation now is akin to college kids posting pictures of themselves involved in all kinds of bungholery on Facebook, thinking that the professional world is far off in the distance.3

Consider the case last year of the neurosurgeons in California whose novel treatment of 3 terminally ill glioblastoma patients drew the attention of a local newspaper. Until news stories appeared detailing the investigation of their research activities, Web site searches of their names mostly turned up their university health system biographies, published research papers and news articles on neurosurgery topics with their expert opinions. After the news stories broke, searches of the physicians by name were dominated by page after page of the negative media coverage, reprinted by news services, bloggers and other developers of online content. A single click on individual news stories also pulled in the comments posted by their readers—many in support of the neurosurgeons and their research and some adding more fuel to the increasingly negative fire. Internet searches also turned up years-old news stories describing long-since forgotten malpractice lawsuits against one of the physicians, which were later referenced in additional negative news coverage.

Similarly, online searches of the medical center that employs the neurosurgeons were dominated by links to various versions, reprints and updates of the negative stories so that even computer users searching for unrelated information unwittingly came across them on their first search attempt. The notoriety sullied the reputations of both the physicians and the hospital, to some extent. A local newspaper editorial, listing suggested New Year's resolutions among newsmakers quipped: We pledge not to let our doctors ever again engage in risky and unauthorized experiments on patients.4 This scenario serves as a reminder that information in the public domain may be far from the truth.

To begin to manage an online reputation, physicians should understand how their information is captured online. Most obvious for physicians are the numerous for-profit physician rating companies, which troll for and collect physician names and addresses then invite computer users to search, view and rate them. Hospitals and medical groups typically offer biographical information about their physicians on their Web sites. Medical boards document disciplinary actions against physicians online, information that is easily mined by curious news reporters. And where once traditional news outlets had a fairly limited reach within a limited geographic circulation or viewership area, most now put their content online, which is then easily reprinted on other Web sites, blogs and social media channels across the globe. Digital applications that allow sharing of content can quickly cause information to go viral, multiplying many-fold the reach of the information. In the internet era, information dissipates faster, while the journalistic creed for accuracy, facts checked by objective editors, and the pride of “getting it right” have all but disappeared.

Scholarly articles authored or cited by physicians are easily searchable in databases such as PubMed, information that can affect an individual physician's reputation. In a 2010 New York Times Magazine article Jeffrey Rosen reported that a 66-year-old Canadian psychotherapist who tried to enter the United States was turned away at the border— and barred permanently from visiting the country—after a border guard's internet search found that the therapist had written an article in a philosophy journal describing his experiments 30 years ago with L.S.D.5

Physician information online also can appear courtesy of a particularly disgruntled patient. According to data attributed to the Society of Plastic Surgery, 60% of plastic surgeons report experiencing online extortion by dissatisfied patients who threaten reputation destruction through online reviews if they do not get refunds for certain procedures. Makeover Travel, an international plastic surgery company, devotes an entire web page to this topic which if validated shows the vulnerability of medical professionals.6 The Web site describes a case in 2010 in which a plastic surgery organization refused to refund a patient's money who was dissatisfied with her experience, and in response dozens of negative posts against Makeover Travel were scattered throughout the internet in different social websites. The organization alleges that a single unhappy patient, using many different usernames, portrayed herself as different people, responded to her own posts and even created new threads to create the appearance of multiple dissatisfied patients.6

All indications suggest that these kinds of vulnerabilities are only likely to increase in the future, just as physician visibility increases online. Arthur, of iMedExchange, explains that the audience for online information is both patients and physician colleagues who care about different things, but whose opinions about a physician's competency are both important. At the end of the day, colleagues want to associate with competent peers and collaborate in the treatment process with colleagues who will match their standards, he writes. Patients obviously want to be treated and healed in the most effective manner possible.3

Considering the importance of a physician's reputation, regular management of information that appears online becomes critical. How to handle information on ratings sites can be one of the thorniest pieces of the puzzle. Although initial research has shown that most patients don't choose doctors based on information gleaned from ratings sites, their use has grown and their impact cannot be ignored.3 An estimated 20% of patients refer to doctor review Web sites when choosing a physicians, such as www.Vitals.com and www.RateMDS.com, according to Reputation.com.7

In fact, most online physician ratings are positive.8 An analysis of 4,999 physician ratings across 10 Web sites reviewed by Daniel Stetch et al in the Journal of Medical Internet Research, found that most patients give physicians a favorable rating on online physician-rating sites, and a single overall rating to evaluate physicians may be sufficient to assess a patient's opinion of the physician.8 It is not known to what extent this is biased by practices that selectively ask their most grateful patients to go to specific physician ratings sites to thank their doctors and staff for the excellent care they have received.

While many patients post positive comments about physicians, they can use the sites to vent about unsatisfactory experiences. Even patient satisfaction surveys that do not allow individual patient comments can reflect poorly on a physician. Healthgrades.com offers satisfaction surveys, which measure such things as the office environment, a patient's level of trust in the physician and the physician's bedside manner. What would a patient conclude when, after searching for information about their neurosurgeon, they find mediocre ratings and comments from patients stating they were not sure they would recommend the physician to others? This is a true physician profile, and the extent to which this patient or others choose to redirect their care as a result gives neurosurgeons and all clinicians reason to manage their online reputations.

In many cases, ratings sites have incomplete or inaccurate information about basic credentials. Neurosurgeons, for example, are often categorized as neurologists. A physician's new office location, hospital or practice affiliation is not always apparent, and negative reviews from one period in a physician's professional life can obscure more recent or more positive reviews. In his blog post on www.kevinmd.com, Tobin Arthur describes a discussion with a group of physicians in Oregon in which they discovered misinformation about each one, in some cases significant.3 Additionally, while physicians are encouraged to check the active patient rating sites for physicians (Figure 1) it may be difficult and frustrating to work with the site to fix errors with correction links that are inactive. Through querying sites for physicians and colleagues in the community, it appears as though the quality control of the sites themselves are in question, making physician reputations based on these sites even more vulnerable.

Figure 1
Figure 1
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Dolan, in her amednews.com article, suggests a simple way to monitor; every physician should Google themselves at least once a month. Things can spread quickly online, so seeing what content is there on a regular basis will help doctors stay ahead of a potential crisis.1 Steven Wyer, managing director of Reputation Advocate Inc., suggests a more sophisticated method of physician monitoring that includes setting up alerts on Google and Yahoo, search engines that comb the internet looking for any new mention of specific keywords on blogs, Web sites, online forums and other sites. When it finds a new mention, it sends an e-mail detailing where the keywords were mentioned, what was said and a link to the Web site.1

To counter negative reviews on rating sites, experts recommend that physicians create profiles for themselves on the ratings Web sites with accurate and current information and encourage patients to use these sites. Countering negative reviews can even boost a physician's rating. The case of a Sacramento obstetrician is one such example. One reviewer posted about the physician on Yelp: Rudest lady I have met. Everyone that has worked with her has nothing good to say. That post prompted 2 well-crafted, positive reviews refuting the first, including: Not only is she deeply compassionate and empathetic with her patients, her clinical skills are superb….As a result, the doctor went from having 1 star to 3.5 stars.9

Removal of negative comments or erroneous information can be difficult. Online communication is mostly protected by free speech laws, and laws that can protect a person against verbal slander and libel in other forms of media don't automatically apply to online review Web sites.7 In addition, it is difficult to prove that a person wrote a review with malice or reckless disregard for the truth, which is the legal standard required. Allen Hoffman, a jobs expert at Monster.com, explains that all information online is archived, but if you believe you have a strong case that incorrect information has been posted, you can request of a Web site owner that certain information be removed. Take a soft stance; explain your reasons for wanting the material removed and assume the owner of the site (or the owner's representative) is reasonable and will listen. If the information is inaccurate, defamatory or libelous, point that out.10 He also suggests learning as much as possible about the site before asking for information to be taken down, as these requests can backfire. Bloggers have been known to post those e-mails, so be aware that your request could end up casting more unfavorable attention on you.10

In the words of Jeffrey Rosen of the New York Times: The truth is we can't possibly control what others say or know or think about us in a world of Facebook and Google, nor can we realistically demand that others give us the deference and respect to which we think we’re entitled. On the internet, it turns out, we’re not entitled to demand any particular respect at all, and if others don't have the empathy necessary to forgive our missteps, or the attention spans necessary to judge us in context, there's nothing we can do about it.5

Many ratings sites do allow physicians the opportunity to edit their own profiles, which they should do. Rather than avoid the online ratings game, physicians should bolster the information presented and highlight positive aspects, says Dolan.1 Physicians can add information such as professional achievements and use the forum to talk about their style of practice. In response to negative comments, the Dolan article suggests, acknowledge the problem and ask the author of the content to take things offline to find a resolution. Respond in public, but … definitely don't play it out in the open.1 As physicians, our online conversations also demand caution. Adherence to state and federal patient privacy laws is paramount, as is tone. Condescension or aggression will garner a negative response and could make any conflict worse. And physicians should think twice before taking legal action for something that appears online, as it could further inflame the situation. Personal threats or threats to the physician's family or staff members are the important exception.1

As Tobin Arthur explains, physician reputations are built the same way today as they always have been: through outcomes, collaboration/assistance, word-of-mouth based on experience or perception, research/publishing, teaching, speaking, community involvement, including charitable contributions and extracurricular activities.3 Getting positive information online can help build a good reputation. Physicians can have the upper hand by creating their own content on personal blogs, Web sites and personal social media pages such as Facebook and Twitter, which all tend to rank high in search engine results.1 Posting information on sites that generally rank high in Google searches, or building an online business and professional site and/or linking to prominent sites, such organizations, philanthropies, physician finder sites and LinkedIn profiles will push other content down in the search results. Reputation.com's Noah Lang, director of business development, says 90% of people won't go past the first page of search results and 99% won't go past page 2.1

Google search results are the outcome of a patented algorithmic process in which computers crawl billions of pages, detect links and compile a massive index of words and their location on each page. When a user enters a query, Google's machines search the index for matching pages and return the results most relevant. Relevancy is determined by more than 200 factors, including PageRank, the measure of the importance of a page based on the incoming links from pages of other Web sites.11 For physicians, these could be ratings sites, newspaper or other media sites or professional organizations. Understanding these algorithms helps physicians provide web content to strengthen their first search pages and thus may move unwanted and unwarranted internet contributions below the most frequently searched Google pages.

To get more favorable reviews on sites that rank highly in search engines, Dolan's article suggests physicians choose reputable sites and direct patients to them verbally, by hanging signs in the waiting room or handing out fliers at check-out desk.

Publicly addressing issues raised online is also an important tactic, explains Scott Sobel, president of Media and Communications Strategy, a public relations firm in Washington, DC. Complaints about long waits, lack of response or other common patient satisfaction issues can be addressed and then broadcast online. A physician's website not only can be a source of the positive information they want patients to find but also can serve as a way to respond to negativity in a positive way. When a physician's reputation has taken a beating, Sobel said, ignoring it and hoping it goes way is not a sound option.1

Earning positive media coverage is also an important part of building a good reputation online. Physicians are advised to take time to get to know reporters, bloggers or other thought leaders in their field, join online conversations and establish themselves as an expert, well-connected resource. Other options include pitching newly published research and surgical techniques and offering expert commentary on such articles and news pieces when appropriate. Utilizing the public relations team within professional organizations, medical groups and hospitals are key to establishing the right kind of reputation.

A good reputation means everything for physicians at any point in their career. In the digital age, when reputations can rise and fall literally overnight, physicians must play an active role in building, repairing and managing online reputations appropriately.

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REFERENCES

1. Dolan PL. 5 ways to manage your online reputation. American Medical News. September 12, 2011. Available at: http://www.ama-assn.org/amednews/2011/09/12/bisa0912.htm.

2. Fox S. The social life of health information. Pew Internet & American Life Project. May 12, 2011. Available at: http://www.pewinternet.org/Reports/2011/Social-Life-of-Health-Info.aspx.

3. Arthur T. Why physicians should care about online reputation management. KevinMD.com. October 29th, 2010. Available at: http://www.kevinmd.com/blog/2010/10/physicians-care-online-reputation-management.html.

4. The Editorial Board. Some resolutions we’d like to see in 2013. The Sacramento Bee. December 31, 2012. Available at: http://www.sacbee.com/2012/12/31/5083714/some-resolutions-wed-like-to-see.html#storylink=cpy.

5. Rosen J. The web means the end of forgetting. The New York Times Magazine. July 21, 2010. Available at: http://www.nytimes.com/2010/07/25/magazine/25privacy-t2.html?_r=1&.



8. Kadry B, Chu LF, Kadry B, Gammas D, Macario A. Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating. J Med Internet Res. 2011;13(4):e95.

9. Yasmeen Shagufta MD UC Davis Medical Group. Yelp.com. Available at: http://www.yelp.com/biz/yasmeen-shagufta-md-uc-davis-medical-group-sacramento.

10. Hoffman A. How to clean up your online reputation. Monster.com. Available at: http://career-advice.monster.com/job-search/getting-started/clean-up-your-online-reputation/article.aspx.

11. Google basics. Google. Available at: http://support.google.com/webmasters/bin/answer.py?hl=en&answer=70897. Updated October 17, 2012.

Copyright © by the Congress of Neurological Surgeons

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