Today’s psychology practitioners are well aware of patients’ use of online consumer reviews on commercial sites such as Healthgrades.comopens in new window, Yelp.comopens in new window, Vitals.comopens in new window, and Wellness.comopens in new window.
While data on how patients use such sites are still somewhat limited, findings show that more and more people are using these sites—and that their searches are informing their decisions. Healthgrades, the largest private-sector provider-review website, saw a jump from about 4 million to about 6 million consumer reviews of physicians between 2011 and 2015 (Findlay, S. D., Health Affairs, Vol. 35, No. 4, 2016). Meanwhile, a third of 854 preoperative patients surveyed in a study said that a positive review of a physician would prompt them to seek care from that provider, while a third said a negative review would prevent them from seeking care from that provider (Burkle, C. M., & Keegan, M. T., BMC Health Services Researchopens in new window, 2015).
While you can’t control what’s written about your practice on these sites, there are ways to lessen the impact of negative comments and improve your online presence, according to psychologists who study and write about these reviews. They offer the following recommendations for practicing psychologists.
Know what’s verboten It might be tempting to respond to a negative review, but the Health Insurance Portability and Accountability Act (HIPAA) and state patient privacy laws say that you can’t. Just because a patient has publicly divulged that they have seen you doesn’t give you permission to acknowledge that association, says Connie Galietti, JD, APA’s director of legal and professional affairs.
The APA Ethics Code standards on confidentiality, testimonials, and avoidance of patient harm also offer guidance on how to respond to these reviews, adds Lindsay Childress-Beatty, JD, PhD, interim director of APA’s Ethics Office. Standard 4.07 says psychologists can’t disclose information in public media in ways that could identify the client to others without permission from the client. Along those same lines, Standard 5.05 says psychologists can’t solicit testimonials from current clients or from past clients who are vulnerable to their influence.
Command your profile Start by filling in your Yelp, Healthgrades, and other profiles to give potential clients a better sense of your skills and practice philosophy, advises Pauline Wallin, PhD, a clinical psychologist in Camp Hill, Pennsylvania, and cofounder of the Practice Institute, a behavioral health consulting organization. While you’re at it, include a welcoming picture of yourself, she suggests.
Wallin also recommends reading each site’s terms of service. These organizations generally don’t let you remove a review, but it’s smart to learn the exceptions, which include the use of hate language or glaring inaccuracies, as well as the steps you would follow to remove such a review (see sidebar).
If a site allows it, consider adding a description of your position regarding online reviews, adds Keely Kolmes, PsyD, a California Bay Area practitioner who studies these reviews. (Kolmes uses the pronouns “they” and “theirs.”) On Yelp, for example, you can share your stance in its “About the Business” section. In theirsopens in new window, Kolmes provides a detailed explanation of APA ethical principles that apply to online reviews, gently discourages patients from posting practice reviews, and encourages patients to bring up their concerns in therapy instead.
Monitor your reviews
Familiarize yourself with how patients review you and look for common themes in their praise or criticism. Keeping track of these themes can help you assess your practice and potentially determine what you might need to change, says Wallin.
To stay up to date, Wallin also advises using notification services such as Google Alertsopens in new window, Talkwalker.comopens in new window, and Mention.comopens in new window that will alert you when new reviews appear.
Sharpen your online presence
Creating a strong web presence can help offset negative reviews, says Lesly Krome, PhD, a researcher and assistant professor of psychology at Southeast Missouri State University (SEMO), who studies online reviews with colleagues Stephen C. Nettelhorst, PhD, Eu Gene Chin, PhD, and D’Arcy J. Reynolds, PhD. They have found that people pay more attention to strongly worded commentary associated with reviews than to the number or quality of those ratings (Journal of Consumer Health on the Internetopens in new window, Vol. 23, No. 3, 2019).
“Work on your publications so that the first thing that pops up when someone Googles you is not a bad review but a sample of your work and value,” Krome advises. Besides academic articles, op-eds, and magazine articles, consider writing blog posts and tweets that point to helpful new research or news articles in your areas of expertise. All of these can help build your online stature and reputation, she says.
Regularly updating your online presence will also help your “search engine optimization,” or SEO—that magic set of ingredients that elevates your position in people’s online searches, Wallin adds. While Google’s SEO algorithms are proprietary and continually changing, the search engine tends to favor new content with keywords that match what prospective clients search for, she says. Because SEO is a complex skill to master, Wallin advises either reading more about it or hiring a consultant to help.
Collect and post your own data
While it’s unethical to solicit or comment on reviews in ways that breach confidentiality, it’s good practice—and a good counterpoint to commercial reviews—to collect your own aggregate treatment satisfaction or outcome data that you can share with clients or with potential clients perusing your professional website, says Reynolds, an associate professor at SEMO.
“At the same time commercial sites are collecting data on you,” he says, “you can collect scientifically valid data based on actual patient experience specific to your practice.” Linking to your business website from the review site can make it easier for people to access the findings and demonstrate that you’re a practitioner who values scientific accuracy and integrity, he says.
Provide great customer service
Many negative online reviews are not about treatment quality, per se, but about poor interpersonal behavior, including by office staff. A 2015 ProPublica surveyopens in new window analyzing 1.7 million Yelp reviews of medical and other health professionals, for example, found that while online reviews were generally more positive than negative, negative reviews tended to focus on rudeness, indifference, and other poor interpersonal behavior.
To avoid that negative feedback, return phone calls and emails promptly and professionally. If a potential client isn’t a good fit for your clinical skills, “help them find somebody who is—it will help your reputation,” says Wallin. Similarly, train staff to answer the phone courteously and professionally—they set the tone for your practice.
Get out there
People still rely heavily on old-fashioned word of mouth and meeting people in person when making decisions about providers, so consider giving free presentations on sought-after topics such as stress and anxiety or volunteering for good causes in your community, Wallin advises.
Part of that means making yourself available to the media in your areas of expertise, she adds. While people may not remember what you said, “they’ll remember that you were on TV or were quoted in a particular article,” and you can promote the piece on your website.
Prepare for patients to mention reviews
Because online reviews are an increasingly common way to choose providers, it’s wise practice to invite patients to share concerns about anything they find about you online that could affect or derail the clinical relationship, including online reviews, news articles, or information on your social media profiles. Make your thoughts about that clear anywhere that people first learn about your practice, including during the informed consent process, in your social media policies, or during therapy itself, Kolmes advises.
Contribute to a better approach
Last but not least, think about how you can contribute to a better review process overall, suggests Nettelhorst, an associate professor at SEMO. Review organizations don’t always use the best assessment science to design their sites, he says, and psychologists have a lot to offer toward improving their reliability and validity.
One valuable potential tweak would be designing sites in ways that optimize people’s ability to find practitioners who are a good fit, adds Chin, also an assistant professor at SEMO.
“As psychologists,” he says, “ultimately we’d like to see this information presented in ways that allow people to find practitioners who provide the services they need and fit with the ways they want to engage with therapy.”
