This is the third interview in a series which explores digital media and the law, including questions about HIPAA and online engagement. Eric Goldman is a professor at Santa Clara University School of Law. While Mr. Goldman's answers don't provide us with legal advice, they do give us some insight into how fertility practices might consider the law when responding to patient reviews online.

Jones: Should physicians respond to reviews written about them online? Why or why not?

Goldman: In most circumstances, physicians either should not respond to online reviews or respond generically by thanking the reviewer and indicating that the physician appreciates and carefully considers online feedback. It rarely makes sense to get into substantive discussions with reviewers online. Not only could such discussions implicate HIPAA, but physicians often look thin-skinned and petty when they attempt to debate fact matters online. Furthermore, increasing the number of comments to a review may actually cause search engines to rank the content higher (a counterproductive result if the review is negative). If the physician chooses to engage a negative review about the facts (which is rarely if ever advisable), the response should discuss the office’s general practices and not discuss how those practices were applied in the reviewer’s specific situation.

J: What information should physicians never include in their responses to reviews?

G: Given the boundaries of HIPAA, there are few circumstances where a physician can discuss any individual facts about the reviewer. Indeed, it is potentially problematic to even acknowledge that the reviewer is a patient.

J: Are there different implications for responding to patients when their identities are public (ex. Facebook) vs. when they are anonymous (ex. RateMDs)?

G: I couldn’t think of any.

J: Are responses to reviews considered protected health information (PHI) if the patient posted the information?

G: It’s a risky practice for physicians to confirm information that a patient or family member voluntarily publicly disclosed.

J: What should physicians and practices always be wary of regarding online reviews and their public reputation?

G:

Prospective patients are increasingly looking at other patients’ reviews when selecting physicians. I know many physicians wish this weren’t true, but there’s no point pining for an alternative universe.
Prospective patients are savvy enough to discount outlier reviews. If one negative review is surrounded by multiple positive reviews, it will have minimal effect on the physician’s reputation.
Patients’ reviews of their physicians are overwhelmingly positive, i.e., in some cases 90%+ of patients’ reviews are positive.
If a physician deals with dozens or hundreds of patients, inevitably there will be a few unhappy patients who will vent online.For these reasons, physicians should be actively encouraging their patients to review them online. This will better inform future prospective patients, and it usually will help create a base of positive reviews that will insulate the physician from the occasional negative reviews that inevitably will come.

G: A final thought: getting negative feedback never feels good, but it can provide a candid insight into the patient’s experiences. If the physician can overcome the emotional sting of a negative review, there may be valuable customer feedback that can help physicians do a better job meeting their patients’ needs.

If you would like to read a short essay by Mr. Goldman which explores how doctors and other healthcare professionals have responded to patient reviews of their services and addresses how they should deal with patient reviews in the future, you can find it here.