“Wow, that is a really bad picture of you. Can you get a new one?”
That's how one of my favorite patients responded when I asked him if he had any additional questions or concerns at the end of his first visit. His partner comedically slapped his own forehead and apologized for the comment, but it was too late — I was already laughing. The patient went on to explain that he saw my photo outside of the office and he thought he was going to see someone else. I had no idea the photo was in front of the office but I was sure that it was not a complimentary picture because he continued.
“No, I am serious, you need to have them take it down.”
I explained that the picture was taken by a professional and I did not have any control over it and if I had my way, I would not post my picture in my place of work. I just showed up one day and my face was on a small poster. His partner felt it necessary to remind me of his mental health issues — which included a complete lack of inhibition — but he wasn’t wrong. The truth was, it was a horrible picture that I vehemently disliked, and it was now my professional image. The obvious next step was to schedule a new photo and request that it be removed, but the photo was also online.
I am sure I am not alone in this, as I have had this conversation again and again with physicians that are unhappy about the management of their physician profile, including any images or information about us: positive, negative, or neutral. How long should a photo follow you? What happens when your profile is online and you have no control over its distribution and content?
But beyond an unflattering photo, what control do we have over unflattering reviews? I never paid much attention to online evaluations until a few years ago when I had a patient submit an unfavorable review after a minor surgery. His complaint was that he experienced discomfort and urinary frequency after his surgery. These were symptoms that we discussed as an expected outcome and yet he was surprised that he was experiencing it. He was angry and he posted a negative review. I had two options: I could gripe online that the patient was not presenting an accurate representation of his care or I could accept that this was the system now and my livelihood could be negatively affected by one patient’s bad day. He continued seeing me despite having the option to transfer to another physician and just as I predicted, his symptoms improved and he reported that he was happy. Is it my responsibility to ask him to take down the review? If there is a sounding board that is available to publicly chastise a physician, shouldn’t there be some follow up from the ranking site to see how things worked out?
A month ago, a different patient returned to review his decision to move forward with surgery. At the end of his visit, he mentioned that reading my reviews was part of his decision-making process and they made him comfortable with moving forward with his surgery. There are so many online ranking sites for physicians that he either didn't see or wasn’t bothered by the negative review.
It is becoming extremely common for patients to read reviews and use them to evaluate physicians. There are so many reasons to submit a review, but one can argue that for many, the most compelling is a bad experience. What happens if as a physician, you have no control over a long wait time or a poor experience on the phone? Should this review be attached to an individual physician profile? I wonder why I and many of my colleagues are required to participate in this ratings system. Who owns the physician profile and what, if any, options do physicians have to manage it?
The management of data on the internet has become a scorching topic lately. At some point we all saw Mark Zuckerberg testify before Congress. When asked who owns someone’s online presence, Zuckerberg responded, “I believe that everyone owns their own content online…”
This is definitely untrue for physicians. If you are an employed physician, use of your name and image is an expectation, and is it used and disseminated without your approval. However, by signing up for social media accounts, users consent to the use of their name, likeness, and content to be posted on that website. Businesses and professionals are usually able to participate on social media accounts. Setting up a Facebook page for your business is a popular form of low-cost advertising. But I have never opted in to having my name listed on rating websites. Many of the websites I’ve found myself on do respect the physician’s request to have their profile removed, but some refuse to remove physician profiles even after a formal request. I received one denial of removal that stated because I was practicing, their policy prohibited the takedown of information.
Why do these sites hold my information so tightly? Perhaps because while patients are searching for a doctor, the rating website is advertising to them. The right of free speech protects ranking websites, and most will post a disclaimer stating this is not medical advice, and they, the company, do not rank physicians. If a patient publishes a poor review, most companies will not remove the review unless the patient requests that it be removed. It is clear that a ranking website is not incentivized to protect physicians from erroneous negative reviews — and one bad review could be a blow to physician’s reputation — so why are we forced to be posted on their page? A few physicians have been successful at navigating this system by encouraging patients with good experiences to leave reviews. The question I have is bigger: What if you do not wish to participate? Do physicians have that right? In this case, you are not asking for a review to be taken down but for your profile to be completely removed. From my research in trying to scrub myself from these sites, I think the answer is no — participation is mandatory.
Many physicians are now mandated to participate in physician rating profiles by an employer, and for many, employers support and encourage patients to submit reviews. Conveniently for employers, if a doctor has a negative review, it follows the individual health care worker, not the institution. Today one might argue that your internet presence comes not only with this job but with being born. After looking at this rating system, I realized that physicians have only one way to take back control in this system: take the time to educate your patients. For this reason, when a patient tells me that they have looked at my reviews and are impressed, I say thank you, but I share with them that these posts are unregulated and should not be why they choose me — or any physician.
What has your experience been with ranking sites? Share how you navigate them in the comments.
Alexandria Lynch is a general urologist with a focus on robotic surgery practicing in New York. She believes that practicing medicine is a privilege that can build a well-educated, healthier society, and encourage a just culture. As a native New Yorker, she enjoys long walks along the Westside highway admiring the Manhattan waterfront, thin-crust pizza, writing, flying, and endless afternoons at the Strand. Dr. Lynch is a 2021–2022 Doximity Op-Med Fellow.
Image by luckyvector / GettyImages