Protect your practice’s reputation

You or a trusted staff member should periodically monitor your online reputation. Start by Googling your name and/or your practice’s name. Use incognito mode so you can see what potential patients see.

If you have a website, review it regularly to see when it was last updated (hours, insurance, upcoming holiday closures, etc). Likewise, if you maintain a social media presence for your practice, ensure that you are posting relevant information on a regular basis. These activities can show up when a prospective patient does an online search for your practice, and can help you build a positive online reputation, without reviews.

Whether or not you’ve encouraged patients to post reviews, you should look for online comments periodically. In most cases, it’s enough to only check the two most popular review sites, Google and Yelp. You may also want to watch for any reviews left on your company’s Facebook page. A social media management tool is often useful collating all reviews across platforms, making it easier to respond to or report reviews from one central location.

Dental practices can be fined thousands of dollars for responding to online reviews with identifiable patient information, such as a patient’s name, insurance information, treatment plan, and/or cost information. But fines might also apply if your response merely confirms that a patient was indeed at your practice.

The Health and Human Services Office for Civil Rights (HHS-OCR) allows patients to file complaints when they feel their HIPAA protections have been violated. State attorneys general can also investigate complaints.

For example, a North Carolina dental practice had to pay a $50,000 civil penalty for responding to a patient’s negative review by detailing their experience with the patient. Other health care providers have entered into settlement agreements for disclosing identifiable patient information online. Affected practices may be required to agree to a detailed corrective action plan.

Keep in mind that HIPAA does not preempt more stringent state privacy laws, and that dental practices that are not covered by HIPAA must comply with state privacy laws.

Just because a patient identifies themself in a review, they have NOT waived their right to privacy!

Thus, it’s best to use generalities when replying to any online reviews (whether positive or negative) to avoid even indirectly confirming that a patient was in your practice.

It’s wise to acknowledge your online reviews as it shows you are paying attention to your reputation; however, you cannot respond in such a way that confirms that the person is a patient — even if they post using their real name.

Hence, it’s best to simply say, “Thank you!” Even something like, “Thank you for coming in,” “We appreciate our patients” or “We love treating your kids” can violate HIPAA.

If you wish to thank a patient for a glowing review, you can do so in person the next time they are in the office — but never online.

People do post negative, and sometimes even untrue, reviews online. While posters can say almost anything, business owners should be mindful of how they respond. Responding is even more complicated in healthcare since patient confidentiality must always be maintained.

So what should you do if a negative or false review is posted about your practice? Proceed carefully.

Be mindful that privacy laws apply. If you choose to respond, it’s best to do so in very broad “all patient” terms, such as with a statement to the effect of “Our office strives to provide the best service to all patients and we do our best to meet this goal. We encourage any patient who would like to discuss their experience to contact us directly.”

If you get a bad review:

• Close the computer, take a deep breath, and think about it overnight
• Strive to use a caring and empathetic tone
• Respond professionally, promptly and privately
• Show willingness to help and resolve the issue

As you think about your response, consider the audience: It’s everyone else reading the review, not the poster. That includes prospective patients. How do you want to come across? Confrontational and angry, or understanding and concerned?

Consider how you, as a prospective patient, would view these two different responses to a negative review in which the patient complained about rude staff and a careless dentist who tried to “upsell” treatment:

1. “You were rude; you screamed at our staff for no reason. As to treatment, your bruxism will certainly cause you dental problems down the road!”
2. “Our practice has many loyal patients who have benefitted from our care over the years. We always strive to put our patients’ best interests first. Please call our office to discuss.”

Option 1 may violate HIPAA by confirming the patient was indeed in the practice. Option 2, however, does not explicitly reference a specific patient seeking treatment. By using generalities, you can help protect your practice from potential patient confidentiality law violations.

Review sites generally have terms of use that prohibit using racial or religious slurs or expletives, stalking, defamation, spam, etc. If a review includes these elements, report it to the site and they may work with you to get it removed.

However, most review sites have a broad interpretation of “opinion” and will not remove reviews for things that cannot be definitively proved. You may also encounter difficulty having spam reviews removed. Be sure to check each site’s unique terms of use or service for details, and if the review in question is not removed and you believe it should be, some platforms allow you to report it again.

For example:

“Your dental office is filthy, and your staff is rude” — these are opinions.

“You’ve been sued four times in the past year for malpractice” — if that’s demonstrably false, you may be able to try to work with the site to have the review removed.

However, removing bad reviews can be time consuming and expensive, especially if you have to engage a lawyer. It can be very difficult to prove damages. You may not know the poster’s real name and identifying an anonymous review may be nearly impossible.

Talk to an attorney before you get too far. Sometimes it’s best to bite the bullet and leave it.

And consider this: attempting to remove or hide information can draw more attention and make it viral. This is known as the “Streisand Effect,” after Barbra Streisand sued a photographer for violating her privacy after he took an aerial photo of her coastal mansion to document erosion. Before the case, only a few people had viewed the photo. But the lawsuit itself attracted attention, and 400,000 people viewed it in the month following the lawsuit.

The one exception may be your Facebook page. If someone leaves a review through the Facebook reviews module, you cannot remove it — you can only report it to Facebook if it is hateful, obscene or factually inaccurate. However, you DO control what someone posts on your Facebook page, or wall. If someone posts a negative review there, you can remove it — but you should attempt to reach out to the person to resolve the issue.

Sites are well protected by the Digital Millennium Copyright Act (DCMA) and other statutes. These laws provide that the website is not the “publisher” and rather simply permits posting by individuals.

In fact, some statutes, like the Strategic Lawsuit Against Public Participation (SLAPP) acts go even further. If you sue the site and lose, you may be on the hook for the site’s attorney fees.

In general, people are more likely to leave a review if they had a negative experience — which is why soliciting positive reviews can help paint a more accurate picture of the average patient’s experience.

You can encourage patients to leave truthful reviews. Some practices do this by handing their patients a small card with a QR code or URL as they leave their visit. Others find that sending patients a text or email 1-2 hours after leaving the practice gets better response rates.

Use this opportunity to address problems before they fester. For example, you may use language like:

“If we please you, tell others; if you’re not pleased, tell us!”

Or

“Were you completely satisfied with today’s visit?”

In either case, if someone was NOT satisfied, reach out — quickly — to address their concerns. And if they are pleased, that’s the perfect time to ask for a review, whether through Google, Yelp, or your preferred platform.

Note that offering something, such as a gift or a chance to win a prize, in exchange for an online review can trigger disclosure requirements and may be prohibited by law. Doing so can implicate FTC rules concerning endorsements, as well as the terms and conditions of some review sites.

Be sure to review the applicable regulations issued by your state dental board and all relevant federal, state and local laws before beginning any online marketing campaign to ensure you’re in compliance. It’s possible that some jurisdictions may prohibit soliciting online reviews by patients.

Unfortunately, fake reviews are currently inevitable, as social media sites do not require posters to confirm their identities. You may be able to spot fake reviews or profiles by:

• Paying attention to the details
• Looking at word and punctuation choices
• Checking the reviewer’s history

You can also reference each platform’s policies for reporting fake reviews or profiles:
Facebook
Google
Instagram
LinkedIn

Meanwhile, the ADA is advocating with the FTC to reduce and eventually eliminate these reviews and their negative effects.

ADA President George Shepley, DDS and executive director Raymond Cohlmia, DDS, wrote a letter to the FTC on January 5, 2023. The letter expressed their concern about FTC rule changes concerning deceptive or unfair uses of reviews.

In part, the letter read:

“We are particularly concerned about reviews by people who are not actually patients of the dental practice, or who are misrepresenting their experiences with the dental office.”

“A common problem that dental offices face with these deceptive or unfair reviews is that, unlike businesses that can respond specifically to negative reviews, dentists, as health care providers, may be constrained by federal and state privacy laws from disclosing patient information even if the review is deceptive or misleading, and even if the reviewer discloses their patient information in the review.”

“The ADA urges the FTC to create an exception to enforcement and regulations under the FTC Act that would permit health care providers, including dentists, to disclose patient information in response to a review without violating the prohibition against unreasonable and deceptive trade practices, provided the disclosure is limited to the scope of the topics addressed in the review.”

“The ADA also urges the FTC to include in its rulemaking a requirement that the reviewer self-identify, as well as a requirement for the social media site to verify that identity. If the reviewer does not self-identify in the review, then the dental practice should have an avenue to request that identification from the social media site.”

In addition to providing this toolkit, the ADA is urging the FTC to create an exception “that would permit health care providers, including dentists, to disclose patient information in response to a review without violating the prohibition against unreasonable and deceptive trade practices, provided the disclosure is limited to the scope of the topics addressed in the review.”

The ADA’s January 2023 letter is also asking the FTC to encourage social media sites to remove blanket prohibitions on responding to posts with health information to the extent that a reviewer has already shared that information.

Finally, the FDA is also urging the FTC to require that social media sites verify the identities of posters to help dentists determine if a review is fraudulent. Such a requirement would also help dentists better respond to patients’ concerns.

Positive review
Say this (safer answer):
Thank you!

Not that (risky answer):
Thanks for coming in!

Negative review
Say this (safer answer):
We strive to provide every patient with the best possible care. Please call the office.

Not that (risky answer):
Your crown was a complicated situation. Please call the office to discuss your concerns.

Positive review
Say this (safer answer):
Thank you!

Not that (risky answer):
Thanks for noticing! We pay close attention to our cleanliness.

Negative review
Say this (safer answer):
We take pride in maintaining a clean, inviting office space. Please call the office.

Not that (risky answer):
You visited us on an unusually muddy day, so we apologize for the mess in the lobby. Rest assured that it has been fully scrubbed to our usual standards.

Positive review
Say this (safer answer):
Thank you! Our front desk team is amazing and they take great pride in their work.

Not that (risky answer):
Thanks! It’s always a pleasure to serve you.

Negative review
Say this (safer answer):
We strive to provide the best possible customer service. However, we occasionally get overwhelmed with calls, especially during lunchtime. We aim to return all calls within 24 hours. Patients can also book appointments directly through the website. Please call the office.

Not that (risky answer):
We apologize for the delay in calling you back — we were understaffed last week due to illness. Donna will call you today.

Positive review
Say this (safer answer):
Thank you!

Not that (risky answer):
We enjoy serving our [payer name] patients!

Negative review
Say this (safer answer):
We work closely with all payers to ensure a smooth process, but occasional mix-ups do happen. Please call the office.

Not that (risky answer):
You didn’t provide your updated insurance information, so we were delayed in processing the claim. Please call the office and we will sort it out.

Positive review
Say this (safer answer):
Thank you!

Not that (risky answer):
It’s always a treat when your family visits! We look forward to seeing you in six months!

Negative review
Say this (safer answer):
Our entire team aims to put patients at ease throughout their visits. Please call the office.

Not that (risky answer):
You were rude to everyone from the moment you entered the practice. Maybe you were having a bad day, but perhaps you could try being nicer.

Positive review
Say this (safer answer):
Thank you!

Not that (risky answer):
Thank you for your prompt payment!

Negative review
Say this (safer answer):
Our financial manager can help patients maximize their insurance benefits, and we offer several payment options. Please call the office.

Not that (risky answer):
We told you upfront that your insurance would only cover X% of the treatment and offered to set you up on a payment plan. Please call our financial manager to discuss your options.

Positive review
Say this (safer answer):
Thank you! We strive to keep our average wait times as short as possible.

Not that (risky answer):
Thank you for arriving on time!

Negative review
Say this (safer answer):
Average patient wait time is X minutes; however, there are occasional delays in our schedule. Please call our office.

Not that (risky answer):
I’m sorry to hear you had a long wait.

Positive review
Say this (safer answer):
Thank you! We offer free parking in the lot next door.

Not that (risky answer):
Glad to hear it! Parking is easiest for mid-day appointments like yours.

Negative review
Say this (safer answer):
We offer free parking in the lot next door. Please call our office.

Not that (risky answer):
We’re sorry you didn’t see the sign directing you to the lot next door.