Whether a patient or their relative is registering with a new doctor, being referred for secondary care, or seeing who will be caring for their relatives, many patients are using the internet as a tool to obtain further information about their doctor with some writing online reviews sharing their own personal experiences of their care from their doctor, says Dr Graham Howarth, head of Medical Services, Africa at Medical Protection.

Critical comments patients make about the care you provided online may be upsetting, potentially damaging to your reputation, or even defamatory, avoid giving a knee-jerk reaction when responding.

ENSURE YOU KNOW WHAT IS BEING SAID ABOUT YOU

Many doctors have already realised that online reviews of their care provide a range of powerful benefits for both their patients and themselves. Once you have asked your patients to provide feedback, it is important that you know what is being said. Again this is not complicated – and doesn’t require you to monitor numerous websites every week.

RESPONDING TO COMMENTS BY PATIENTS

You’ll find that your patients will often leave detailed comments with a number of points in a few paragraphs. In the same way that you wouldn’t ignore a letter from a patient, it is important that you can easily respond when you want or need to.

THINK BEFORE YOU TYPE

Critical comments patients make about the care you provided online may be upsetting, potentially damaging to your reputation, or even defamatory, but avoid giving a knee-jerk reaction when responding. It is important to keep a cool head and look at the issues objectively. Consider treating the comment as a formal complaint. Using the appropriate formal complaint channels will allow you to explore and investigate patients’ concerns and provide an explanation and apology where appropriate.

Doctor-patient confidentiality can prevent you from directly challenging negative feedback. The National Health Act 2003 makes it an offence to disclose patients’ information without their consent and the HPCSA’s official guidance, Confidentiality: Protecting and Providing Information (2008) views confidentiality as central to the doctor–patient relationship. However, negative comments can be defused creatively with a positive response. For instance, if a patient comments ‘my appointment was late and my doctor seemed in a hurry to get me out the door’, you could reply by stating: “We are sorry that you are unhappy with the service on this occasion.

As the only practice offering this service in the area, we pride ourselves on serving as many patients as possible.” Should a user’s feedback reveal a genuine deficiency, use it as an opportunity to improve your practice. Invite the patient to discuss their concerns and provide a point of contact, demonstrate that you have listened to their concerns and are addressing them – the patient may even reply with a positive comment online.

BE PROFESSIONAL AT ALL TIMES

As doctors, you are not only representing yourself and your practice but also the profession. You have a responsibility to act professionally at all times and not bring the profession into disrepute. Derogatory or flippant comments about patients can be damaging to the public perception of doctors and their trust in the profession.

MAKE ONLINE PATIENT REVIEWS WORK FOR YOU

One of the most useful things about real-time, online patient feedback is that it helps you meet a whole range of professional needs. There is only one person who can tell you the experience you give to your patients and help you ensure it is as good as it can possibly be – and that is the patient.

BE SECURE

Maintain strict security settings and be vigilant with your standards. Use the most secure privacy settings on social networking sites, but remember this is not failsafe and not all information can be protected on the web. Identities can be traced so be careful you don’t inadvertently post comments about your work, patients or your hospital. Declaring that you are a doctor adds weight and credibility to your views; however with that privilege comes a responsibility not to undermine public confidence in the profession.

If you are providing medical opinion and are happy for it to be professionally held to account then you must identify yourself as a doctor. A social network is not an appropriate place to raise a concern. Even ‘doctors only’ forums have risks as they may be accessed by members of the public, employers, or friends of friends may pass on information attributable to you.

RESPECT CONFIDENTIALITY

Your duty of confidentiality applies online as well as offline. Doctors are afforded a privileged position by their access to patients and information divulged in communication with them. To abuse this is to erode trust and confidence in the doctor-patient relationship.

The National Health Act 2003 makes it an offence to disclose patients’ information without their consent and the HPCSA’s official guidance, Confidentiality: Protecting and Providing Information (2008) views confidentiality as central to the doctor– patient relationship. It states that:

“Patients have a right to expect that information about them will be held in confidence by health care practitioners. Confidentiality is central to trust between practitioners and patients. Without assurances about confidentiality, patients may be reluctant to give practitioners the information they need in order to provide good care.”

Posting inappropriate comments/photographs or describing a patient’s care on a social media website could damage your reputation, lead to disciplinary action and attract unwanted media attention. Even if you do not mention a patient’s name they may be identifiable from information written about them, especially if the case is reported in the local press.

ACT PROFESSIONALLY

As doctors, you are not only representing yourself but the hospital or practice you work in. You have a responsibility to act professionally at all times and not bring the profession into disrepute. Consider who may be able to access photographs of you on your personal accounts and whether there is information you would not want your employer to see. Derogatory or flippant comments about patients can be damaging to the public perception of doctors and their trust in the profession.

MAINTAIN BOUNDARIES

It may be flattering to receive online contact or a ‘friend’ request from a patient with whom you have a good rapport, but conversing with patients online is inadvisable. Relationships should be kept strictly professional and the doctor-patient boundary should not be blurred. Be cautious about online contact with colleagues too so as to maintain the distinction between your personal and professional lives.

IF YOU ARE STILL UNSURE

If you are still unsure about how to tackle a tricky situation online, talk to your employer, supervisor, medical school or contact your medical defence organisation to discuss the best way forward. Taking care to avoid these potential pitfalls will help you make the most of social media, which offers exciting new ways to communicate in the ever-changing world of medicine, and has become an integral part of our lives.

AUTHOR/BYLINE: Dr Graham Howarth Head of Medical Services, Africa at Medical Protection