Identity Crisis

Are you monitoring your online reputation?

idcrisis2

By the end of 2014, Internet users will total more than 3 billion worldwide.1 This digital revolution has affected health care — particularly radiology, a specialty relying on technology — in many ways.

It has revolutionized communication between physician colleagues and between physicians and their patients. It has made document and data management more accurate and seamless. And it has improved access to information at the point of care, resulting in enhanced diagnoses.

Yet the introduction of some websites, from social media to sites for reviews and ratings, also puts physician reputations at risk. For example, anyone from patients and referring clinicians to future employers routinely perform Google searches for their radiologists or interviewees. If they find an inappropriate personal post or negative review, it could sway their perception or increase their likelihood of changing physicians. Here are some tips for putting your best foot forward online.

Facebook Follies

William F. Shields, JD, LLM, CAE, ACR general counsel, says members should be aware that anything they say or do online can come back to haunt them. "I could search for you," Shields says, "and had you done something foolish on spring break ten years ago, it could still be online. There's no law that prohibits a future employer from looking for past indiscretions on the Internet. Anything you say or do could come up on a search engine."

David M. Naeger, MD, assistant professor of clinical radiology at the University of California, San Francisco, agrees, pointing out the challenging gray zone between personal and professional social media accounts (read his tweets @DavidNaegerMD). "Facebook is an example of a social media site on which  many physicians try to keep their accounts 100 percent personal — by not reaching out to colleagues or patients and not making any attempt to promote themselves or their practices. Even then, private information can sometimes be found by people who know you professionally," he says, also noting the importance of privacy in personal accounts. "That's why I'm an advocate of protecting personal information on these sites. You absolutely need to learn about the privacy settings available."

Naeger adds that even when content is made private, posts about you can still be made public without your knowing. As a rule of thumb, Naeger advises limiting any personal information you post, even on a private or non-professional account: "If you don't want something to be seen by colleagues and patients, you just shouldn't post it."

Tweet With Caution

When it comes to Twitter, Saurabh Jha, MBBS, assistant professor of radiology at the Hospital of the University of Pennsylvania in Philadelphia, believes the benefits outweigh the risks for most physicians. Joining Twitter in December 2013 after his colleagues advised him to try it, Jha was initially opposed to any form of social media (read his tweets @roguerad). Now Jha appreciates Twitter because it helps him disseminate articles he's written, gaining exposure and feedback, while also engaging other health care professionals. "I like when people challenge me and call me out," Jha explains, adding that he doesn't shy away from controversial issues.

According to Jha, the best approach to Twitter, which he utilizes for primarily professional reasons, is not tweeting anything you wouldn't feel comfortable saying in public. "You need to be able to stand up for every tweet," he says. "If you're not willing to do that, you shouldn't tweet something. There should be no difference between what you would say in real life, at a forum, or in a journal."

"There's no law that prohibits a future employer from looking for past indiscretions on the Internet. Anything you say or do could come up on a search engine."

-William F. Shields, JD, LLM, CAE

Still, radiologists need to be cautious about sharing clinical experiences. Jha says it may be okay to make general points about their work, but radiologists should avoid tweeting about their experiences with patients. Even venting online about one's day can create a problem, says Naeger. "If you're in a public forum, you may not be violating a law with the information you post, but you might be revealing patient details that seem personal," he says. "Someone might read your post and think 'I wonder if that's me' or 'I wonder if this doctor would post about my office visit.' A sense of privacy is violated."

Ultimately, Naeger believes, "The number one riskiest part of being online is violating patient privacy laws." Of course, you should never share patient information online due to HIPAA. But some physicians will ask for help in diagnosing or managing a challenging case online. "I have seen situations where people are trying to have an intellectual or professional discussion but accidentally include patient information in an uploaded image, thereby violating the law," says Naeger.

Making the Grade

Radiologists' online reputations aren't only made or broken on social media: they're also deeply affected by physician review websites like Health Grades, RateMDs, and even Yelp. Shields says it's common for dissatisfied patients to turn to these sites, and reviews could impact a referring physician's decision to employ a particular radiologist or radiology practice for image interpretation.

In fact, a federal law protects the website from being required to take negative reviews down. Plus, Shields adds, "Physicians aren't free to respond. If it has something to do with the patients' condition, HIPAA prevents you from discussing the case. You really can't respond without the patient's permission." On the bright side, many websites have policies against defamatory statements, so contacting the website directly could potentially compel the managers to take down an off-putting comment.

But should you take legal action upon finding a defamatory, or even false, comment about you? Shields notes that several physicians have tried to sue patients for posting negative reviews to no avail. One Minnesota doctor tried to sue an individual who posted negative reviews and wasn't even his direct patient. The doctor not only lost the case but was ordered to pay the attorneys' fee for the defendant. Shields emphasizes that there is relatively little upside to suing over online comments, but there is significant downside. "Just as doctors settle some malpractice claims even when they think they've done nothing wrong, these online scenarios require a cost-benefit analysis that seldom finds sufficient potential benefit," he concludes.

Solicit Positivity

Nonetheless, there are proactive actions you can take if your reputation is being defamed on a review site. Many of the search engine site algorithms allow positive reviews to push down the negative ones.2 Shields says radiologists can even hire a company to design an online reputation management strategy. "Often, if physicians are finding themselves on the receiving end of a multitude of negative reviews, it's an indication of a much larger systematic problem, which may be tied to other factors such as the office staff's behavior, administrative procedures, the patient's ease in setting up an appointment, and so on," explains Jeremy Nelson, CEO of Afia, Inc., a health IT consulting firm. "Any service that affects a patient directly and is related to the physician or the office could be the culprit — not necessarily the physician's bedside manner or quality of services."

Another suggestion given in the Physician Risk Management Newsletter is providing your patients the opportunity to voice opinions directly to you.3 That way, they'll be less likely to turn to websites when feeling frustrated. Try surveying patients via email or having an office manager contact dissatisfied patients directly because they may be too intimidated to speak up to doctors.

"You can solicit positive reviews by having a flyer or sign at the front desk when a patient checks in, saying, 'Go to www.healthgrades.com if you're happy with your treatment here,'" says Shields.

But the best way to keep your online reputation positive? Put your patients first by focusing on quality care and align your goals with the ACR's Imaging 3.0™ campaign. "If patients feel well taken care of and heard, you can spend more time worrying about their health than their negative online reviews," says Naeger.


By Alyssa Martino, freelance writer for the ACR Bulletin

ENDNOTES
1. "Internet well on its way to 3 billion users, UN telecom agency reports." UN News Centre. Published May 5, 2014. Accessed July 25, 2014. Available at http://bit.ly/WktV8M.
2. Schepke K. "Ratings and reviews: 5 strategies for local businesses." Search Engine Watch. Published Feb 25, 2011. Accessed July 25, 2014. Available at http://bit.ly/1uhngYQ.
3. AHC Media."You can prevent negative reviews." Physician Risk Management. May 2013:121–32.

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