Share this article by copying this link: https://medicaljustice.com/dr-scott-green-surgeon-traffic-court-real-story/

You can also share by clicking one of the social media icons on the top left of your screen.

Dr. Scott Green is a talented plastic surgeon trapped in a 21st-century media storm. Dr. Green received a traffic ticket. Because of COVID restrictions, he appeared in traffic court via Zoom after successfully completing the salient portion of his patient’s surgery. His fellow was closing. A faulty Zoom connection created a false narrative that Dr. Green was careless and cavalier. This judgment is both false and unfair.

How do we know? We spoke to Dr. Green ourselves. Every doctor needs to hear his side of the story. Why? What happened to him could happen to any of us. Listen to his story.

Meet Your Host

Jeff Segal, MD, JD

This week we have a guest post from Kathryn Dean. She is the creator of FakeReviewWatch.com and its eponymous YouTube channel. She’s exposed a large international marketplace for purchasing and posting fake reviews and a domestic marketplace for trading reviews between businesses. One such review trader teaches law and ethics at a major US university. Ms. Dean connects the dots between reviewers who posted reviews about a mortgage company in California, a dog walker in New York, a motel in New Zealand, a restaurant in Florida, AND an SEO company. Oh, and other “reviewers” coincidentally visited the same businesses and posted reviews. Imagine the odds. And physicians are participating. Read on.

Doctors Who Purchase Fake Online Reviews from Bangladesh

Guest Post by Kathryn Dean, Creator of FakeReviewWatch.com

Scrolling through the Google reviews for a prominent mental health treatment center in Washington state, you’ll run across a review by a Jeremy Maria which begins, “I don’t know if I have words enough to truly express my gratitude to each and every member of my team. I don’t know if I have ever felt as accepted and cared for during such an intensely vulnerable state in all my life. I mean that with all of my heart.”

That glowing, heartfelt review could certainly sway anyone afflicted with depression or addiction into considering this clinic as the place to go for help. The trouble is, that review wasn’t written by any Jeremy Maria at all. A Bangladeshi review broker paid another Bangladeshi man 83 cents to post it on Google. The review broker provided the entire text, which was likely written by someone at the clinic.

This is not an isolated occurrence. As a citizen investigator, I have researched online review fraud for three years. The problem is much worse than you might imagine. I have seen literally thousands of businesses faking reviews, and plenty of medical and dental practices are among the guilty parties.

The above case is particularly interesting because the evidence I found is right out in the open in public communications in a Facebook group. It’s all documented in a video titled Bangladeshi Facebook Group Fakes Google and Trustpilot Reviews for U.S. Businesses on my YouTube channel, Fake Review Watch. The Bangladeshi review broker publicly outs his U.S. clients, how much he pays for posting a review, and the text of the reviews he wants posted. The responses from various Bangladeshi participants are also there for all to see, including screenshots of the reviews they posted on Google or Trustpilot in order to get paid. That mental health treatment center wasn’t the only client; there are many others, including other U.S. medical and dental practices.

Keep in mind, too, that this case comprises communications from just one review broker in one Facebook group. There are scores of these Facebook groups out there dedicated to buying, selling, and trading fake reviews. I myself have joined 60. Review sellers and other online marketers, many based in India and Bangladesh, abound in these Facebook groups and sell fake reviews in bulk or form networks of businesses for buying and trading reviews.

While many businesses simply buy reviews, others trade for them, and plenty of medical practices are involved. A Virginia psychologist traded reviews with a Missouri educational supply store. A Michigan eye surgeon traded with a Seattle martial arts studio. A California dermatologist traded with a Wisconsin home inspector. And a California psychiatrist swapped with a Texas credit counseling business, just to name a few. Businesses often write their own reviews and send them to their trading partners via Facebook private message to post. I’m able to piece together cases of faking, though, through snippets of public communications, other publicly available information, and people’s memberships in Facebook review exchange groups. I can also ferret out fraud by looking at review patterns on Google or Yelp. What I’ve found is both infuriating and depressing.

A Torrance, California, hernia surgeon is faking his reviews across multiple platforms. At the same time he sued a woman for posting a negative Yelp review because she claimed the doctor’s botched hernia surgery caused her husband’s death (she says she has an autopsy report that corroborates her accusation). A Manhattan orthopedic surgeon is a prolific faker on Yelp and Google, and likely other sites. A famous Beverly Hills cosmetic surgeon apparently needs to fake his Yelp reviews to keep the clients coming. A Miami plastic surgeon who “exposes” other doctors for not being transparent about their qualifications in his online videos is busily faking his own Google reviews. And, in a case that affected me personally, a psychiatric practice that’s faking reviews threatens patients with legal action over negative, real reviews.  In fact, an officer of this particular practice fraudulently passed himself off as a lawyer and forged the signature of a real lawyer to try to force me to remove my review, showing just how far some medical practices will go to manicure their online reputations.  He’s now being prosecuted by the district attorney.  (Follow the links for the evidence in each case). 

Unfortunately, despite all of the evidence I provided, the psychiatric practice is not being prosecuted for faking reviews, and the state medical board appears uninterested as well. Meanwhile, the psychiatric practice retains stellar Yelp and Google ratings bolstered by fraudulent reviews, and patients continue to be duped into using this unscrupulous practice instead of going to more reputable doctors. I was recently contacted by a woman complaining that this same practice had defrauded her of over $3,000 on her credit card.

Millions of people are being deceived by this fraud, and thousands of honest businesses are being cheated out of customers. The only ones profiting are the cheaters and the tech companies who abet them. As I demonstrate in my YouTube videos, Google and Yelp certainly see the extent of the fraud on their platforms, and Facebook ignores the rampant fraud being arranged on its site in groups with names as obvious as “Google+ Review Swap” and “Yelp Review Exchange”. Of course, these and other tech companies have little incentive to clean up the fraud since they are not held liable for it under Section 230 of the Communications Decency Act of 1996.

It’s far past time for government action. Federal and state enforcement agencies and attorneys general must start prosecuting businesses who are faking reviews at the expense of consumers and honest businesses. The last significant action was way back in 2013, when the New York Attorney General prosecuted 19 companies involved in review fraud. Perhaps even more importantly, Congress must reform CDA Section 230 to alleviate the unchecked and corrupting influence of big tech, which is eroding business ethics to the point that some small businessmen, including doctors, feel they must cheat to compete.

Government action won’t come without public pressure, however, and it’s time for influential organizations such as the medical and dental professional societies to mobilize support for regulatory enforcement and legislative action to combat fake review fraud.

Kathryn Dean is creator of FakeReviewWatch.com and its eponymous YouTube channel.  She is a member of the Alliance to Counter Crime Online.

Then I met Kathryn Dean.

She pointed me to a collection of videos demonstrating compelling proof of this overseas review purchasing and domestic review trading marketplaces.

My recommendation to physicians: Don’t do it. It’s even possible you have hired a marketing firm engaging in this fraud and you are entirely unaware you’re involved, burying yourself in your work.

I do believe at some point there will be a reckoning. Maybe not today. Maybe not tomorrow. But, it will come.

First, there is bipartisan support to amend or even throw out Section 230 of the Communication Decency Act which provides legal immunity to large technology platforms. Section 230 has a short forward-looking shelf-life. I do not believe sites such as Yelp will escape legal accountability forever. Hold the applause.

Next, state boards of medicine and dentistry all have edicts against false and deceptive advertising. Purchasing fake reviews would qualify for investigation and potential discipline. While Ms. Dean does not believe the licensing boards have an appetite for holding doctors accountable for such mischief, my experience with the boards is the exact opposite. I have seen boards take action many times for charges of false and deceptive advertising. And even if the primary reason for a board investigating a practice is some other offense, the board may use an additional charge of false and deceptive advertising to pile on and bump up the penalties.

How would a state medical board ever find out?

Well, the conventional way. A disgruntled employee, a competitor, or an ex-spouse. Or an unhappy patient. Or an unconventional way. A citizen investigator.

Many actions go unregulated until they eventually are. I spent some time on Ms. Dean’s YouTube channel. It’s mesmerizing. I would not be surprised if 60 Minutes runs a segment on the topic. Most of the time, when 60 Minutes comes for an interview, it’s not a feel-good story for the interviewee.]

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Learn how Medical Justice can protect you from medico-legal mayhem… 

So – is it against the law to pay patients for online reviews?

The short answer…

Yes.

The more nuanced longer version…

Giving anything of value for reviews without disclosing the gift can be considered false and deceptive advertising by the Federal Trade Commission (FTC). It does not matter if it is $1, an Amazon gift card, or free services. Or even entry into a sweepstakes where the patient has a mere chance to win something of value.

So, the “safe harbor” is that the party doing the review would have to conspicuously disclose the gift. Here’s what a safe harbor FTC compliant review might look like:

“Dr. Segal saved my mother’s life. He is my hero. (Dr. Segal gave me a $25 Amazon gift card for the review.)”

The disclosure devalues the review and makes it looks ridiculous. And in the real world, no patient receiving a gift discloses the gift. But that is what the FTC is getting at. They want the public to know if the reviewer had an incentive or bias. The public has a right to know so it can judge the validity of the review.

The simple version of the FTC’s position can be found on its FTC’s website. Select Questions and Answers are below.

I’m starting a new Internet business. I don’t have any money for advertising, so I need publicity. Can I tell people that if they say good things about my business on Yelp or Etsy, I’ll give them a discount on items they buy through my website?

It’s not a good idea. Endorsements must reflect the honest opinions or experiences of the endorser, and your plan could cause people to make up positive reviews even if they’ve never done business with you. However, it’s okay to invite people to post reviews of your business after they’ve actually used your products or services. If you’re offering them something of value in return for these reviews, tell them in advance that they should disclose what they received from you. You should also inform potential reviewers that the discount will be conditioned upon their making the disclosure. That way, other consumers can decide how much stock to put in those reviews.

A company is giving me a free product to review on one particular website or social media platform. They say that if I voluntarily review it on another site or on a different social media platform, I don’t need to make any disclosures. Is that true?

No. If you received a free or discounted product to provide a review somewhere, your connection to the company should be disclosed everywhere you endorse the product.

There’s a much longer guidebook published by the FTC which goes into great detail. If you are looking for an even deeper dive, see the Federal Register.

If the FTC takes action for non-disclosure of the consideration, both the practice AND the reviewer (in this case the patient) would be in the crosshairs.

The first question a practice might ask: How would the FTC find out if we pay for reviews?

The usual way. Disgruntled employee, ex-spouse, or competitor. It is complaint driven.

If the FTC does act, and the charge is false and deceptive advertising, the state Attorney General and medical licensing board may be next in line to seek blood.

In 2016 the NY Attorney General settled with two companies, Carmel Car Service and Medrite (an urgent care center), for $75,000 and $100,000 respectively for paid online reviews. The fine was ugly. The PR that followed was even worse.

Finally, it’s entirely unnecessary to pay for reviews. A plug for eMerit, the online review platform behind Medical Justice. eMerit captures patient feedback and gets it automatically uploaded to the dominant review sites. eMerit captures patient feedback at the point of service for upload. Your practice can also collect surveys via text message, email, and a survey link integrated into your existing EMR systems.

We provide video instruction on how to ask for candid feedback to promote quality of service. Virtually everyone who is asked says yes. Their reviews post online. Over 300,000 reviews have posted – and no patient has received a penny to do so.

Request a free consultation below to learn how your practice can leverage eMerit to put your best foot forward online. Medical Justice also specializes in protecting doctors from a bevy of medico-legal threats. We have solutions for medical board complaints, defamatory patient reviews, sham peer review, and more.

Learn how Medical Justice can protect you from medico-legal mayhem… 

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.

Elite Dental Associates, a Dallas dental practice, just wrote a check for $10,000 to the Office of Civil Rights (OCR) for Dept. Health and Human Services. The reason. A HIPAA violation. What “egregious” act did the practice commit?

Responding to negative reviews on Yelp.

OCR’s investigation found that the dental practice had impermissibly disclosed the protected health information, or PHI, of multiple patients in response to reviews on the Elite page on Yelp.

The patient first filed a complaint on June 5, 2016, which alleged Elite responded to a social media review about the provider with the patient’s last name and details of the patient’s health condition. The post also included details of their treatment plan, insurance, and cost information.

The practice got off easy. OCR showed mercy.

OCR accepted a substantially reduced settlement amount in consideration of Elite’s size, financial circumstances, and cooperation with OCR’s investigation.

Elite Dental is a single practitioner practice. The potential penalty could have been an order of magnitude higher or more. Whether or not his professional liability carrier paid the penalty was not made public. My guess is they did not. Most policies preclude payment of a penalty.

Social media privacy “breaches” are becoming fair game for the HIPAA police.

In 2016, Complete PT, Pool & Land Physical Therapy paid OCR $25,000 over patient allegations that the provider “posted patient testimonials, including full names and full face photographic images, to its website without obtaining valid, HIPAA-compliant authorizations.”

More will come.

How am I so sure?

Because most healthcare professionals believe the privacy laws are grounded in logic and make sense. They assume, INCORRECTLY, if a patient has “outed” themselves, disclosing all types of details about their care, then their medical or dental record is fair game. The doctor can then respond with facts to get the truth out. While logically it should be the case, it is not so. Responding by disclosing protected health information (PHI) is a breach. Even acknowledging a reviewer is your patient is a breach. A patient can use a pseudonym. If their picture is plastered on the screen, they are identifiable. We have even seen a case where an attorney argued a patient’s freckling pattern identified her. No face. No name. Just before and after photos of her breast augmentation. That attorney was rewarded with a settlement.

Responding to a review can be done safely only under the following circumstances:

A.

The patient has given prior written authorization to disclose protected health information. If a patient is slamming you online, this likely will not be a viable path.

B.

There is a statutory exception which allows one to disclose protected health information with advance written authorization. For example – providing information to a treating doctor to help treat your patient. Or providing financial records to resolve a claim or addresses a financial dispute. There are a bevy of other statutory exceptions; most will never be relevant to responding to an online review.

C.

Your response does not disclose protected health information. It does not even acknowledge the reviewer is your patient. There are ways to do this. We do it for our clients all the time. But this is not for amateurs. The goal is not to get into a factual online debate with the patient. It is to broadly send a message to the public. This seems like a subtle distinction. It is not. It is the difference between protecting your reputation and writing a big check to OCR.

Now, let me digress and talk a minute about responding to positive reviews. Some marketing companies state that medical practices should thank patients for their thanks. Patients will react positively to this. They like knowing their reviews are being read.

While this may make sense for retail stores, automobile dealers, and hair salons, in healthcare, do not do this. Repeat. Do not do this. Why? Each response is a potential vector to trigger a complaint. As stated above, there are ways to respond to negative reviews. This should be an infrequent occurrence. Positive reviews are more frequent. So, you would be increasing the number of times you are potentially committing a privacy breach. No less important, it’s hard to come up with fresh material thanking someone for their thanks. If you are that creative, quit your job, and move to Hollywood. You will be handsomely compensated as a script writer.

Complaints related to HIPAA are triggered by unhappy patients. Would a happy patient really complain? Remember, not all happy patients stay happy. Some go to a competitor and later become unhappy. With you. Then the complaint gets filed.

Or a HIPAA complaint is triggered by a “concerned citizen”. A disgruntled employee, ex-spouse, or competitor.

My two closing points.

Do not respond to positive reviews.

Respond judiciously to negative reviews in a way that discloses zero protected health information. Not even disclosing the complaining patient was your patient. Do not guess how to do that. Speak with professionals. As stated above, we provide this service to our clients. To request a complimentary consultation, visit our booking page or use the scheduling tool linked below.

Back to Elite Dental.

In addition to the $10,000 penalty, Elite will be required to follow a corrective action plan that includes developing, maintaining, and revising, as a necessary, written policies and procedures to ensure the privacy and security of individually identifiable health information in compliance with HIPAA.

The policies should address permissible and impermissible uses and disclosures of PHI, as well as the appropriate administrative, technical, and physical safeguards to protect PHI. Elite must also create a process for evaluating and approving authorizations around PHI, before that data is used or disclosed.

As mandated by HIPAA, the policies must also outline how a patient may revoke authorization and a “statement regarding a covered entity’s ability or inability to condition treatment, payment, enrollment, or eligibility for benefits on the authorization.”

Elite must also bolster its current notice of privacy practices to include the requirement of obtaining an individual’s authorization before use and disclosure, including posting on its website, social media pages, and or other public platforms.

The dental provider must also assign a contact person for inquiries or concerns around HIPAA compliance in relation to PHI. All workforce members must report to this designated person or office any potential violation, as part of its internal reporting procedures.

Elite will need to apply and document appropriate sanctions, such as retraining or instructive corrective action.

“Such reporting procedures shall require Elite to promptly investigate and address all received reports in a timely manner,” officials wrote. “Training shall cover all the topics that are necessary and appropriate for each member of the workforce to carry out that workforce member’s functions within Elite.”

The Department of Health and Human Services must receive those policies within 30 days of the effective date to be reviewed and approved. Any changes will need to be made by Elite within 30 days of receipt and distributed to all workforce members.

New employees must receive the documents within 30 days of beginning their employment. Elite must require its workforce to sign a compliance certification, which attests the employee has read, understood, and will follow the policies.

Elite will be required to assess, update, and review the procedures on an annual basis, and as necessary. What’s more, employees that fail to sign the procedure are not permitted to use or disclose PHI.

So, there you have it. The HIPAA Privacy law may not follow common sense. But, failure to adhere to its tenets in the online world can empty your wallet. Medical Justice can help you get this right. Request a free consultation with our Founder and CEO, Jeff Segal, MD, JD to learn how we can help you address patient reviews of all kinds while protecting your practice from a bevy of other medico-legal threats. To request a complimentary consultation, visit our booking page or use the scheduling tool linked below.

Learn how Medical Justice can protect you from medico-legal mayhem… 

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.

Responding to Patient Reviews: 5 More Golden Rules Physicians Should Follow

In February, we published two articles related to patient reviews. One piece was published online. The second was made available for download. Both remain available, and we encourage our readers to study them. Considering the overwhelmingly positive reception both pieces received, we decided to return to the topic and discuss five more golden rules physicians should follow when responding to online reviews.  Summarized, the questions this piece will answer are… 

+ How should physicians thank patients for online reviews? 

+ How should doctors respond to mixed reviews? 

+ How should doctors respond to reviews that lack detail? 

+ How should doctors deal with fake reviews posted by non-patients? 

+ How should doctors deal with “review vigilantes?”  

Without further ado – let’s begin… 

Some doctors are in the habit of responding to positive patient reviews. If you are one of them, we understand the impulse. That said – we implore you to break the habit. 

When a patient publishes a glowing review, it is tempting to interact with them. You may feel compelled to thank them. This is a natural response – most of us have been conditioned since childhood to thank those who take an action that benefits us.  

We urge you to resist this urge. 

Thanking the patient increases the likelihood you will betray his privacy. Even something as benign as  

“You were a wonderful patient, Bill. You make my job easier.”  

can be construed as a HIPAA violation. The reason is simple: Acknowledging the author’s status as your patient violates his privacy. The fact that the patient has just shared his experience online does not matter. If the patient wants to share that experience online, he has the freedom to do so. His doctor does not without the patient’s explicit (and signed) authorization.  

Doctors know fines accompany HIPAA violations. Fewer know the exact costs associated with these fines. The graphic below will shed some light. Even “light” violations incur a stiff penalty. 

https://www.hipaajournal.com/hipaa-violation-fines/ 

If you must thank the patient, pick up the phone and call him. Write him a short letter of gratitude. Or thank him in person the next time he visits your office. Thanking someone in-person is always a more memorable experience. It demonstrates you noticed. It’s personal. And it’s devoid of the likely platitude you would have inserted online. It’s hard to come up with original content on a regular basis to express thanks.  

Not all patient reviews fit neatly into prescribed categories. How should doctors respond to mixed patient reviews? 

Not all reviews are positive. Not all reviews are negative. Some reviews are a mix of positive and negative sentiments  – we call them “candid” reviews. A candid review may read something like this… 

“The doctor was great. My results are excellent. The lady at the desk always seemed confused though. Would highly recommend!” 

Candid reviews are perplexing because they are ambiguous. The example above praised the doctor but was critical of his staff. Will patients perceive this negatively? Positively? Will they care at all? Our answer is: It depends. Pick your battles.  

Start by breaking the review apart and assigning character traits to each piece. “The doctor was great” is obviously a positive element. “My results are excellent” may or may not be useful to a new patient. But the statement suggests the author experienced a positive outcome as a result of the physician’s care, so let’s assume that statement is a positive element as well. “The lady at the desk always seemed confused” is a negative element, but unrelated to the quality of care rendered by the attending physician. The final statement “Would highly recommend!” is a positive element. 

So – we’re left with three positive elements and one negative element. A positive review, all things considered. We’d suggest leaving this one alone. Remember – every time you respond to a review (positive or negative) you are courting a certain level of risk.  

Responding to a patient review is only appropriate when the risk of leaving the review alone exceeds the risk of addressing the review with a carefully constructed response.  Crafting a HIPAA compliant response by yourself is possible, and this article’s purpose is to act as a pathfinder. That said, even with proper research, crafting an optimal response can be time-consuming and risky. Professional guidance is indispensable. Schedule a free consultation to learn how we can help.

Many patient reviews are vague. How should doctors respond to negative patient reviews that are short on details?  

You won’t always have the luxury of knowing why a patient was dissatisfied with his care. Some reviews will be as brief as: “Bad. Just bad. Trust me, you don’t want to know.” These comments leave little room for the physician to extend an olive branch. What are you going to write? “No, I’m not bad.” Therefore – economize your reply. Your response should achieve the objectives outlined below… 

Identify why the patient was dissatisfied with his care – once you deduce why the patient is upset, you can attempt to remedy. 

Present the public with proof the practice is reasonable and willing to discuss perceived wrongdoings. Be firm, but amicable. Negative reviews give physicians an opportunity to defy expectations. The expectation is that you’ll deliver an emotionally-charged reply and validate all the awful things the patient has alleged. Sanitize your reply by stating facts. Doing so will allow you to take back control. 

Take the conversation offline. No physician has ever profited from indulging in a drawn-out online argument. Present the author with your practice’s phone number. Invite the public to call the practice to discuss their quality of care.  

Sometimes malicious entities (ex-spouses, dismissed employees, angry patients) defame doctors online by posting “fake” patient reviews. What can doctors do to combat fraudulent patient reviews?

A physician’s first instinct is to find some way to remove these fraudulent posts from the web. We do not recommend this strategy. We’ll explain why shortly. Instead, prioritize the collection and publication of fresh patient reviews. Your goal is to dilute the damage caused by the malicious posts by supplanting them with new (hopefully favorable) reviews. Your existing patients will be your lifelines. Be straightforward. Explain to qualified patients (face-to-face) that you value their opinions and are interested in collecting patient feedback. Objective measurements (patient reviews) are the most valuable statistic they can provide.  

The next step is to identify where the suspect review is hosted. This is important because it will make it easier for you to direct a patient’s actions. Asking a patient to simply write a review is too broad. Was the fraudulent review posted on Google? If so, encourage patients to post their reviews on Google. Doing so will increase the speed at which the malicious content is displaced.  

Competing positive and negative narratives are preferable to only a few negative narratives. 

After you identify where the fraudulent post is living, study the website’s Terms of Use. If the review violates this policy, you may be able to successfully petition for the review’s removal. A fair warning, though – this is not a fast process. Review sites are inundated with these requests every day. It will take time before someone puts a pair of eyes on your request. And unless your argument for the review’s removal is ironclad, it likely won’t happen.  

Doctors can easily prove to themselves (and their staff) that a review is fake. But doing so achieves nothing. Existing patients do not need to be convinced a review is fake. They are already excellent judges of a physician’s character and skill. Fake reviews are damaging because they have the power to influence the perceptions of new patients – members of the doctor’s community who do not know him well enough to discern fact from fiction. To an outsider like Google, fake patients look identical to real patients. 

To prove our point – quickly Google the name of a colleague or a competitor. Examine his patient reviews. If he has received a negative review in the past, study it. Could you, with absolute certainty, prove that the negative review was written by a non-patient? Unless the review references a procedure that you know your colleague does not perform, you can’t know. And neither can Google.  

So – what can be done? If you cannot supplant it and you cannot remove it, you must refute it. The incorrect way to go about this is to deliver an emotionally-charged response. You’ll see much better results if you deal only with facts.   

Start by studying the review’s content. As we said before – identify opportunities to educate the public. The author’s “real” identity is a “truth” outside of your control. Accusing the author of being a fraud is a waste of time.  

Instead, de-escalate the situation by addressing the “truths” you do control – namely the rules and policies your practice abides. Does the review reference a procedure your practice does not offer? Does it reference a staff member who is no longer employed by the practice? Look for holes you can probe. Referencing these inconsistencies in your response will make it clear the testimony is either grossly exaggerated or outright false.  

Negative patient reviews trigger arguments between doctors and patients. But what happens when a negative patient review triggers an argument between patients? Do doctors need to play peacemaker?

Doctors are popular people. They work to minimize and relieve the suffering of others. They are not perfect, but people (generally) like them. So, when doctors are criticized online, sometimes members of their community come to their defense. We call these entities “review vigilantes.” These phantom knights will respond to negative reviews and challenge the critic’s assertions. The ensuing arguments often turn ugly. This phenomenon is rare, but it does happen. And while the intentions of these vigilantes are often good, their actions sometimes do more harm than good in the long run.  

If this happens to you, contact the vigilante and politely tell him to stop defending you online. You may feel tempted to let the vigilante just “do his thing.” He is, after all, acting in your defense. 

We discourage this passive line of thought. 

Imagine you’ve been criticized online by a former patient. You respond with strategic intent, but while emotions are still high, another patient joins the conversation. He’s come to your defense. This interference is uninvited. Your vigilante’s response is not strategic. It is likely emotionally charged. It questions your critic’s intelligence, as well as his motivations. This compels the critic to fight back. He assumes you two are in cahoots. The exchange escalates. The argument spreads across your practice’s Google profile. You do not participate. You don’t have to participate – the argument has become self-sustaining. The belligerents feed off one another’s negativity.  

The third-parties observing this conflict may arrive at several unfavorable conclusions. They may assume the vigilante is a gopher – an anonymous troll hired by the doctor to police the online space and descend upon perceived malcontent. They may assume the vigilante is a false identity the physician assumes when he wants to engage his critics. Or they may assume the physician simply has limited control of his affairs and is better avoided.   

The ultimate objective of any response is to take the conversation offline. Allowing vigilantes to act freely achieves the opposite. If you become a “victim” of this phenomenon, put a stop to it. You’ll inherit any negative consequences brought about by the vigilante’s actions. 

With this as backdrop, it is occasionally helpful to have an existing patient weigh in – one and done. No debate, just a single response. It is the back and forth that needs to be avoided. 

While thorough, we do not consider this an exhaustive treatise. Additional input from our readers is always welcome. We invite you to share your thoughts in the comments below.

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Learn how Medical Justice can protect you from medico-legal mayhem… 

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.

In the past, reputation management meant doing your job well and avoiding controversies. Take care of your patients. Participate in your community. Don’t kick puppies.  

Then the internet emerged, and the public received the power to praise and condemn doctors online anonymously. Many doctors perceive the online world as a two-edged blade. Case in point: A patient who experiences a positive outcome may share that experience online in the form of a review. That positive experience, memorialized online, has the potential to influence many more patients than a single word-of-mouth referral. There is no better marketing platform. 

But unfavorable reviews enjoy as much visibility, if not more. And if a favorable online review can drive patients to your practice, unfavorable reviews will drive them away.  

Capitalizing on the good while mitigating the effects of the bad is the task. On paper, it sounds simple. Yet reputation management is challenging for everyone, especially doctors. We must respect HIPAA. We must respect the TCPA (more on that acronym shortly). And our jobs, by their very nature, require we deliver important news our patients. That important news is not always good news. Still, many of your colleagues are thriving online. Their online reputations drive revenue. There are ways to do it. 

This piece covers tips specific to reputation management for doctors. We’ll open with key definitions. Then we’ll identify the dials you can turn to benefit your practice. Here’s a summary of the topics we’ll cover. Click on the links below to jump to the topic that interests you most.

+ Reputation management for doctors – what is it? 

+ Why doctors should develop their online reputations… 

+ The role of websites and patient reviews… 

+ How to make Google work for your practice and not against it… 

+ How to increase the likelihood a patient will post his experiences online… 

+ The average number of reviews a doctor needs to buffer against defamation… 

+ Negative reviews and strategies for managing unfavorable sentiment…

+ COVID-19 and reputation management for doctors… 

There’s a lot to unpack. Let it be said Medical Justice understands reputation management for doctors viscerally. And we understand the regulatory landmines most others do not. Our strategies are designed to promote your practice and keep you out of the crosshairs. 

Schedule a consultation to learn how we can help.

Let’s begin with the basics. 

Reputation Management for Doctors – What is it? 

This phrase has multiple definitions. Here’s the one that matters. Reputation management for doctors refers to strategies that increase the likelihood your quality of care is portrayed accurately.  

Simplified: Any action that makes you look good (assuming, of course, you are delivering high quality care). 

Reputation management for doctors can be broken into two categories: offline reputation management and online reputation management. Offline reputation management refers to actions specific to your brick-and-mortar practice (for example, the three A’s: affable, able, and available). Online reputation management refers to digital properties that influence how you are perceived on the internet.  

To thrive, you must take ownership of both. We’ll explain how. 

What is a doctor’s offline reputation? 

The cornerstones of any doctor’s reputation are laid offline. Your reputation is the fruit of human-to-human interactions.  

Develop your offline reputation by establishing professional rapport with your patients and staff. Do your best to be a great doctor. Practice according to the standard of care. Don’t cut corners. Don’t leave patients in the dark. Over-communicate. Set the correct expectations before, during, and after a patient’s treatment. Be transparent. Provide patients with a clean environment. Optimize wait-times. And if you are surprised by an unfavorable outcome, be upfront. Yes, there’s more. But you get the picture. Treat your patients the way you’d want to be treated.  

What is a doctor’s online reputation? 

A doctor’s online reputation is the summation of that doctor’s perceived quality of care, limited to data points published online. Put simply: How a given doctor looks according to Google. 

Your online reputation is influenced by every online property that has your name on it. For example, your website, your social media, and your patients’ online reviews all contribute to your online reputation.  

Positive or negative, accurately or inaccurately, those properties define you online.

And if there is nothing on the internet with your name on it, you have no online reputation. You’re invisible. And that’s a problem.  

The bigger challenge: A doctor with a great reputation is not guaranteed to have a great online reputation. What gives?  

The internet moves quickly. Technology moves quickly. And doctors are preoccupied with being doctors. Not every great doctor has a great website. And not every great doctor is equipped to safely, compliantly, and conveniently facilitate publishing of patient sentiment online. A doctor with no website and few reviews will have a harder time standing out online because there is little evidence that he exists online. And search engines (such as Google) cannot supply patients with information about a physician who does not exist online. 

Recall our prior definition: A doctor’s online reputation is limited to data points published online.  

Therefore, if you want to capitalize on your online reputation, it is critical you understand the advantages of maintaining a high-quality website and empowering your patients to share their experiences online. 

Why should I care? What’s the advantage of developing my online reputation?

Reason one: Patients are using the internet more and more to inform their healthcare decisions. Patients seeking elective care are especially attuned to a doctor’s online reputation. A physician with a strong online reputation (a well-maintained website and favorable online reviews) will be perceived as “the right choice” by new patients. 

Reason two: Google is not omniscient. You’ve heard the joke: “Google knows everything.” But that’s not true. Its library of knowledge is limited to the content that human beings publish online. Just because you exist does not mean Google knows you exist. If a doctor has no online properties, as far as the internet is concerned, he doesn’t exist. (This would probably drive René Descartes mad.) This means that patients seeking the kind of care you provide will not find you. They’ll find a competitor. Doctors taking ownership of their online reputations will be found more easily by those patients using the internet to identify qualified providers. A doctor who ignores the online world cannot capitalize on the same opportunities. That doctor is limited to opportunities generated via alternative, and less effective, marketing methods. 

Before improving any metric, you must establish a benchmark. You must answer the question: “How do I look now?” Gathering this data alone is challenging. Leave that to us. Request an online reputation analysis. We’ll scan the internet and compile your existing patient reviews into a single report. Our report will identify where you excel and reveal opportunities for growth.  

What role does your website play in a doctor’s online reputation?

Think of your website as your brick-and-mortar practice’s digital twin. You cannot develop your offline reputation without a brick-and-mortar practice. A doctor lacking a website can still thrive online if he focuses on online reviews. But having a website dedicated to your work can only help you – provided the website is well-maintained.  

What role do patient reviews play in a doctor’s online reputation? 

Patient reviews (positive and negative) represent your perceived quality of care online. These imperfect metrics are used by patients to evaluate physicians. You deny this evolving truth at your own peril. The more of these reviews online, the more likely a patient will perceive your quality of care accurately. A doctor with few online reviews is at risk of being defined inaccurately. Why? Such a doctor has no counter-narrative. It is the digital equivalent of the heckler’s veto, whose voice drowns out others. 

We’ve had many clients contact us with questions specific to toxic reviews published by non-patients. These reviews were written by ex-spouses or former employees who left on bad terms. We’ve devised strategies for managing these situations, but the best strategy is as follows: The solution to pollution is dilution. 

If a doctor’s patients populate the internet with reviews in advance of a bad outcome, the likelihood the doctor will be defined by that bad outcome is low. 

Search engines (such as Google) seem to play a key role. How can I make Google “work” for my practice?

Put more stuff with your name on it on the internet. It sounds crude, but that is the solution. The implementation is tricky. To understand why, it is necessary to briefly discuss how search engines work. 

First: The job of a search engine is not to ask questions. Its job is to answer questions. A search engine is like a librarian. Let’s pretend a patient asks Google a question specific to plastic surgeons in his geographic area. Let’s assume this patient lives in Miami, FL. He submits the search query below… 

“best plastic surgeons miami florida” 

It is Google’s job to assemble a list of websites, patient reviews, and articles that it “thinks” are most relevant to the patient’s question. But Google can’t tell the user where to go or with whom to schedule an appointment. It can only present data points. The decision making is left to the human being. 

Therefore, it is critical that doctors, particularly those specializing in elective care, take steps to manage their online reputations. If there is little or no information about you online, there is little for Google to report. You won’t show up. Possibly worse – if the only patient review attached to your name was published by an angry patient, that review, young or old, becomes your reputation.  

As we said previously, Google is not omniscient. It cannot fact check. It can only report data points published by its human masters. 

The most reliable way to make Google “work” for your practice is to take the following actions…

Deputize your patients to post online about their experiences…

Update your website so that it accurately reflects your current offerings and expertise…

Collaborate with colleagues. Consider producing content (articles, videos, podcasts) specific to you and your work. If it is on the internet and has your name (or your practice’s name) attached to it, Google will associate that content with your name and your business. If the content is well-received, it has the power to favorably impact your online reputation.

Which is most important? 

Prioritize the publication of patient reviews. Though patient reviews are an imperfect way to measure a physician’s quality of care, most patients trust them. We understand the importance of these metrics and have devised strategies for uploading patient sentiment to the web. To learn more, schedule a consultation with us. 

What is the minimum number of patient reviews I need to protect myself from defamation?

We’ve constructed an interactive tool to help answer this question. Use the slider below to adjust the formulae to suit your circumstances.

On a mobile device? For the best experience, click here to access the mobile responsive online review calculator. Tap the grey bar to adjust the slider.

How can I convince patients to regularly share their experiences online?

Patients are like us – they are busy. To increase the likelihood a patient will share his experience online, do the following: Make it easy and make it quick. 

 Strike while the iron is hot. Ask the patient for “feedback” before he exits your practice. This feedback will likely become a “review.” Trusting the patient will remember to take this action at home is risky. Once he departs, he becomes consumed by his other priorities. What’s for dinner, for instance. A point-of-service survey tool (like an iPad equipped with a short survey) works best. If a point-of-service survey is not possible or practical, email or text the patient a link to a survey he can complete online. 

We devised a texting-based option in the wake of COVID-19. Our member doctors have implemented this tool with great success. Want to learn more about how this works? We are happy to demonstrate. Schedule a free consultation with us. 

A critical medico-legal issue: Texting a patient a link to a survey may be considered a “marketing tactic” by most regulatory agencies; meaning, you must obtain a patient’s written authorization BEFORE sending him such a text message. What are the consequences for texting a patient a marketing message without his prior written authorization? This is that TCPA acronym we warned about earlier. If a patient acts (and it’s a cash cow for attorneys), you’ll likely be fined hundreds of dollars per text. And these damages are uncapped, meaning the sky is the limit. If you are using texting for ANY marketing activities, you must be compliant with TCPA. We can help walk you through this thicket. 

Medical Justice designed its own point-of-survey and email/text message marketing tools with regulatory compliance (including TCPA and HIPAA) in mind. So, our clients don’t need to worry – we’ve got their back. 

How should I address negative reviews?  

With expert advice, a cool head, and strategy. First, don’t freak out over one or two poor reviews. The occasional bad review is inevitable. It means you are human. And many patients perceive doctors with a few negatives more favorably than those with perfect reviews. Why? Patients, like us, are smart. If a doctor looks too perfect online, most patients assume that doctor is gaming the system. As the saying goes: “You can have too much of a good thing.” 

This is a topic we’ve written about extensively. For general tips specific to negative review management, read our previous publication: How to Respond to Negative Patient Reviews…

If you really want to keep a bead on the online space, request a consultation and ask about our complimentary review monitoring. For a limited time, we will monitor your online reviews. Review content is memorialized in a dashboard you can access at your convenience. Schedule a consultation to learn more.

How has COVID-19 changed reputation management for doctors?

The COVID-19 pandemic has transformed all aspects of healthcare. Old rules have been modified. New rules were written. At the time this piece is being written, most states have re-opened their economies. Doctors are returning to practice. And patients are returning to their doctors. But the rate at which patients return varies. Some are returning in droves. Others are being cautious. But patients everywhere have the same appetite: They want to feel safe. 

Here’s what we know: Doctors who go the extra-mile to keep patients safe are being celebrated online. These positive processes and outcomes draw patients to their practices. There is a ripple effect. Conversely, when patients perceive, accurately or inaccurately, that their doctors have dropped the ball, they take that frustration to the internet. You do not want to be labeled unsafe. 

Medical Justice is equipped to provide member physicians with guidance specific to COVID-19 safety precautions. We’ve been working around the clock to dispense this counsel to our member physicians. And our survey tools make it safe and convenient for patients to share their experiences online. Our guidance will help you address two emergent priorities… 

Create a safe environment for your employees and patients…

Get the revenue flowing…

Closing Remarks: A Prescription for Success 

Great doctors will always be great doctors. Unfortunately, not all great doctors are represented accurately online. Still, remedies exist. Online patient reviews carry the most weight. Implement a tool that makes the publication of online patient reviews safe, compliant, and reliable. Be prepared for the occasional negative review. If you consistently survey patients, the positive reviews will likely drown out the rogue negatives. And if doctors supply Google with sufficient signals, their online reputations will likely reflect their quality of care. 

Medical Justice is equipped to partner with your practice to ensure you nail all these critical elements. The medico-legal and regulatory landmines cannot be overstated. Our expertise will protect your patients, market your practice, and keep you out of the medico-legal (and COVID-19) crosshairs. To get started, schedule a free consultation with our Founder and CEO, Jeff Segal, MD, JD. 

Learn how Medical Justice can protect you from medico-legal mayhem… 

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.