Medical Reviews & HIPAA Compliance:
Rips Dentist After Finding Better(?) Deal

Kudos to Allison T. If a contest were held for best crowdsourced attack reviews, we'd nominate her. Having only received x-rays and an exam, she succeeds in writing an obliterating review, portraying our dentist client as an incompetent, uncaring, greedy liar and cheat. And she does it in under 400 words. Key features of her masterpiece:

• Tries to establish credibility by sounding fair and balanced upfront. She graciously informs readers that her review is based on limited experience, as she never had any actual work done by the dentist, and how wonderful it was that the dentist saw her right away. But that's like Shakespeare's Antony telling the Roman mob that Brutus is an honourable man.
• Tells a story. Storytelling is highly effective in most commmunications. It's a strategy we like to use in responses. Allison T. elevates way beyond simply telling a story. She creates a parable: Good Dentist vs. Evil Dentist. Like a knight in shining armor, the good dentist from afar saves the helpless, innocent maiden from the clutches of the evil dentist. Echoing popular mythology, her review taps into the human psyche.

Through the storytelling, readers are led to the following conclusions, seemingly on their own, which is much more effective than if she made direct accusations:


• A greedy liar. EvilDentist told her she had twice as many cavities as did GoodDentist —at least according to Allison. Of course, we don't know what GoodDentist actually told her, such as that the small cavities could wait, which she exaggerated to mean no cavities. He likely understood that a low price upfront would win Allison's business, and other work could come later.
• Rapacious pricing. They wanted $3,000!!!!, and that's EXCLUDING the root canal, while GoodDentist only charged $1,800, INCLUDING the root canal. However, it's easy to overlook that Alison does not tell us what Dr. GoodDentist actually does include, besides a root canal. We know he tells her she has three cavities vs. EvilDentist's six, but the major issue--the need for the root canal--is not addressed.
• Incompetent and uncaring. EvilDentist is inferior because he can't even do a simple root canal, and uncaring for sending her to a specialist who won't return her calls. And as if the sins already committed weren't enough, "It took them 3 days!!" to send over the x-rays. Plus, these boobs don't even know how to take an x-ray. GoodDentist had to take new ones because they were "very poorly done." And with a knightly gesture, he did so at NO CHARGE!

Need for & Effectiveness of HIPAA-Compliant Responses

[NOTE: If requested, Review HELPER will add a legal professional specializing in the medical industry to the review and approval process for responses to client reviews.]

Medical professionals and organizations are challenged more than any other profession in responding to online reviews, because they must comply with the Privacy Rule of HIPAA. You must not reveal a patient's treatment or personal identifying information, no matter how many details are offered by the patient in attacking you. This means reviewers can make outrageous false statements about your treatment of them, and you can't call them a liar--at least not directly.

The point of this case study is to show that 1) you need to respond to such reviews, and 2) you can respond effectively. Also, it's not all defensive: Responding to a negative review provides an opportunity to deliver key marketing messages.

In HIPAA-compliant responses, it's advisable not to address the reviewer directly. This is our general approach anyway, with most negative reviews in any business category, especially hostile attack reviews. A response posted in a public forum is intended to communicate with prospective customers/clients/patients—not the reviewer. If you want to communicate with reviewers, call or email them, if you know who they are. If you don't, you may be able to private-message them through the review site.

In non-HIPPA-compliant responses, we'll refer specifically to the reviewer and his/her specific situation. In a HIPPA response, everything needs to be generalized. We don't speak to Allison T. We speak to the general experience or treatment of all patients, as would apply to the general issues and situation raised by Allison.

Dr. EvilDentist's Response We're legally bound by federal law concerning medical privacy (HIPAA) not to reveal a patients' treatment details or even if they're a patient. We're happy to comment on the general issues raised in this review. Not all dental offices are the same in their approach to patients and treatment. Our dental office is not trying to be the lowest-price dental services provider. We're a high-quality practice that takes a conservative and comprehensive treatment approach for the best health of our patients. We give patients a comprehensive picture, with options and recommendations. Patients make choices for different reasons, e.g., their financial situation. The choices one patient makes might not be the choices another patient would make. An example: For a large cavity in a tooth, a patient may have the option of filling it, or treating it with a crown. The filling will cost less, but how long it holds up is a question. A crown is more expensive, but offers a more stable, long-term solution for the tooth. Small cavities may be left untreated for a time. If for this reason one chooses not to call them cavities, that does not negate their existence and potential need for attention at some future date. And filling them sooner rather than later can prevent them from becoming larger and possibly causing other problems, such as the need for a crown and root canal. All general dentists are trained to do root canals, and we could do them, as well. But we believe it best serves our patients to have their root canals done by a specialist, an endodontist—who has two more years of specialized training beyond dental school, who does nothing but root canals, who has state-of-the-art equipment for the procedure (such as operating microscopes, ultrasonic instruments and fiber optics) to treat patients quickly and comfortably, and who can handle any complexity or complication that arises. People tend to choose the dentists who are best suited to the kind of choices they wish to make. Our dental office has successfully treated thousands of patients over the past 20 years. Again, our focus is preventative. We try to solve minor issues before they become major, when they then cost more to treat.

We find that being safely HIPAA-compliant need not be all that contraining, that the fundamental response strategies we pursue for any business still apply. And there's a benefit: we can use HIPPA as a shield to avoid having to address unpleasant specific treatment results and issues. It enables us to be more message oriented.

In general, our approach to responding to reviews in all industry categories is to avoid trying to explain away every accusation. That comes across as defensive, and nobody's going to remember the details, anyway. There'll be one or two takeaways for the reader, at best. So we counsel trying to establish as much credibility as possible, select the most important accusation(s) to counter, and seek a takeaway of one memorable, high-level, positive marketing message.

Applied to the Allison T. review, we use the response as a marketing communications opportunity, to establish a memorable umbrella positioning that differentiates our client, Dr. EvilDentist, from Dr. GoodDentist in a way that appeals to the type of patients our client seeks: patients who value high-quality preventative dental care and can pay for it.

This positioning helps address the rapacious pricing and greedy liar accusations. It gets an assist with the general examples we provide, that speak to Allison's accusations—albeit in a general way—about not needing a crown and not having so many cavities. Readers can see that Allison is making an oversimplified analysis of her situation based on her desire to get the cheapest possible solution.

We want readers to conclude that dental work is like a lot of other things—there are low-cost, no-frills options, and high-quality premium options. And Allison is a price shopper, someone who values low cost beyond all else, even the health of her teeth. It's only natural that she'd be more comfortable with a low-cost dentist.

The discussion about referring patients to an endodontist for root canal procedures is the real coup de grâce that discredits Allison and Dr. GoodDentist and shows our client to be the antithesis of Allison's accusations. If our client were so money obsessed, he wouldn't leave money on the table by referring patients to endodontists.

In responding to major attack reviews, it's important to establish as much credibility as you can, because in this context, credibility is a zero-sum game: What you gain, the reviewer loses. Here we include the marketing statement that our client has been serving the community for 20 years and has successfully treated thousands of patients. Businesses should press the inherent credibility advantage they have over anonymous individual reviewers.

Finally, most lay people don't know about HIPAA, and may mistake indirect, unspecific review responses for admission of wrong-doing. For this reason, we sometimes tell people about HIPAA in the response, as we do here. It's not elegant, and oftentimes it's not necessary. But when you're up against a tough challenge, it can be worth mentioning.

This is a long response. If people are genuinely interested, they'll read a long response as they will a short one. People researching this dentist should be curious to read his defense against such a beat down.

In our page, Why You Should Respond, we used a legal analogy and posit a hypothetical jury trial. Imagine your potential new patients are on a jury, and they just heard Allison's testimony (imagine her telling her story to actual people in an actual room). Now the prosecution rests and it is your turn. Will you put on a defense?