Dealing with feedback – both in the workplace and online

Doctors are subject to more feedback and scrutiny than ever before, both in the workplace and increasingly, in the public sphere.

In a clinical setting, this can be verbal – for example, expressing thanks or appreciation at the end of a consultation. It can also be in written form, as a letter of thanks or as an email.

Patient feedback questionnaires are also beginning to have a role in training and appraisal of doctors.¹

Historically, doctors have faced a substantial burden both to provide and receive feedback. Junior doctors, in particular, may get significant feedback from their seniors or educational supervisors. This is sometimes mirrored by the expectation of providing similar feedback for colleagues.

The British Medical Journal has explored – in the UK context – how to make feedback meaningful when there is simply so much of it.² While the specific channels for feedback differ from one jurisdiction to the next, the principle of using feedback to create a supportive workplace, rather than a burdensome box-ticking exercise, is relevant around the world.

However, the snowballing volume of feedback is no longer restricted to the workplace.

Patients’ feedback via online platforms

The increasing use of social media and online reviews has made it easier for patients to comment publicly on the care they receive. Patients can make comments on social media, such as Facebook, or on online doctor listing platforms, such as See Doctor.

Patients can also be active in popular online communities, such as Geoexpat which, while not medically-focused, can still provide a platform for positive and negative comments about doctors.

Medical practices themselves can also receive very public feedback via Google reviews.

On the one hand, comments are often positive and are heartening for any healthcare professional to read. Feedback in general can be useful in helping a doctor or a service improve.

However, receiving negative feedback can be challenging in any circumstance. Seeing unfair criticism in a public forum, in view of colleagues, patients and friends, can be even more challenging – especially if it is felt that there is no right of reply.

Dealing with negative feedback

Medical Protection is often asked to provide support and advice for doctors who feel that they are being unfairly portrayed in online comments.

How a doctor responds to negative feedback can be an important factor in whether matters escalate. Some types of comment may warrant reporting to the website, although this does not prevent the person from simply posting the comments elsewhere.

Doctors sometimes feel that some negative feedback amounts to defamation. However, taking legal action over a comment needs to be considered very carefully, as this can risk inviting more attention and publicity in respect of the comments.

Duty of confidentiality

When receiving such negative feedback, it is tempting to defend one’s reputation by engaging in a war of words with the patient. However, doctors need to be mindful of their duty of confidentiality when responding to feedback on public forums. When writing in haste, in particular, it is possible that comments may inadvertently breach doctor-patient confidentiality.

It can also be tempting to become defensive and respond by saying that many other patients are happy with the service provided, or to try and provide a more balanced picture through evidencing positive feedback.

However, the Code of Professional Conduct of the Medical Council of Hong Kong states that “Letters of gratitude or announcements of appreciation from grateful patients or related persons identifying the doctor concerned should not be published in the media or made available to members of the public”.³

A calm and professional response helps

Becoming aggressive or defensive is generally an unhelpful approach and often leads to more confrontation. A more effective response can be to express disappointment that the patient did not have a positive experience and offer the opportunity to discuss the concerns in more detail. By resolving the complaint, the person posting the negative comments may choose to remove the comments themselves.

Bear in mind that if you think a comment is unreasonable or unfair, others may see it that way too. Informal patient surveys in the US found that 65 percent of patients tended to ignore negative reviews that seemed unreasonable or exaggerated.4

Similar US surveys found that almost one in five patients will disregard a negative review if the provider has responded in a thoughtful manner.5

A calm and professional response will come across well to others who may read comments, and is the best way to try to resolve the patient’s concerns. Here are five steps that will help you provide a good response:

1. Although a prompt response is important, try to make sure the reply is calm, measured and not written in haste.

2. Thank the patient for his/her comments, acknowledge concerns he/she has raised, and apologize if appropriate.

3. Explain that you take all concerns very seriously, and that you will investigate the matter further.

4. Invite the patient to contact you, giving him/her specific contact details to arrange a telephone call or meeting. Consider using your complaints procedure to resolve any expressions of dissatisfaction.

5. Bear in mind your duty of confidentiality and do not disclose any personal information.

Finally, you should contact your medical defence organization for further advice if you are unsure how to proceed or require media support.