Burned by negative reviews, some health providers are projecting their patients’ privacy aside and sharing intimate details online as they attempt to rebut criticism.
In the course of these arguments — which have spilled out publicly on ratings sites like Yelp — physicians, dentists, chiropractors and massage therapists, amongst others, have divulged details of patients’ diagnoses, treatments and idiosyncrasies.
One Washington state dentist turned the tables on a patient who blamed him for the loss of a molar:”Due to your clenching and grinding habit, this is not the first molar tooth you have lost because of fractured root,” he wrote. “This tooth is no different.”
“The exam identified one or more of those signs I mentioned previously for scoliosis. I absolutely recommended an x-ray to decide whether that condition existed; this x ray was at no additional cost to you.”
And a California dentist scolded a patient who accused him of misdiagnosing her. “I looked very closely at your radiographs and it was evident that you have cavities and gum disease that your other dentist has overlooked. … You can live in a world of denial and simply believe what you want to hear from another dentist or create an educated and informed choice.”
Health professionals are adapting to a harsh reality in which consumers rate them on websites like Yelp, Vitals and RateMDs much as they do restaurants, hotels and spas. The vast majority of reviews are positive. But in attempting to respond to negative ones, some providers seem to be violating the Health Insurance Portability and Accountability Act, the federal patient privacy law called HIPAA. The law forbids them from disclosing any patient health information without consent.
Yelp has given ProPublica unprecedented accessibility to its trove of public testimonials — more than 1.7 million in all — allowing us to search them by keyword. Using a tool developed by the Department of Computer Science and Engineering at the NYU Tandon School of Engineering, we identified more than 3,500 one-star testimonials (the lowest) in which patients cite privacy or HIPAA. In dozens of cases, responses to complaints about medical care turned into disputes over individual privacy.
The patients affected say they’ve been injured — first by poor service or care and then by the disclosure of information that they considered private.
The shock of exposure can be effective, prompting patients to back off.
“I posted a negative review” on Yelp, a client of a California dentist wrote in 2013. “After that, she posted a response with details that included my personal dental info. … I removed my review to protect my medical privacy.”
The office warned that the dentist about submitting personal information in response to Yelp reviews. It is currently exploring a New York dentist for divulging private information about a patient who complained about her care, according to a letter reviewed by ProPublica.
The office couldn’t say how many complaints it has received in this area because it doesn’t track complaints such a way. ProPublica has previously reported concerning the agency’s historical inability to analyze its complaints and identify repeat HIPAA violators.
Deven McGraw, the office’s deputy director of health information privacy, said health professionals responding to online reviews can talk generally about the way they treat patients but must have permission to discuss individual cases. Just because patients have rated their health provider publicly does not give their health provider consent to rate them in return.
“When the complaint is about poor patient care, they can come back and say,’I supply all of my patients with good patient care’ and’I’ve been reviewed in different contexts and have good reviews,'” McGraw said. But they can not”take those accusations on individually by the individual.”
Yelp’s senior manager of litigation, Aaron Schur, stated most reviews of physicians and dentists aren’t about the actual healthcare delivered but rather their office wait, the front office staff, billing procedures or bedside manner. Many health providers are careful and appropriate in responding to online reviews, encouraging patients to contact them apologizing for any perceived slights. Some don’t respond in any respect.
“There is certainly ways to respond to reviews that don’t implicate HIPAA,” Schur said.
In 2012, University of Utah Health Care in Salt Lake City was the first hospital system in the nation to post patient testimonials and comments online. The system, which had to overcome doctors’ resistance to being rated, found positive comments far outnumbered negative ones.
“If you whitewash remarks, in case you only put those which are highly optimistic, the public is very savvy and will consider that to be only advertising,” said Thomas Miller, chief medical officer at the University of Utah Hospitals and Clinics.
Unlike Yelp, the University of Utah does not allow comments about a doctor’s medical competency and it does not allow doctors to respond to comments.
In discussing their battles over online reviews, patients said they’d turned to ratings websites for closure and in the expectation that their experiences would help others seeking care. Their suppliers’ responses, however, left them with a lingering sense of lost trust.
Angela Grijalva brought her then 12-year-old daughter to Maximize Chiropractic in Sacramento, Calif., a couple years ago for an exam. At a one-star review on Yelp, Grijalva alleged that chiropractor Tim Nicholl led her daughter to”think she had scoliosis and urgently needed x-rays, which could be carried out in her next appointment. … My daughter cried all night and had a difficult time focusing on school.”
Nicholl responded on Yelp, acknowledging that Grijalva’s daughter was a patient (a revelation that’s not allowed under HIPAA) and discussing the procedures he performed on her condition, though he said he couldn’t disclose specifics of the identification”because of privacy and patient confidentiality.”
“The following day you brought your daughter back in for a verbal review of this x-rays and I informed you that the x-rays had identified some issues, but the great news was that your daughter didn’t have scoliosis, great news!” he recounted. “I proceeded to correct your daughter and the adjustment went really well, as did the entire appointment; you made no mention of a’misdiagnosis’ or another concern.”
“I would not want another parent, another kid to go through what my daughter went through: the panic, the anxiety, the fear,” she added.
Nicholl declined a request for comment. “It just doesn’t seem like that is worth my time,” he said. His practice has mixed reviews on Yelp, but more positive than negative.
A few years back, Marisa Speed posted a review of North Valley Plastic Surgery in Phoenix after her then-3-year-old son received stitches there for a gash on his brow. “Half-way through the process, the doctor seemed flustered with my crying child. “At this point the doctor was upset and he ended up throwing the tools to the floor. I understand that dealing with kids requires extra effort, but if you do not like to do it, do not even welcome them.”
Speed and her husband complained to the Office for Civil Rights. “You may wish to remove any specific information about current or former patients from your Web-blog,” the Office for Civil Rights wrote in an October 2013 letter to the operation center.
In an email, a representative of the operation centre declined to comment. “Everybody that was directly involved with the incident no longer works . The nurse with this case left a year ago, the surgeon at the case retired last month, and the administrator left a couple of years back,” he wrote.
Reviews of North Valley Plastic Surgery are mixed on Yelp.
Health providers have tried a range of approaches to attempt and combat negative reviews. Some have resisted their patients, bringing a torrent of attention but scoring few, if any, legal successes. Others have begged patients to remove their complaints.
Jeffrey Segal, a onetime critic of review websites, now says doctors will need to embrace them. Beginning in 2007, Segal’s firm, Medical Justice, crafted contracts that health providers could give to patients asking them to sign over the copyright to some testimonials, which allowed suppliers to need that negative ones be eliminated. But following a litigation , Medical Justice stopped recommending the contracts in 2011.
Segal said he’s come to think reviews are valuable and that providers should encourage patients that are satisfied to post positive reviews and should respond — carefully — to unwanted ones.
“For physicians who have bent out of shape to eliminate negative reviews, it is a denominator problem,” he said. “If they only have three testimonials and two are negative, the denominator is the problem. …If you can find a way to cultivate reviews from hundreds of patients instead of a few patients, the issue is solved.”