An Ethical Response to Physician-Rating Websites

Modern life affords so many choices and so much complexity that it helps to turn to reviews to help us make decisions. Which blender is best? Which new restaurant merits a reservation? Which plumber is most reliable? It’s understandable that prospective patients search for a psychiatrist by reading online reviews about us, too, except that online reviews don’t provide the kind of meaningful information people need to make a decision about seeking treatment.

While an online restaurant reservation or product purchase often results in an invitation to write a review, generating a volume of comments that gives readers a good sense of the spectrum of experience with the object or service being reviewed, reviews of psychiatrists are generally more sparse and less informative. First of all, most psychiatrists don’t invite their patients to submit an online review—nor should they, as solicitation of a review would place the psychiatrist’s interest above the patient’s. As a result, the few reviews a psychiatrist has online generally fall into two distinct categories: very positive and overtly negative. There may be comments left with either type of review or there may be mute stars with no explanation.

What do patient reviews tell the reader about the psychiatrist? A patient can reasonably evaluate politeness, punctuality, cleanliness of the office, and other details of how your practice or clinic runs. A patient isn’t in a good position to evaluate a psychiatrist’s training and expertise, to what extent the psychiatrist follows evidence-based treatment guidelines, or whether the psychotherapeutic technique used was skillful. Thus, the information in an online review offers only a sliver of what psychiatrists might deem important to communicate to prospective patients.

A negative review is often the result of an interaction that is as much about the patient as about the psychiatrist. If a psychiatrist refused to write a prescription for a controlled substance for a patient with a substance use disorder, the patient may be angry, but that doesn’t mean the doctor was wrong. If a patient with a personality disorder leaves a psychiatrist’s practice in the midst of a negative transference, his or her online review may reflect significant distortions. Devoid of context, these reviews may be confusing or misleading to the public.

What is a psychiatrist to do? It is not advisable to respond to online reviews. Responding to a negative review by providing explanatory context would be a breach of confidentiality, both illegal and unethical. Some online review companies may be willing to take down an inflammatory review, but others may not. Psychiatrists may be stuck with bad reviews, unable to publicly respond.

If a patient asks a psychiatrist about a negative review they read online, the psychiatrist can provide a brief statement that it is difficult to respond to the question without revealing information about another patient, which is unethical. The restraint in the psychiatrist’s response demonstrates professionalism and an underlying respect for patients, which may be what the inquiring patient is really asking about.

Inability to respond to a bad review doesn’t mean psychiatrists are powerless to influence their online persona. When patients search a psychiatrist’s name, they may appreciate finding more toothsome information than the simple demographic details available on the rating sites. Psychiatrists can proactively create a web presence that reflects their clinical training and skills. It is relatively easy to build a simple website for a practice; this might include an abbreviated curriculum vitae or a biosketch, information about areas of expertise, a statement about practice style, and contact information. Some physicians create a Facebook page for their practice; just be sure all the content is professional. Psychiatrists could write a blog about psychiatric diagnosis and treatment; this gives prospective patients a sense of their voice and approach to treatment.

There may be ways we can influence our profiles on physician-rating websites. In response to a marketing email from an online review company inviting doctors to solicit reviews to their website from patients, I explained why solicitation of reviews by a psychiatrist violates our ethical principles. The company offered to remove all reviews from my profile. That was unexpected, but welcome.

Psychiatrists can choose to exercise some control over their online presence. Bad online reviews may be something to tolerate silently, but they do not have to be the totality of web content about a doctor. Creating a website, a blog, or a professional Facebook page are current options. As we adapt to the ever-evolving influence of technology on our practices, psychiatrists may find new ways to buffer the effect of physician review websites. ■