Article Date: 10/1/2011

Safeguard Your Online Reputation

Safeguard Your Online Reputation

To put your best foot forward, manage your online reputation

Brian Chou, O.D., F.A.A.O., San Diego, Calif.

“I have been disappointed on both my visits to this doctor. Rushed through, the doctor said I was difficult simply because I had questions, and he didn't want to take the time to answer. He felt I wasn't trusting him or his equipment, which may actually be the case at this point. They did not act as if they valued my business.”

These comments, posted anonymously, appeared on a popular review website. What would you do if they were written about your practice?

No longer limited to restaurants and hotels, online ratings and reviews affect all business and service organizations, including optometric practices. Positive reviews can help you attract new patients, and fortunately most ratings are positive.

Data compiled by the website Yelp indicated that 85% of businesses received three or more stars out of a possible five stars. Even negative reviews may offer you the opportunity to improve your practice via responding to constructive criticism, albeit in a publicly visible forum.

Unfortunately, a single malicious online review can be the pin prick that deflates your good reputation, even if someone other than an actual patient posts the comments. As Warren Buffet, said, “It takes 20 years to build a good reputation and five minutes to ruin it.”

However, there are steps you can take to mitigate the impact of a “thumbs down” online review.

In this article, I will share some of the strategies that I believe can help you put your best foot forward in managing your online reputation.


The first step of online reputation management is to perform a “vanity” web search for your name and practice. Take inventory of all the available information about you and your practice, then categorize it as positive, negative or neutral.

You might be surprised by what you find. For example, I found pictures of a body builder who shares my name. On a more disturbing note, when I looked up other optometrists, I found records about divorce, a DUI conviction, protocol violation in an FDA study and even an allegation of sexual misconduct by a state board of optometry. Imagine how a patient would react upon finding this information, even if it were untrue.


If you discover personal information or embarrassing photos on a forgotten social networking website, you can simply remove them if it's a web page that you control. If you can't remove the information—for example, when your photograph is tagged on someone else's webpage—consider “burying” the information. Here's how:

The crux of online reputation management is to promote positive information ahead of negative information. In practical terms, this means that you want to control the first two pages of any search results. This is because 98% of users don't look past the second page of search results (and 92% stay on the first page), according to Chris Martin, founder of Therefore, if negative information is demoted onto page three or beyond, the likelihood of that information coming to light is lower.

One strategy in controlling search results is to prolifically generate positive content about yourself and your practice, crowding out the negative information “Filibuster” by creating new content using websites such as LinkedIn, Google Profiles, Facebook, Twitter and YouTube. If you co-manage with a refractive surgeon, ask the surgeon to create a webpage on his/her website that contains your biography.

Whatever you do to control the search, don't “stuff the ballot box,” or fabricate reviews, which is illegal. The Federal Trade Commission has enforced truth in advertising laws against fake reviews. Also, Yelp, among other websites, employ algorithms to filter out suspicious postings.

On the other hand, you can encourage positive commentary about your practice. Just as you may ask patients to refer a friend, ask them to write a review from their Google account or a search or social media site.

Web-based services make it easy to encourage, collect and monitor reviews. Examples include WebSystem3, from Eyefinity/OfficeMate, DemandForce, from DemandForce, Inc., focalCenter, from eyecareScore and Active Presence by Smile Reminder.

Also, you may consider using a practice consultant, mystery shopping and more insightful patient surveying to drive practice improvements and thus earn high marks. While each of these can play a role, patient surveying is one of the most cost-effective methods of pro-actively driving business improvement, which ultimately elevates your reputation. (See the sidebar, “Surveying: Not So Simple” at the end.)

With adequate content, the next step is to employ search engine optimization (SEO) to promote the positive information to the top of search results. SEO is a topic in itself, however an excellent overview of SEO is offered through AllAboutVision at: SEO companies can be found through a web search.

Beyond optimizing your website lies reputation monitoring. This requires tracking your digital footprint, which includes your listing in a multitude of sites, reviews, comments, posts and tweets about your practice. You can sign up for keyword alerts on Google and Bing, and continually check popular review sites, such as Yelp, Citysearch and HealthGrades. Automated reporting tools, offered through sites, such as focalCenter, provide a quick dashboard view and analysis of patient feedback.

Inevitably you can't control the outcome of search results completely. Rating and review sites, such as Yelp, have enough credibility that Google will boost those websites high in the search results, so you can't always hide from negative postings.


If a negative post still appears in the first two pages of the search results, don't ignore it—or worse, remove it—because the presence of some negative information lends credibility that the reviews are genuine.

“If everything is positive, that raises a red flag among consumers,” says Forrester Research (

Best practice dictates a response. (See “Five Tips for Answering a Negative Post,” at the end.) I contend that patients do not expect perfection, but they do expect competency. A wellcrafted response demonstrates your willingness to listen and act on feedback, while offering prospective patients reassurance that if something goes wrong, you'll make a reasonable effort to correct it.


If you consider a posting defamatory, should you take legal action? I know of at least two San Francisco, California-area dentists who filed lawsuits against both a review site and former patients for their harsh comments that continue to haunt the practices.

However, restoring your reputation through legal maneuvers is a minefield. First Amendment rights allow the free expression of opinions. As they can neither be proven true nor false, opinions cannot be found defamatory.

Also, Section 230 of the federal Communications Decency Act provides a safe harbor for website operators, stating that websites cannot be held liable for third-party comments. Reviewers are also protected by the anonymity policy of review sites. In addition, understand your state laws. For instance, California gives judges the right to dismiss lawsuits that don't seem likely to prevail on their merits.


What rankles us is that there is no guarantee that postings are even those of an actual patient. They could be fabricated from a disgruntled employee or an unscrupulous competitor. Yet, if you are receiving numerous negative reviews with some legitimacy (from patients actually seen), it's time to face the music: Use the post to re-evaluate operations to identify areas for improvement. And then, act on them. Let the poster know you are sincerely trying to fix the problem.


If you haven't yet received a negative online posting, know that it is almost inevitable that eventually you will. This is analogous to how every refractive surgeon who is in practice long enough will experience a serious surgical complication. Practically speaking, a refractive surgeon who has not experienced any complications has not performed enough surgeries.

Rest assured, it is fine to have negative commentary. Not only does it demonstrate being human and add credibility to any positive commentary, it offers you an opportunity to publicly demonstrate your level of concern and professionalism.

Certainly, we all must be vigilant in protecting our online reputations. (See “Why You Can't Ignore Patient Satisfaction,” at the end.) Yet, I still find wisdom in the words of the late, legendary U.C.L.A. basketball coach John Wooden: “Be more concerned with your character than your reputation, because your character is what you really are, while your reputation is merely what others think you are.” OM

Five Tips for Answering a Negative Post
Follow these steps when answering a negative post.

► To comply with privacy laws, never disclose protected health information.
► Take the high road, without belittling the poster.
► Accept responsibility, and make a reasonable effort to resolve the problem.
► Be timely, but don't post your response on a whim.
► Make sure your response is free of grammatical and typographical errors, and have someone else proofread it before posting it.

Why You Can't Ignore Patient Satisfaction
The consumer-generated online ratings and reviews appear unstoppable. They are poised for increasing importance in consumer-oriented businesses, including healthcare.
Witness the newly (Jan. 2011) created Medicare “Physician Compare” Web site (, which includes O.D.s. Within the next two years, this website will report outcomes and patient satisfaction results. Even critics have embraced these provider-specific data for providing patient-centered care and transparency.
In this environment, the winners will be those who emphasize customer service. Value-based purchasing, or pay for performance “P4P” schemes, are coming, and Medicare is poised to base your reimbursement, in part, on your patient-satisfaction scores. Private insurers, such as Aetna, already offer patient ratings of their providers. It may just be a matter of time before the major vision benefit plans post online ratings and reviews of their providers and perhaps develop a P4P program as well.

Surveying: Not So Simple
Dr. Brian Chou, O.D., F.A.A.O.

Besides just asking for a 5-star rating, wouldn't you like to know what exactly the patient thought about key service areas of your practice? Just about everyone thinks they can put together and administer a survey. But to put together a valid and reliable survey requires more skill than many would imagine.

Removing bias

Take my practice as an example. When I joined the practice over a decade ago, there was an existing paper survey that the staff was asked to hand out to each patient. The problem, however, was that if the staff got very busy, they forgot to hand out the survey. And if an unhappy patient disputed a charge, the staff would not provide a survey. After all, why would a staff member give a disgruntled patient the opportunity to get him in trouble right before his performance review?

The problem was that this system introduced significant selection bias. The results that came back were misleadingly positive. Yet the goal of surveying is to get a representative picture of patient perception in order to make business decisions. Bad information can lead to bad, and costly, business decisions. A better method of distributing surveys is to systematically select which types of services will trigger patient surveying (e.g. 92015 CPT for refraction). Having a third party administer the survey will also ensure that the patient can maintain anonymity of their response, encouraging honest feedback, without the fear of retaliation by members within the practice.

Ensuring a high response rate

The survey design and administration must also encourage a high response rate. One of the keys is to minimize the burden of responding to help maximize the response rate. For example, a survey with just three true-false questions will have a greater number of responses compared to a survey with 100 open-ended questions. A mail-based survey will have a higher response when a self-addressed stamped envelope is provided versus one that does not. Increasing response rate is also achieved through techniques such as pre-notification (e.g. sending out a postcard in advance letting the recipient know to look for the survey in a week), providing a reward (e.g. respondents receive $5 dollars), or sending a follow-up response to non-responders.

Watch out for numbers

Another common error in patient surveying is asking a question like, “On a scale of zero (worst) to ten (best), please indicate your level of overall satisfaction.” Although this may sound like a reasonable question to ask, the problem manifests when your office scores a 9.0 in November and an 8.5 in December. First, does the drop in satisfaction from November to December represent a meaningful change, or is it due to chance variation?

Second, if the change is significant, what must you do to increase “overall satisfaction”? If the goal is to identify operations that require changes, then ask task-oriented questions, such as, “Upon entering our practice, were you promptly acknowledged?” It is far easier to calculate statistical significance in such a case, and if there is a significant drop from one month to another, the business owner knows to have a chat with the front reception staff.

Several companies, like Motorola and General Motors have applied the quality management and process improvement methodology, Six Sigma, in their organizations. Six Sigma is about identifying the critical areas of operation in their organization and monitoring them. By measuring for defects in critical operations and then taking action to reduce errors, the process is repeated until the ideal of one defect per 3.4 million opportunities (6σ) is attained. Implementing a regimented patient survey system such as the one offered by focalCenter, in an optometric practice is similar, and can pay significant dividends in the form of improved customer service and a boost to online patient ratings and reviews. OM

Dr. Chou is an industry consultant and private O.D. in San Diego, Calif. He co-developed the EyeXam iPhone app which has more than one million downloads. E-mail him at, or send comments to

Optometric Management, Issue: October 2011