Patient reviews should be banned in psychiatry.

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Sorry im just ranting but lately we have implemented a system where patients leave ratings for each category based upon their experience. So of course the people who leave reviews are the drug seekers/severe personality disorder people who didnt get what they want. I feel like we have plunged into the era of "the patient is always right!", so its like Fk knowledge, actual facts, or data because 70 year old woman has new onset ADHD and needs her adderall. Last 5 intakes were PCP referring because they didnt want to keep doing long term benzos, or cause patient wanted adderall so of course they're going to probably leave unhappy.

I like my job but the number of people wanting controlled substances appears to only get worse, and they're given a louder voice by our society that enables them and encourages them to complain if they dont get their drugs.

also our reviews are scored against all other medical clinics, which I would say its about 30x harder getting reviews in psychiatry than other fields lol

/endrant

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I mean, I get what you’re saying, but people with mental illnesses can still receive legitimately bad, dangerous, or even abusive care, and often times, it’s blown off because “they’re crazy anyway.” And other specialities have plenty of drug-seeking patients, too, so it’s not just a psych thing.
 
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I mean, I get what you’re saying, but people with mental illnesses can still receive legitimately bad, dangerous, or even abusive care, and often times, it’s blown off because “they’re crazy anyway.” And other specialities have plenty of drug-seeking patients, too, so it’s not just a psych thing.

I get that there should be some way to capture the bad service, but patient advocate may be the better place there. In adding to the OP there, in my spouse's system, patient reviews count towards bonuses. Last bonus period she had a review from a patient that bottomed out all of the ratings, in the comment section, the patient stated that it was because they were on hold too long when scheduling. Nothing about the appointment. She has also had the bad reviews because she would not prescribe maintenance benzos, or stimulants in people with no documented history of ADHD. In general, I agree with the OP that reviews in healthcare are by and large, useless. They do not serve any sort of intended purpose in general website reviews given the nature of who actually leaves reviews there, and in practice within systems themselves, they punish providers for things outside of their control, or for practicing good healthcare.
 
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I get that there should be some way to capture the bad service, but patient advocate may be the better place there. In adding to the OP there, in my spouse's system, patient reviews count towards bonuses. Last bonus period she had a review from a patient that bottomed out all of the ratings, in the comment section, the patient stated that it was because they were on hold too long when scheduling. Nothing about the appointment. She has also had the bad reviews because she would not prescribe maintenance benzos, or stimulants in people with no documented history of ADHD. In general, I agree with the OP that reviews in healthcare are by and large, useless. They do not serve any sort of intended purpose in general website reviews given the nature of who actually leaves reviews there, and in practice within systems themselves, they punish providers for things outside of their control, or for practicing good healthcare.
Oh I definitely agree there’s lots of bull**** in patient reviews but also some legit complaints. And sometimes office stuff can matter to care—for example,a couple of years ago my mom was told by a GI she needed an “extremely urgent” scope, but the office staff couldn’t be bothered to get things arranged for weeks, for example (not as in the only appointment was weeks out, as in they just didn’t call to schedule it for weeks). My dad had a post-cancer surgery CT rescheduled four times at the last minute because the office staff by their own admission kept forgetting to submit the pre-auth paperwork. Are these things the physician’s fault? For the most part, probably not. Can they affect patient care? Possibly.
 
Oh I definitely agree there’s lots of bull**** in patient reviews but also some legit complaints. And sometimes office stuff can matter to care—for example,a couple of years ago my mom was told by a GI she needed an “extremely urgent” scope, but the office staff couldn’t be bothered to get things arranged for weeks, for example (not as in the only appointment was weeks out, as in they just didn’t call to schedule it for weeks). My dad had a post-cancer surgery CT rescheduled four times at the last minute because the office staff by their own admission kept forgetting to submit the pre-auth paperwork. Are these things the physician’s fault? For the most part, probably not. Can they affect patient care? Possibly.

I don't doubt that they affect care and the overall experience, but patients often make ratings on overall experience based on one small thing. So now, the onus gets put on providers instead of the support positions or for the patient advocating for themselves. I agree that a mechanism should be in place, but the current practice is irrevocably broken.
 
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I mean, I get what you’re saying, but people with mental illnesses can still receive legitimately bad, dangerous, or even abusive care, and often times, it’s blown off because “they’re crazy anyway.” And other specialities have plenty of drug-seeking patients, too, so it’s not just a psych thing.
Yeah and it screws us over too.
 
Oh I definitely agree there’s lots of bull**** in patient reviews but also some legit complaints. And sometimes office stuff can matter to care—for example,a couple of years ago my mom was told by a GI she needed an “extremely urgent” scope, but the office staff couldn’t be bothered to get things arranged for weeks, for example (not as in the only appointment was weeks out, as in they just didn’t call to schedule it for weeks). My dad had a post-cancer surgery CT rescheduled four times at the last minute because the office staff by their own admission kept forgetting to submit the pre-auth paperwork. Are these things the physician’s fault? For the most part, probably not. Can they affect patient care? Possibly.
Of course there are instances in which this can impact patient care, but if the doctor is an employee they have ZERO control over the hiring/training of this staff. Penalizing the doc for bad support staff in an employed position is a 100% do not pass go direct path to burnout and a great embodiment of everything that is wrong with corporate medicine.
 
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Patient reviews are bad, period. They do NOT capture bad acting providers. They need to be banned all over, not just psych.
 
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In our system, we get patient ratings which are reported as the percentage "top box" (5/5 rating) in each of the assessed categories. The range for the team in terms of overall average was from about 60% for a doc who seems to have a legitimately bad bedside manner (I get transfer patients from him who are 100% reasonable, normal patients who just didn't like him) to 95% for some of our top docs, some of whom are the kindest/sweetest people I've ever met and I'm sure are very gentle in how they approach patients.

Rate of stimulant prescribing does not seem to significantly correlate with patient ratings, although I think that might be a statistical sampling size limitation to some degree.

I kinda hate the rating system we have because it doesn't give any further breakdown, making it really hard to determine if your average is low because you tell people no (and they just rate you 1/5 on everything) or if you're actually basically doing fine but you just don't blow them away (4/5 on everything) or if there are legitimate aspects of your practice that could use improvement (2 or 3 / 5 on isolated subscores.)

So, at least with these internal rating scales, I think there's an element of actual reflection of bedside manner. One of the docs with the highest ratings in our system also has very good boundaries and tells people no appropriately, so he's a counterpoint to the idea that high ratings equal poor boundaries and enabling.

Our organization is going to be moving to a new system and it'll be interesting to see if we find something that gives a more helpful signal for feedback.
 
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Addiction, psychiatry, pediatrics and ER are the fields where if we do our jobs right we're pissing off the patient half the time.

These little incentivized methods to get the patient to like us doesn't work in several branches of medicine. When it was first introduced I balked at it. "So when my patient who thinks he's time-travelled from the future and wants to asasinate someone is mad at me for involuntarily committing him I'm penalized" The pediatrics chief and ER chief said the same. "So when I deny someone Xanax I get penalized?"

This is a classic example of someone who doesn't work in the field manipulating us into well-meaning play rules while not knowing how the actual field itself works.
 
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I mean, I get what you’re saying, but people with mental illnesses can still receive legitimately bad, dangerous, or even abusive care, and often times, it’s blown off because “they’re crazy anyway.” And other specialities have plenty of drug-seeking patients, too, so it’s not just a psych thing.

Sure they can get bad care but you miss a few points . PCP can say "oh sorry, i dont manage ADHD or benzos, that will require a specialist like psych". Then they arent the ones telling the pt no, we are. We become the villian because its deferred onto us. Other specialities may see patients with personality disorders, drug seeking, etc but we see a significantly higher amount in this field because often people with severe cluster B traits make their way into psych in some way shape or form. Often were tasked with fixing someones entire life to where they have never felt happy but expect to leave happy within a month and have generally unrealistic expectations. So of course you let them down when you didnt fix all of their life issues.

99% of reviews are purely subjective, and I would wager have nothing to do with whether or not you did the right thing for the patient.

My point is exactly what others said, we use this metric for patient satisfaction, but often times the right thing in psychiatry isnt what the patient wants, its often what they need. The metric is satisfied by giving people what they want, rather than what they need.

And while I do agree, bedside manner is important, but it doesnt mitigate the number of subjective reviews, imo. Maybe it helps some, but i think it largely depends on the intakes/referralls you get.

I mean I still like my job overall, and try to think positive, but I think the entire review system/patient metric is negatively impacting patient care. If anything, it makes doctors less inclined to take on sicker patients because they have less chance of bad reviews. Also it may tempt some doctors to appease patients out of fear of retaliation.
 
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Addiction, psychiatry, pediatrics and ER are the fields where if we do our jobs right we're pissing off the patient half the time.

These little incentivized methods to get the patient to like us doesn't work in several branches of medicine. When it was first introduced I balked at it. "So when my patient who thinks he's time-travelled from the future and wants to asasinate someone is mad at me for involuntarily committing him I'm penalized" The pediatrics chief and ER chief said the same. "So when I deny someone Xanax I get penalized?"

This is a classic example of someone who doesn't work in the field manipulating us into well-meaning play rules while not knowing how the actual field itself works.
In addition to those fields, I had a friend in med school who wanted to be a rural PCP since he was like 4 years old. Stayed the course through 2 years of residency and found outpatient PCP visits were about 25% controlled substance seeking. This took such a toll on him (as 25% of a 25+ outpatient visits is having this conversation several times/day) that he stayed on to do a year of hospitalist medicine fellowship and essentially spent 4 years of training to shift into being a hospitalist/IM field. This is a person who is rural to his core, these were "his people", same culture, same religion, same ethnicity, and he still couldn't stomach it.
 
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Sure they can get bad care but you miss a few points . PCP can say "oh sorry, i dont manage ADHD or benzos, that will require a specialist like psych". Then they arent the ones telling the pt no, we are. We become the villian because its deferred onto us. Other specialities may see patients with personality disorders, drug seeking, etc but we see a significantly higher amount in this field because often people with severe cluster B traits make their way into psych in some way shape or form. Often were tasked with fixing someones entire life to where they have never felt happy but expect to leave happy within a month and have generally unrealistic expectations. So of course you let them down when you didnt fix all of their life issues.

99% of reviews are purely subjective, and I would wager have nothing to do with whether or not you did the right thing for the patient.

My point is exactly what others said, we use this metric for patient satisfaction, but often times the right thing in psychiatry isnt what the patient wants, its often what they need. The metric is satisfied by giving people what they want, rather than what they need.

And while I do agree, bedside manner is important, but it doesnt mitigate the number of subjective reviews, imo. Maybe it helps some, but i think it largely depends on the intakes/referralls you get.

I mean I still like my job overall, and try to think positive, but I think the entire review system/patient metric is negatively impacting patient care. If anything, it makes doctors less inclined to take on sicker patients because they have less chance of bad reviews. Also it may tempt some doctors to appease patients out of fear of retaliation.
I actually think we agree here. I definitely agree that PCPs terfing benzo and stim denials to psychs are bull****, bad practice for patient satisfaction is a serious issue, and also that relying on the numbers alone as a metric is bad (the content should be read, although we all know that no system will do that), so I agree on disabling star ratings and all that. I’ve just seen a lot of patients with mental illnesses and other disabilities get objectively substandard care (it’s well-documented in health systems research that people with SPMI, IDD, autism, etc, get worse care on average) and they often have little if any recourse, because they aren’t believed until they’re dead (and sometimes not even then), even moreso if they’re also women or POC. Patient reviews are an admittedly crappy bandaid for that, but at least if there’s a pattern, it might catch someone’s eye. It’s really hard, because there’s a huge, huge signal to noise ratio here, with drug seekers, munchies, etc.
 
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If your clinic is requiring reviews, I’d request some changes:

1. Add questions that review office staff that you don’t control, ease of scheduling, and cleanliness. If your personal review results are above that of the clinic or equal too, the review shouldn’t count against you at all. You performed above that of the clinic.

2. Negative clinic scores should result in action plans as their short-falls could affect your bonuses/income.

3. Add a question set that asks if patient requested a specific medication and if so, did they receive it. If they did and it wasn’t provided, the score against you gets thrown out. Patients unable to process what is in their best interest should not be able to determine what is best for the clinic/you.
 
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The equation I came up with is patients should be doing reviews if they have good insight. A good insight patient wants to get better and work with their doctor. If their doctor sucks they're the best type of person to detect it.

The problem being that anyone can write a review and there's no way to nicely filter who has good insight and who doesn't.

While I was in residency a mentor introduced me to the Rule of Opposites for ER psychiatry. If the person has bad insight you do the opposite of what they want.

Schizophrenic wants to be discharged? Admit.
Borderline pt wants to be admitted? Discharge.
 
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The problem being that anyone can write a review and there's no way to nicely filter who has good insight and who doesn't.

this for sure sums it up. I agree with texasphysician, should add the question "Was the doctor cruel, and he did not prescribe the specific medication you felt you needed for your mental health?". Answering yes equals automatic deletion of review
 
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Actively soliciting patient satisfaction is bad. Also the way how easy it is to write reviews for someone online even if they do not solicit reviews, I believe leads to us trying to ward off these patients from seeing us in the first place, whereas, some could probably derive some benefit from a specialist telling them that no their Xanax 1 mg tid for anxiety that PCP started them on is not appropriate. When specialists do not want to treat conditions in their own specialty, ultimately it leads to worse patient outcomes.
 
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Working in involuntary psychiatry, I can say that most patients do not have a favorable review for me, since I am holding them and administering medications against their will.
 
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Any business that spends a lot of energy trying to solicit patient reviews is annoying to me. I agree that patients should have ability to have complaints heard and that should be a completely different process. Rating scales tied to bonuses are such a waste of time on so many levels that I don’t even want to waste my time explaining all of the reasons.
 
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At least half of the problem is the terrible health and science literacy of the majority of our population.

Correct, information asymmetry is so high in medicine that most of the population doesn't even know what "good" medical care is. They just know what they think makes them feel good or not, which isn't necessarily aligned even most of the time.

I'm not sure it's terrible health and science literacy though as much as a significant proportion of people just will not really ever understand most of medical care. Even fairly well educated people. The classic primary care example is the "antibiotics for viral pharyngitis/otitis/sinusitis/URI/etc". There's plenty of stories of PCPs being berated by patients as to why they have to pay their co-pay if they're just going to tell them to do supportive therapy and come back if things don't get better in a week...so again viewing this as a transaction where you're not paying a doctor for expertise but for some pre-concluded "service" you expect to get.
 
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No no OP you're thinking about it wrong.

You actually want the disgruntled reviews in your psych practice because it helps filter out patients.

"Dr Monocles is the worst ever I was on a bazillion benzos and Adderall and all my other prescribers filled them no questions asked but this guy won't write them when I flushed mine down the toilet??? 0/10 don't waste your time!!!!"

I'd pay to frame that review front and centre
 
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Google makes easy it these days for businesses to get rid of reviews they don't like, which is why google reviews skew positive. Their policy is extremely "flexible", in that if you contest something you don't like as 'non-factual', they will remove it. Probably they figured out the only way to make money is to be profitable for businesses.

I'd go against the grain here and disagree that patient reviews should be banned. From my experience, good psychiatrists will have issues with the occasional patient but if you regularly get into problems then imo you're doing something wrong. Part of the work is knowing how to engage difficult patients. It's probably the hardest challenge in psychiatry, yes, but it is measure of skill imo. If you don't want to open a controlled substances candy store then you can screen people out.
 
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Google makes easy it these days for businesses to get rid of reviews they don't like, which is why google reviews skew positive. Their policy is extremely "flexible", in that if you contest something you don't like as 'non-factual', they will remove it. Probably they figured out the only way to make money is to be profitable for businesses.

I'd go against the grain here and disagree that patient reviews should be banned. From my experience, good psychiatrists will have issues with the occasional patient but if you regularly get into problems then imo you're doing something wrong. Part of the work is knowing how to engage difficult patients. It's probably the hardest challenge in psychiatry, yes, but it is measure of skill imo. If you don't want to open a controlled substances candy store then you can screen people out.

Having multiple businesses and friends having businesses, I’d say that Google is especially hard at removing any reviews.

Even when it is obviously inappropriate, they do nothing. I’ve had multiple people flag some of my reviews that are either not my business or the same person reviewing me 3x. Google doesn’t care. No removal.
 
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Having multiple businesses and friends having businesses, I’d say that Google is especially hard at removing any reviews.

Even when it is obviously inappropriate, they do nothing. I’ve had multiple people flag some of my reviews that are either not my business or the same person reviewing me 3x. Google doesn’t care. No removal.
I have a friend OBGYN. Has a crazy patient harassing them with threats of violence on Google reviews. Google doesn’t do anything
 
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Having multiple businesses and friends having businesses, I’d say that Google is especially hard at removing any reviews.

Even when it is obviously inappropriate, they do nothing. I’ve had multiple people flag some of my reviews that are either not my business or the same person reviewing me 3x. Google doesn’t care. No removal.
What are the multiple businesses that you have? You’re a practicing psychiatrist right?
 
Google makes easy it these days for businesses to get rid of reviews they don't like, which is why google reviews skew positive. Their policy is extremely "flexible", in that if you contest something you don't like as 'non-factual', they will remove it. Probably they figured out the only way to make money is to be profitable for businesses.

I'd go against the grain here and disagree that patient reviews should be banned. From my experience, good psychiatrists will have issues with the occasional patient but if you regularly get into problems then imo you're doing something wrong. Part of the work is knowing how to engage difficult patients. It's probably the hardest challenge in psychiatry, yes, but it is measure of skill imo. If you don't want to open a controlled substances candy store then you can screen people out.

you can be nothing but nice to some people and still inevitably receive a bad review. Im more focused on patient reviews directly related/tied to the workplace system, that are often used as a metric of grading performance and weighed against other clinics. Often can influence things like bonuses/raises. A few months ago roughly 80% of my intakes were people inappropriately wanting benzos. For that month my "patient approval" was significantly lower compared to other months. I was nice and understanding with them but that doesnt work on people with severe personality disorders and very little insight.
 
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Do reviews affect anything? Does your waitlist get shorter? Then reviews are meaningless expressions, where the patient is admitting that they are organized, and that you met Freud's principles.
 
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It does actually. Negative reviews on Google My Business affect Google SEO
Well that and fair or not, it makes prospective patients apprehensive about contacting your office. What my office does is we encourage feedback from patients and do make it easy to leave a google review. Most patients are happy with their care. The only way to combat this since reviews won't go away is to try to give a more balanced view of your practice so happy patients can also share their experiences. Standard/recommended practice guidelines don't seem to have a major consensus on how this review business should be handled. Although we as MH professionals try to keep healthy boundaries, we have a living to make too. And it is also unfair to us for our living to be so severely damaged due to a handful of disgruntled drug seekers. When I first started private practice, I had that issue. There were negative reviews of me and I knew exactly who they were and they were all over Adderall. Overtime, I managed to get each addressed one by one. Actually, they all slowly disappeared, I took most of them down. Then on starting my own practice, which got a lot of positive feedback and it drove the SEO way up. There are legit/Google rules kosher ways to go about this. I don't feel the greatest, but it's an unfortunate presence we have to deal with.

Even when it is obviously inappropriate, they do nothing. I’ve had multiple people flag some of my reviews that are either not my business or the same person reviewing me 3x. Google doesn’t care. No removal.
Yes, it is awful!! and I totally agree with the hard place we're put in when dealing with people with severe personality disorders. That's why I bear no guilt in encouraging people to leave public feedback about the practice (there's electronic tools you can use that sends emails or texts to the patient after a visit). Infrequently you'll come across such a vindictive and scathing situation that is hell bent on getting revenge. I had one such patient that I saw at a different clinic, severe borderline personality. We terminated, I transitioned her to a new psychiatrist. She finds me at the clinic I started, tries to sneak in as a follow up of an "established patient" and was told she's not established here and I cannot accommodate returning patients. Then she goes on a rampage and left several fake google reviews on my GMB profile. Thank thank goodness that the SEO folks I worked with actually got most of then taken off! I was impressed.
 
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It does actually. Negative reviews on Google My Business affect Google SEO
But does that objectively affect revenue? Or does it just affect some metric that has zero relationship to income?

I’ve never met a psychiatrist that is struggling to fill their panel. The highest grossing psychiatrists I’ve met don’t have websites, aren’t easy to find, and don’t answer the phone all that often.

Or maybe I just have an affinity for that population.
 
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But does that objectively affect revenue? Or does it just affect some metric that has zero relationship to income?

I’ve never met a psychiatrist that is struggling to fill their panel. The highest grossing psychiatrists I’ve met don’t have websites, aren’t easy to find, and don’t answer the phone all that often.

Or maybe I just have an affinity for that population.
That’s not what I’m seeing in this geographic area. Many my age in private practice are 2+ years out. Take insurance and are still not full. Most prospective patients are drug seeking. It’s hard to get paneled with blue cross here as a psychiatrist unless you agree to take their Medicaid too. Myself? I have major seo rankings and efficient answering of phone calls at the office so all prospectives are explored and we’re matched with a good fit population. Very unfortunate that literally 80% of the calls are for benzos, stims or both and a good chunk of them are already on an opiate. The self pay practices regularly send our office their marketing brochures and follow up calls to check for referrals. I remember when I dramatically reduced seeing patients, one tried to set up a meeting as she was hoping to get the panel but I told her we have a new internal psychiatrist. So yes, the competition here is very real. There are now services like Talkiatry and many online clinics popping up like crazy that also take insurance.

And yes, when I had all those bad reviews and was trying to build my practice, huge drop in inquiries. When my reviews swung the other way, opened some floodgates for sure. It’s almost like a celebrity or brand status. When I was seeing more patients but not accepting new ones, I was known as the psych who was impossible to get in to see but if you get an appointment by some stroke of luck, run with it! I haven’t accepted a new patient in three years and it even says so on my website. People still call daily to become a patient. Compared to my colleague who works at the clinic with me. She’s 1.5 years into private and full, due to our marketing. But she gets no direct inquiries. I think this is strongly tied to SEO and reviews. My name is blasted all over the internet and I’m featured in media like Yahoo News answering educational questions so we get powerful back links.
 
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That’s not what I’m seeing in this geographic area. Many my age in private practice are 2+ years out. Take insurance and are still not full. Most prospective patients are drug seeking. It’s hard to get paneled with blue cross here as a psychiatrist unless you agree to take their Medicaid too. Myself? I have major seo rankings and efficient answering of phone calls at the office so all prospectives are explored and we’re matched with a good fit population. Very unfortunate that literally 80% of the calls are for benzos, stims or both and a good chunk of them are already on an opiate. The self pay practices regularly send our office their marketing brochures and follow up calls to check for referrals. I remember when I dramatically reduced seeing patients, one tried to set up a meeting as she was hoping to get the panel but I told her we have a new internal psychiatrist. So yes, the competition here is very real. There are now services like Talkiatry and many online clinics popping up like crazy that also take insurance.

And yes, when I had all those bad reviews and was trying to build my practice, huge drop in inquiries. When my reviews swung the other way, opened some floodgates for sure. It’s almost like a celebrity or brand status. When I was seeing more patients but not accepting new ones, I was known as the psych who was impossible to get in to see but if you get an appointment by some stroke of luck, run with it! I haven’t accepted a new patient in three years and it even says so on my website. People still call daily to become a patient. Compared to my colleague who works at the clinic with me. She’s 1.5 years into private and full, due to our marketing. But she gets no direct inquiries. I think this is strongly tied to SEO and reviews. My name is blasted all over the internet and I’m featured in media like Yahoo News answering educational questions so we get powerful back links.
We live in the telehealth age. If the patient population in your area is truly that bad, market yourself to other areas of the state or even other states
 
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Do reviews affect anything? Does your waitlist get shorter? Then reviews are meaningless expressions, where the patient is admitting that they are organized, and that you met Freud's principles.
Many psychiatrists are cash only, and these reviews do make a difference
 
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Well that and fair or not, it makes prospective patients apprehensive about contacting your office. What my office does is we encourage feedback from patients and do make it easy to leave a google review. Most patients are happy with their care. The only way to combat this since reviews won't go away is to try to give a more balanced view of your practice so happy patients can also share their experiences. Standard/recommended practice guidelines don't seem to have a major consensus on how this review business should be handled. Although we as MH professionals try to keep healthy boundaries, we have a living to make too. And it is also unfair to us for our living to be so severely damaged due to a handful of disgruntled drug seekers. When I first started private practice, I had that issue. There were negative reviews of me and I knew exactly who they were and they were all over Adderall. Overtime, I managed to get each addressed one by one. Actually, they all slowly disappeared, I took most of them down. Then on starting my own practice, which got a lot of positive feedback and it drove the SEO way up. There are legit/Google rules kosher ways to go about this. I don't feel the greatest, but it's an unfortunate presence we have to deal with.


Yes, it is awful!! and I totally agree with the hard place we're put in when dealing with people with severe personality disorders. That's why I bear no guilt in encouraging people to leave public feedback about the practice (there's electronic tools you can use that sends emails or texts to the patient after a visit). Infrequently you'll come across such a vindictive and scathing situation that is hell bent on getting revenge. I had one such patient that I saw at a different clinic, severe borderline personality. We terminated, I transitioned her to a new psychiatrist. She finds me at the clinic I started, tries to sneak in as a follow up of an "established patient" and was told she's not established here and I cannot accommodate returning patients. Then she goes on a rampage and left several fake google reviews on my GMB profile. Thank thank goodness that the SEO folks I worked with actually got most of then taken off! I was impressed.
How did you get the bad ones taken down?
 
We live in the telehealth age. If the patient population in your area is truly that bad, market yourself to other areas of the state or even other states
Oh, I’ve marketed the practice all over the state alright. We even take insurances that are geographically limited to certain parts of the state even though our office is based on the other end of the state. We also live in the prescription epidemic age and consumer mentality of health care age. One of the psychiatrists who regularly asks for referrals is licensed in three states. She even moved to the state border. Also, states can vary in their telehealth and medical documentation laws, so that warrants caution. I think CA has something specific about copy and paste? The other thing I think about is what exactly do we do should a case evolve into something high acuity from a med mal standpoint.
 
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Oh, I’ve marketed the practice all over the state alright. We even take insurances that are geographically limited to certain parts of the state even though our office is based on the other end of the state. We also live in the prescription epidemic age and consumer mentality of health care age. One of the psychiatrists who regularly asks for referrals is licensed in three states. She even moved to the state border. Also, states can vary in their telehealth and medical documentation laws, so that warrants caution. I think CA has something specific about copy and paste? The other thing I think about is what exactly do we do should a case evolve into something high acuity from a med mal standpoint.
You transfer the case to an in person provider
 
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That’s not what I’m seeing in this geographic area. Many my age in private practice are 2+ years out. Take insurance and are still not full. Most prospective patients are drug seeking. It’s hard to get paneled with blue cross here as a psychiatrist unless you agree to take their Medicaid too. Myself? I have major seo rankings and efficient answering of phone calls at the office so all prospectives are explored and we’re matched with a good fit population. Very unfortunate that literally 80% of the calls are for benzos, stims or both and a good chunk of them are already on an opiate. The self pay practices regularly send our office their marketing brochures and follow up calls to check for referrals. I remember when I dramatically reduced seeing patients, one tried to set up a meeting as she was hoping to get the panel but I told her we have a new internal psychiatrist. So yes, the competition here is very real. There are now services like Talkiatry and many online clinics popping up like crazy that also take insurance.

And yes, when I had all those bad reviews and was trying to build my practice, huge drop in inquiries. When my reviews swung the other way, opened some floodgates for sure. It’s almost like a celebrity or brand status. When I was seeing more patients but not accepting new ones, I was known as the psych who was impossible to get in to see but if you get an appointment by some stroke of luck, run with it! I haven’t accepted a new patient in three years and it even says so on my website. People still call daily to become a patient. Compared to my colleague who works at the clinic with me. She’s 1.5 years into private and full, due to our marketing. But she gets no direct inquiries. I think this is strongly tied to SEO and reviews. My name is blasted all over the internet and I’m featured in media like Yahoo News answering educational questions so we get powerful back links.
You’re saying conflicting things. You’re full, and still have demands for more work than you can handle. But you’re also saying that reviews somehow affect your income.

Inquiries mean nothing, if you’re full.
 
Helps to have an SEO service that has closer ties to google.

Yep. This is what I referring to.
If you somehow make them money, they will take the bad reviews down, and if one looks at their terms of service, they have a very broad definition of what you can contest. Talk about a COI.
It's a bit of a joke really, which is why I don't check google reviews for businesses if I'm looking for a service or going to a place to eat.
A good rating on yelp though will probably mean something.
 
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You transfer the case to an in person provider

Lol yeah good idea try to transfer the case to the nearest in person provider who is an hour each direction from the patients house because they live in the middle of rural New York. Because this is telepsych so the patients you’re picking up are anywhere.

it’s also not as simple as “transferring” unless you have some kind of actual relationship with the in person practice. You’re basically giving the patient a list of in person places to try to get into (many of whom may not be taking new patients) that you’re likely not familiar with anyway because they’re in another state or across the state from your typical catchment area or trying to refer people to IOPs/PHPs that have months long waiting lists if they’re even taking patients. That patient is also still your patient until they actually transfer to another practice or higher level of care, it would be considered very unacceptable from most medical boards standpoint (and would be a setup for a medical board complaint) to try to discharge a patient because they became higher acuity.
 
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Lol yeah good idea try to transfer the case to the nearest in person provider who is an hour each direction from the patients house because they live in the middle of rural New York. Because this is telepsych so the patients you’re picking up are anywhere.

it’s also not as simple as “transferring” unless you have some kind of actual relationship with the in person practice. You’re basically giving the patient a list of in person places to try to get into (many of whom may not be taking new patients) that you’re likely not familiar with anyway because they’re in another state or across the state from your typical catchment area or trying to refer people to IOPs/PHPs that have months long waiting lists if they’re even taking patients. That patient is also still your patient until they actually transfer to another practice or higher level of care, it would be considered very unacceptable from most medical boards standpoint (and would be a setup for a medical board complaint) to try to discharge a patient because they became higher acuity.
You have the right to transfer a patient for any reason you want, it could be as simple as “I don’t like them” as long as you keep that reason to yourself. If they are higher acuity than you’re comfortable with that’s what you do you tell them to find an in person but you have to ensure their safety and keep treating until they establish with a new person. Do you have a better idea?
 
Lol yeah good idea try to transfer the case to the nearest in person provider who is an hour each direction from the patients house because they live in the middle of rural New York. Because this is telepsych so the patients you’re picking up are anywhere.

it’s also not as simple as “transferring” unless you have some kind of actual relationship with the in person practice. You’re basically giving the patient a list of in person places to try to get into (many of whom may not be taking new patients) that you’re likely not familiar with anyway because they’re in another state or across the state from your typical catchment area or trying to refer people to IOPs/PHPs that have months long waiting lists if they’re even taking patients. That patient is also still your patient until they actually transfer to another practice or higher level of care, it would be considered very unacceptable from most medical boards standpoint (and would be a setup for a medical board complaint) to try to discharge a patient because they became higher acuity.
What scenarios are we thinking about? A schizophrenic non-compliant patient with oral meds? Well you can screen patients on LAIs out on intake. How is not providing telehealth services improving care for those patients? Patients who become actively suicidal? You call their local PD
 
You have the right to transfer a patient for any reason you want, it could be as simple as “I don’t like them” as long as you keep that reason to yourself. If they are higher acuity than you’re comfortable with that’s what you do you tell them to find an in person but you have to ensure their safety and keep treating until they establish with a new person. Do you have a better idea?

Im well aware, I’ve discharged quite a few patients myself. You do not have the right to discharge a patient for being higher acuity than you’re comfortable with if you already have a doctor patient relationship with them. For instance, if I refer someone to a PHP but they can’t get in, I can’t just say sorry can’t keep seeing me because you continue to have chronic fluctuating suicidality. That can absolutely be construed as patient abandonment. It’d be like endocrinology discharging a patient for being “too diabetic”.

Again, in the situation I described above there may literally be no in person psychiatrist taking new patients at all in any reasonable radius for these patients. This is not unusual in larger states or rural areas of midwestern states. There may simply not be an option to “transfer to an in person provider”.
 
You’re saying conflicting things. You’re full, and still have demands for more work than you can handle. But you’re also saying that reviews somehow affect your income.

Inquiries mean nothing, if you’re full.
If you read it fully, when I was STARTING my practice, yes, it was affecting my income. My first 14 months out of residency yes. And I did not have SEO or good reviews. Over time I got great reviews and powerful SEO, and that was the game changer. I continue to market broadly, it's always good to be safe (and some patients in the clinic trail off or graduate from care) and it's a great way to not have to be stuck with a drug seeking population. That and marketing broadly exposes you to a wider variety if insurance payers, so you get a larger volume of better paying insurances.
 
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Lol yeah good idea try to transfer the case to the nearest in person provider who is an hour each direction from the patients house because they live in the middle of rural New York. Because this is telepsych so the patients you’re picking up are anywhere.

it’s also not as simple as “transferring” unless you have some kind of actual relationship with the in person practice. You’re basically giving the patient a list of in person places to try to get into (many of whom may not be taking new patients) that you’re likely not familiar with anyway because they’re in another state or across the state from your typical catchment area or trying to refer people to IOPs/PHPs that have months long waiting lists if they’re even taking patients. That patient is also still your patient until they actually transfer to another practice or higher level of care, it would be considered very unacceptable from most medical boards standpoint (and would be a setup for a medical board complaint) to try to discharge a patient because they became higher acuity.
Thanks bro! Exactly this. Plus a lot of patients do not want to leave this clinic. They find convenient reasons to not leave and want you to be stuck with them. I've had patients say "no one is taking new patients." Although I know that is not true. Or they will have a scheduled intake and find some reason to flake out on the new place. It's really tough to discharge someone in a high acuity state, especially when there is a severe personality disorder and they don't want to separate. Been there, done that.
 
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Im well aware, I’ve discharged quite a few patients myself. You do not have the right to discharge a patient for being higher acuity than you’re comfortable with if you already have a doctor patient relationship with them. For instance, if I refer someone to a PHP but they can’t get in, I can’t just say sorry can’t keep seeing me because you continue to have chronic fluctuating suicidality. That can absolutely be construed as patient abandonment. It’d be like endocrinology discharging a patient for being “too diabetic”.

Again, in the situation I described above there may literally be no in person psychiatrist taking new patients at all in any reasonable radius for these patients. This is not unusual in larger states or rural areas of midwestern states. There may simply not be an option to “transfer to an in person provider”.
We’re saying the same thing..you transfer them to someone else but you have to keep seeing them until they establish..if there’s literally no one else they will never establish with anyone and you’ll see them forever. In that case you tel them to establish with another telehealth provider and wait for them to do that because they have more “expertise” in their condition. Long story short you can always get rid of someone if you want to and it’s probably recommended as you likely won’t be providing the best of care unless you actually like your patients.
 
We’re saying the same thing..you transfer them to someone else but you have to keep seeing them until they establish..if there’s literally no one else they will never establish with anyone and you’ll see them forever. In that case you tel them to establish with another telehealth provider and wait for them to do that because they have more “expertise” in their condition. Long story short you can always get rid of someone if you want to and it’s probably recommended as you likely won’t be providing the best of care unless you actually like your patients.

Which is not the same thing as your one line initial solution of “you transfer them to an in person provider”.
 
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Im well aware, I’ve discharged quite a few patients myself. You do not have the right to discharge a patient for being higher acuity than you’re comfortable with if you already have a doctor patient relationship with them. For instance, if I refer someone to a PHP but they can’t get in, I can’t just say sorry can’t keep seeing me because you continue to have chronic fluctuating suicidality. That can absolutely be construed as patient abandonment. It’d be like endocrinology discharging a patient for being “too diabetic”.

Again, in the situation I described above there may literally be no in person psychiatrist taking new patients at all in any reasonable radius for these patients. This is not unusual in larger states or rural areas of midwestern states. There may simply not be an option to “transfer to an in person provider”.
This is not my understanding of patient abandonment, maybe you can provide me more information. I have a number of colleagues who refer patient's to PHPs that need a HLoC, if the pt/family refuse to do this, they document the referral, the refusal and provide the requisite 30 days of treatment while being discharged for non-adherence to treatment. I am not aware of any occasions in which there was any concerns over patient abandonment for non-adherence to treatment but I also have not had my own PP and am very interested in learning more.
 
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This is not my understanding of patient abandonment, maybe you can provide me more information. I have a number of colleagues who refer patient's to PHPs that need a HLoC, if the pt/family refuse to do this, they document the referral, the refusal and provide the requisite 30 days of treatment while being discharged for non-adherence to treatment. I am not aware of any occasions in which there was any concerns over patient abandonment for non-adherence to treatment but I also have not had my own PP and am very interested in learning more.

So not refusal but for instance if there is lack of resource availability. If the patient is actually refusing to engage in treatment, then yes. But if you've got a patient where there is limited/no resource availability for higher levels of psychiatric care in the area, you can't just tell them you're going to discharge them and they have to wait to get into IOP for 6 months with no care. I mean I live in a relatively well resourced area for psychiatric care and for adults (less so for kids, can usually get kids into IOP/PHP/inpatient in a timely manner), I literally have most IOP/PHP programs telling me they aren't even putting people on waitlists because they have no idea when they'll have availability.
 
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