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First Person: The Online Defamation of Emergency Medicine

Roberts, Martha ACNP, CEN

doi: 10.1097/01.EEM.0000488837.00703.12
First Person

Ms. Robertsis an acute care nurse practitioner for Johns Hopkins Medicine at the Sibley Memorial Hospital in Washington, DC, and an adjunct faculty associate and clinical instructor of nursing at the Malek School of Health Professions, Marymount University in Arlington, VA. She and her father write the EMN blog, The Procedural Pause:http://emn.online/ProceduralPauseEMN. Follow her on Twitter @ProceduralPause and visit her Facebook page, Procedural Pause.

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The other night I was sitting at home after a long shift eating my takeout meal. I was fiddling on my phone, about to leave a semi-enthusiastic review about my local hoagie joint when the website prompted me to review other nearby places.

This well-known website allows customers of all ages, intelligence levels, and questionable taste to review everything from tires to sushi to bikini waxes. Customers can write whatever they want, and it is available for everyone to see in a matter of seconds. What disturbed me was that it suggested I review my local hospital when I clicked on the local business link. Even more surprising was that it had only two of five stars. But it had 127 reviews, so surely some of them had to be positive.

The emergency department is a business for consumers just as much as it is a place of medical treatments. I once worked at a hospital whose motto was, “We are in the Business of Healing.” You don't really get to choose where to go when you live in a suburb, but you think about who is best when you live in a city with 30 hospitals within 30 miles. We're in the age of the iPhone, Angie's List, and Facebook, which means we must consider what our community thinks of our industry and of us. What are people saying about you and the way you treat your patients? Should you care? Online reviews of businesses, even hospitals, can make or break everyone's future.

Some of the same providers kept popping up by name on the website. It shocked me that this kind of material is out there unmonitored. Is it defamation? How do we know it really happened? But why would anyone make up this sort of thing? I think the majority of the reviews are true, and sadly, only poor reviews tend to get written. Providers cannot comment back for several reasons, not the least, because of HIPAA. Maybe public relations should respond. Certainly a public debate over a poorly treated broken ankle can't be held online. Or can it?

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Winning Hearts

We also question the truth. Patients say bad things about even the nicest providers. No one is perfect, and some days our patients wait longer, do not have gold-star treatment, or are offered extra time for questions. Almost all of our care is team-based, too, which effects our overall rating. Even when you think you are doing the right thing and winning hearts, treatment delays from imaging, volume, or medication administration cause patients to see you in a different light. Then, they write about it online. But hey, maybe your care really wasn't that great after all.

Most amazing to me is that when patients mention specific providers by name. Should hospitals or emergency medicine groups take these online reviews to heart? It's difficult to ignore the same name repeatedly being criticized. That name has now become the face of your ED. Maybe it's time to take the comments into consideration; they appear to be honest. Could we make improvements from this feedback?

Online feedback may be biased, judgmental, inaccurate, and hateful, but it is essential to staying motivated, channeled, and on target. It also helps businesses (even hospitals) stay safe. Most people writing reviews map out their problem and how their care wasn't helpful. Hospitals need to ensure their team is caring and skilled. Maybe some truth is hidden behind the online reviews. Reviews complained the hospital was “dirty,” “loud,” and “crowded.” We can't control that sometimes. Blood gets on the floor, patients yell crazy things, and it gets busy. Some commenters said, however, their caregiver was “mean,” “rude,” or “unkind.” Oddly enough, some commenters said their caregivers were considerate and polite even though they had to sit holding their own vomit in a bin for an hour.

One of my favorite stories was from a man who named each provider he had and how awful they made him feel. He went on to say a security guard “of all people” assisted him while he was in a wheelchair. Again, we are reminded that our care team is the total package, not just one person or the doctor. People notice everything from the lights and your tone to your presence and the long waits.

I gave my hoagie place five stars. It wasn't a five-star hoagie, and it was not from the fanciest shop. But I have eaten there for 10 years and never once had food poisoning, a Band-Aid in my drink, or even a dirty look. What mattered most to me was that Joe the sandwich guy was always nice, let me in when they were closing, and gave me a free sandwich when he learned where I worked. I know people make choices based on what others say, especially when they are kind. As for Joe, it's easy. He is in the business of being nice, and that has made all the difference.

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