Hernias and Candles

The world can be unkind.

Get used to it.

In the not so distant past, an article came up on my screen detailing the inequities of online reviews with respect to the medical profession. The idea was, and surely still is, practitioners, be they involved directly or indirectly with a patient, should be immune to such reviews for a variety of reasons.  People get to write whatever they want, and medical professionals just have to take it.

“The doctor smelled liked tuna…and he saved my mother’s life. Gross!”

The main argument for this degree of unfairness was rooted in an inability to defend oneself or one’s practice due to mandated medical standards and patient privacy limitations.

Because, you know, ethics.

In most circumstances, even an innocuous response risks identifying an individual as a patient in a given office, the service they were offered, or the condition for which they were treated, which is a big no-no, and from a legal perspective considered only slightly less dangerous than performing a hernia examination on an unwilling gorilla.  Or so I’ve been told.

The second half of the argument detailed how many of the complaints were misdirected towards a practice, when in reality, the complaint was with the terms of reimbursement laid out by a third party payer. Namely, a major insurance company. 

Get that? People are unhappy with their insurance coverage – who’da thunk?

In the past, we have discussed the game insurance companies play (Spoiler Alert – the table is tilted in their direction) so this one doesn’t surprise me as much, but still deserved inclusion here. As someone who has been on the wrong end of a few online reviews (my office – not personally), the trend seems to be accurate. Estimates of a few friends around Developmental Optometry, Physical Therapy and Chiropractic equate to around 1 in 10 “online complaints” are related to patient care, with the balance relating to co-pays, deductibles, billable versus not, and my personal favorite, the “incompetent billing staff who did not know how to cheat the system to get my kid’s services covered”.

Stop laughing.

Someone actually wrote it.

So assuming the internet is here to stay and people continue to write whatever they want under a cloak of anonymity, online reviews are something to be dealt with. Our friends who manage these reviews on Yelp, Google, and even Facebook who themselves are looking to capitalize, see to it most of the negative reviews hit the top of the list and are served up to any interested individual.  The bulk of positive reviews, which might help balance the scales of public perception tend to be held hostage in some online prison facility which almost certainly looks and smells like my uncle Guido’s laundry basket. (Guido was his name when he was involved in “Waste Management”, now he just goes by Steve). Anyway, the metrics used by these online review companies seems to be greatly influenced by our wallets – a process they politely refer to as an “algorithm”. If we’re interested in having those positive reviews released and placed near the top, membership and payment are required. Those who choose to not open their wallets, well, feel free to roll the dice. Sounds more like an “algo-ripoff” to me, but that’s their game. 

In all seriousness, though, these online ideas shared by patients and parents are something to be watched and managed since it’s the information used by some potential clients when forming a perception of an office. Responses written in general terms explaining financial policies and quests for quality patient care seem fine, although surely not as satisfying as a well-written cynical one. Going into negative detail about conversations and unreasonable expectations of a patient seem to only invite the gorilla and his hernia to the office. Plus, such responses seem fruitless since it’s always better to light a candle than to curse the darkness.

A practice we’ve adopted lately as part of our graduation ceremony is requesting (along with a written success story) our patients and their families write an online review of our office, our staff, the care they received, the changes made, and the overall experience. Most have been willing and many have followed through, although it continues to be a work in progress, thanks to those “algorithms”. My rudimentary math skills figure if we flood the system with positive, the negative will eventually be drowned out. Remember, it’s always better to light a candle than to curse the darkness.

Here’s to lighting a candle!

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