Patient Review Solicitation

[MrFlyGuy]

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Is it legal/ethical for my office staff to send out review requests?

I know in other similar professional such as psychologists they forbid the clinician from doing so but I'm not sure for us as psychiatrists this situation would be taboo?

 

[Merovinge]

The local hospital systems do this around me. I was amazed to see the reviews of their psychiatrists (>4.6) are better than some of our best local restaurants...

 

[comp1]

Why would this be considered unethical? I mean as a patient I would find it hugely annoying and it would turn me off to the practice intensely. As a provider, I would be very wary of referring to anyone with high scores as they are likely pill mills. However, requesting it isn't unethical. Hospitals do Press-Ganey all the time and they definitely advertise the results. This would be no different (ethically or in terms of annoyance for everyone).

 

[romanticscience]

APA (Psychiatry) Ethics
Avoiding exploitation (Section 2, Annotation 8): Psychiatrists should not use the doctor–patient relationship for personal gain, which would include pressuring or soliciting patients for reviews.

APA (Psychology) Ethics
Under the APA Ethics Code (2017, Standard 5.05: Testimonials and Endorsements), psychologists are prohibited from soliciting testimonials (reviews) from current therapy clients/patients or from others who may be vulnerable to undue influence.

 

[MrFlyGuy]

APA (Psychiatry) Ethics
Avoiding exploitation (Section 2, Annotation 8): Psychiatrists should not use the doctor–patient relationship for personal gain, which would include pressuring or soliciting patients for reviews.

APA (Psychology) Ethics
Under the APA Ethics Code (2017, Standard 5.05: Testimonials and Endorsements), psychologists are prohibited from soliciting testimonials (reviews) from current therapy clients/patients or from others who may be vulnerable to undue influence.

This is what I was looking for/referring to. To be fair I'm not sure what type of power the American Psychiatric Association has anyway but I do want to make sure I'm not making unethical decisions.

Do you think it would make a difference that is my front desk staff asking for reviews instead of me directly asking for reviews?

 

[FlowRate]

I'm not a fan of the reviews thing in the first place. That said, our system is going to start sending automated requests for reviews to patients, with a goal that all psychiatrists have at least 20 reviews on Google. The vast majority of both satisfied and dissatisfied patients (and customers of things outside of medicine, as well) do not spontaneously leave reviews. If <1% of your patients are dissatisfied enough to leave a negative review (unsolicited) and those negative reviews are the only thing on your google page, it looks like you only have negative reviews. When you start asking patients to leave reviews, maybe 2-5% will leave one, but many more of those 2-5% will be positive rather than negative. The goal is to capture an accurate sample rather than just the most motivated negative experiences. In doing so, usually star ratings will dramatically improve.

What's the rationale for focusing on Google star reviews? It's the rating system seen by the most people and people make decisions/judgements about whether it's worth engaging with our system based off of those reviews. Same way people decide on which restaurants to try.

I think it helps when the request feels very impersonal/divorced from the psychiatrist themselves. A system outreach, like a press ganey survey, rather than a personal request for a positive review.

 

[MrFlyGuy]

I'm not a fan of the reviews thing in the first place. That said, our system is going to start sending automated requests for reviews to patients, with a goal that all psychiatrists have at least 20 reviews on Google. The vast majority of both satisfied and dissatisfied patients (and customers of things outside of medicine, as well) do not spontaneously leave reviews. If <1% of your patients are dissatisfied enough to leave a negative review (unsolicited) and those negative reviews are the only thing on your google page, it looks like you only have negative reviews. When you start asking patients to leave reviews, maybe 2-5% will leave one, but many more of those 2-5% will be positive rather than negative. The goal is to capture an accurate sample rather than just the most motivated negative experiences. In doing so, usually star ratings will dramatically improve.

What's the rationale for focusing on Google star reviews? It's the rating system seen by the most people and people make decisions/judgements about whether it's worth engaging with our system based off of those reviews. Same way people decide on which restaurants to try.

I think it helps when the request feels very impersonal/divorced from the psychiatrist themselves. A system outreach, like a press ganey survey, rather than a personal request for a positive review.

I HATE the whole review game/process but it effects the entire practice in multiple ways so you are forced to play the game.

It's just annoying because the other professionals in the practice such as LPCs and psychologists state that it is against the guidelines of their professional boards (which is BS it's more their professional societies) state that soliciting patient reviews is against their ethical guidelines. So basically they're saying that if the patient has had one psychological assessment one time but they've been seen for 2 years by a psychiatrist they don't want a review solicitated for the entire practice.

 

[randomdoc1]

There are software services you can use for this. Because it is very awkward to directly ask the patient. Whereas something that is asking for feedback and encouraging public feedback on behalf of the clinic feels a bit...less awkward? Some of these softwares are designed specifically for medical practices. I hate the idea of talking about money (e.g. collection at time of service) and reviews. But it's the only way to survive the competition or you die in the stampede. My office asks for patient feedback on the software, which is not so bad. Because it opens a discussion for us to better our delivery. And in that same platform, it encourages patients to share their experience publicly to better inform others in the community.

I talk a lot here about how I'm a huge fan of tech. It's been a massive game changer for me in many ways. Another thing that is good about having reviews is it helps dilute out the bad ones that are just so embellished. It's unfair, but when you don't encourage reviews, practices are more likely to look worse than they are. Angry patients are more likely to leave reviews than satisfied ones. My phone system also has AI, VOIP, recording, and note taking. We had an incident lately where someone was trying to get established to get SSDI approved. They clearly stated they do not want care but must speak with someone with very specific credentials. The intent was very clear and we very professionally said 1)we don't have what they are looking for and 2)stop contacting. But the practice has a big name and lots of glowing feedback on the internet, so they got a little enamored with the place. They would not take no for an answer. They started calling from different numbers, blocked numbers, etc etc. I got a threat saying they would report us to one of our major insurance payers and that they'd tell them this story to get us unpaneled (an entirely made up story). The tech is a saving force, because the incriminating communication is all saved. Plus we have written threads. If we get more contact, it's helpful for legal purposes too. Once in a blue moon, any one of us can get a very deranged demand from someone established or not established and the tech tracks the evidence very well. It's privacy compliant and theres various platforms that have the warning saying if the patient does not consent, they can decide to not opt to continue the communication.

 

[Sushirolls]

I have a bunch of negative google reviews. Routinely I mull over the pros/cons of responding to them, but continue to not, as arguing on the internet yields no results. I have solicited from ~5 patients to drop a review. But also point out the reality of my understanding if they don't, as now your name is linked to a psychiatrist forever in internet repository. Only I've had several say they would, but only one follow through. I might ask a few more. Not looking to get 4+ rating. Just looking for a counter balance to the rage fits of people people told cannabis isn't good, or no you don't get/need a stimulant, or yeah, getting an HST/Sleep consult is good.

 

[randomdoc1]

I have a bunch of negative google reviews. Routinely I mull over the pros/cons of responding to them, but continue to not, as arguing on the internet yields no results. I have solicited from ~5 patients to drop a review. But also point out the reality of my understanding if they don't, as now your name is linked to a psychiatrist forever in internet repository. Only I've had several say they would, but only one follow through. I might ask a few more. Not looking to get 4+ rating. Just looking for a counter balance to the rage fits of people people told cannabis isn't good, or no you don't get/need a stimulant, or yeah, getting an HST/Sleep consult is good.

good news, there is an official report form.

Report inappropriate reviews on your Business Profile - Google Business Profile Help

If you find a review on your Business Profile that violates Google policies, you can report it for removal. This helps keep Maps and Search safe and reliable for everyone. Report inappropriate reviews

support.google.com

Google has a very specific terms of service and if you can prove somewhere in the review a term was violated, I've had success with getting them removed. Some of them are pretty straightforward and not hard to point out
-spam content
-personal contact information
-URLs and phone numbers
-rambling that seems to have nothing to do with the service

I've found the above four, easiest to prove and get a review wiped off. Another tip, I usually wait a couple months to do this. Some of the severely personality disordered individuals will stalk your profile and if they see it got removed, they make another account and try something else.

My VOIP also has a call blocking system. It does not allow calls from people who *67 and I can enter individual numbers to block. It's also great for blocking spam callers. And what they hear when they call, sounds very convincing. It's 5 fake ring tones and a "sorry, this voicemail box is full, thank you for calling."

 

[Merovinge]

I'm not a fan of the reviews thing in the first place. That said, our system is going to start sending automated requests for reviews to patients, with a goal that all psychiatrists have at least 20 reviews on Google. The vast majority of both satisfied and dissatisfied patients (and customers of things outside of medicine, as well) do not spontaneously leave reviews. If <1% of your patients are dissatisfied enough to leave a negative review (unsolicited) and those negative reviews are the only thing on your google page, it looks like you only have negative reviews. When you start asking patients to leave reviews, maybe 2-5% will leave one, but many more of those 2-5% will be positive rather than negative. The goal is to capture an accurate sample rather than just the most motivated negative experiences. In doing so, usually star ratings will dramatically improve.

What's the rationale for focusing on Google star reviews? It's the rating system seen by the most people and people make decisions/judgements about whether it's worth engaging with our system based off of those reviews. Same way people decide on which restaurants to try.

I think it helps when the request feels very impersonal/divorced from the psychiatrist themselves. A system outreach, like a press ganey survey, rather than a personal request for a positive review.

My partner's practice just started doing this and her ratings shot up like crazy. It's exactly as you say, she's an excellent doctor who's rating really does reflect her work ethic and practice, but was dragged down by the <1% who are upset about a diagnosis or her not prescribing the exact thing they want that is medically inappropriate.

I both think it's absurd this is what medicine has come to but also understand that sometimes you just have to play the game. Le sigh...

 

[randomdoc1]

My partner's practice just started doing this and her ratings shot up like crazy. It's exactly as you say, she's an excellent doctor who's rating really does reflect her work ethic and practice, but was dragged down by the <1% who are upset about a diagnosis or her not prescribing the exact thing they want that is medically inappropriate.

I both think it's absurd this is what medicine has come to but also understand that sometimes you just have to play the game. Le sigh...

it's unfortunate this is what it's become to protect ourselves. Ideally, there'd be better processes to pursue legal action for these behaviors. It's slander really. But this is the best protection we have for now.

I always said, if it was such that a patient can just ask for the med, then it would be OTC. It's not OTC for a reason.... le sigh indeed

 

[Merovinge]

I always said, if it was such that a patient can just ask for the med, then it would be OTC. It's not OTC for a reason.... le sigh indeed

I thought it was bad for psychiatrists and PCPs with all the controlled substance demands, but she's a surgeon and still has to spend a significant amount of time telling people she isn't a Pez machine dispensing the meds they want/think they need. Apparently just an occupational hazard for all the patient facing doctors of the world.

 

[Sushirolls]

good news, there is an official report form.

Report inappropriate reviews on your Business Profile - Google Business Profile Help

If you find a review on your Business Profile that violates Google policies, you can report it for removal. This helps keep Maps and Search safe and reliable for everyone. Report inappropriate reviews

support.google.com

Google has a very specific terms of service and if you can prove somewhere in the review a term was violated, I've had success with getting them removed. Some of them are pretty straightforward and not hard to point out
-spam content
-personal contact information
-URLs and phone numbers
-rambling that seems to have nothing to do with the service

I've found the above four, easiest to prove and get a review wiped off. Another tip, I usually wait a couple months to do this. Some of the severely personality disordered individuals will stalk your profile and if they see it got removed, they make another account and try something else.

My VOIP also has a call blocking system. It does not allow calls from people who *67 and I can enter individual numbers to block. It's also great for blocking spam callers. And what they hear when they call, sounds very convincing. It's 5 fake ring tones and a "sorry, this voicemail box is full, thank you for calling."

I've tried before twice, but didn't meet the strict bulleted points and response was 'they didn't violate' therefore it stands.

And in recognition the high likelihood of personality fervor, I don't dare respond directly to them. I've seen on a non google site, a post replicated several times. Another delete their comment then re-post it every 1-2 years later to keep it fresh. The cult of cannabis is strong.

 

[randomdoc1]

I've tried before twice, but didn't meet the strict bulleted points and response was 'they didn't violate' therefore it stands.

And in recognition the high likelihood of personality fervor, I don't dare respond directly to them. I've seen on a non google site, a post replicated several times. Another delete their comment then re-post it every 1-2 years later to keep it fresh. The cult of cannabis is strong.

You gotta fight back bruh! You are right, I don't respond directly to the review itself. But there is something deliciously satisfying about
-having lots of good google reviews, it makes them stand out in a bad way
-having tech to protect you and block calls
-when patients know the documentation/tracking is good, they magically disappear and all of a sudden "there's no longer a problem"

Some of my favorite experiences are that as the practice continued to mature, some of the patients who really transformed here over the years left bordering on viral reviews of the place. And they called out the negative reviews basically saying
-you gotta be ready to take ownership
-sounds like some of you are a buncha sissies
-this practice has a no BS policy so if that's not for you, then stfu and go back to doing what was clearly not working

It's satisfying to see patients talk to each other on the Google My Business platform!

 

[Merovinge]

I also would argue that psychotic patients badmouthing you for not feeding their delusions review should be a badge of pride for all psychiatrists. As are any Dr. XYZ didn't listen to me and prescribe my AddyXanny/medical THC combination that has lead to amazing results!

 

[comp1]

Again, I don't think it's unethical in the least (and not sure the American Psychiatric Association clearly views it as such either), but I really would prefer our profession, medicine in general, stay away from either collecting or using patient reviews, online or otherwise. It degrades everything we do. There are much better sources of feedback out there.

 

[randomdoc1]

I also would argue that psychotic patients badmouthing you for not feeding their delusions review should be a badge of pride for all psychiatrists. As are any Dr. XYZ didn't listen to me and prescribe my AddyXanny/medical THC combination that has lead to amazing results!

There is definitely truth to this. There's a population that is able to read between the lines on our digital presence. If there are too many ultra high rankings, some patients will think it's a place that will "give me what I want". It makes me think of Burger King "have it your way." Sprinkle in some reviews that are upset -- but when you read it, it's clearly about professional boundaries being set, not being a pill mill, or having a no bs clinic policy --> actually creates an image of a place that can offer really great care and we're not afraid to put our foot down for the right principle. At least, that's the image I strive for. I do purposely want a minority of low reviews and with the right wording, it actually augments the reputation. There's one review that said I was "too honest" and other patients on the google listing commented on that particular review with saying:
-ownership is not a bad thing
-your ability to progress is a function of how much you can handle about yourself.
le sigh...tis a silly game

speaking of reviews...this would be epic on a psychiatrist listing. I think if anything, it would increase traffic. I'd love to meet a psychiatrist who can do this.

 

[PsyDr]

It's just annoying because the other professionals in the practice such as LPCs and psychologists state that it is against the guidelines of their professional boards (which is BS it's more their professional societies) state that soliciting patient reviews is against their ethical guidelines. ...

Yeah, it's a little annoying that states that codify professional societies' ethics into their practice laws (e.g. ALASKA Sec. 08.86.180).

One wonders how maybe psychiatrists there are in Alaska who think that the law is “BS”

 

[Stagg737]

This is what I was looking for/referring to. To be fair I'm not sure what type of power the American Psychiatric Association has anyway but I do want to make sure I'm not making unethical decisions.

They have the power to kick you out of the APA. If they do then boo boo, too bad you can’t get your rental car discount when you go to conferences I guess?

That all said, idk that either APA (or the AMA for that matter) are the best groups to strictly adhere to ethical guidelines. Even if they are, their codes are still guidelines and in general are not absolutes with a few exceptions (views on assistance in executions for example).

I hear the people saying reviews in general are gross, but this is the world we live in. It’s the same thing as small town gossip but on a larger, more easily accessible scale.

Yeah, it's a little annoying that states that codify professional societies' ethics into their practice laws (e.g. ALASKA Sec. 08.86.180).

One wonders how maybe psychiatrists there are in Alaska who think that the law is “BS”

Not sure why they would think it’s bs since there’s a specific carve out for certain professions including physicians and school counselors.

 

[FlowRate]

I was just perusing our department's Press Ganey survey results, as is part of my job. Here's a more detailed view of something I described either in this thread or another similar one recently:

The difference between 20th percentile and 99th percentile is an average PG score of 92 vs 98 (mean score method) or 83% vs 96% (% top box method). ~1st-3rd percentile is mean score of 90 or % top box of 70%. When you have someone with a mean score of 70 and a top box % of 50%, you know there's an actual problem. I think it speaks to the significant majority of docs doing a very good job most of the time (rated excellent/top marks 80ish+ percent of the time and average score of 90+.) I think these surveys are most useful to find significant deficiencies.

But it also speaks to the threshold effect of being more stingy than average with controlled substances. Averaging a couple 0/100 surveys into only 50 survey responses will tank your apparent percentile real quick.