| Monday, January 01, 0001
How and Why the Internet Patient Community Cracks the Whip
No doubt, practicing physicians see a variety of personality types when dealing with patients in their office. Some are pleasant and demure, while others can be downright feisty. It's part of the (often thankless) job though, administering healthcare to those who need it, even those unruly and unappreciative. Nowadays, physicians have an even larger patient community than that which exists in their regional practice district...or at least, nowadays they're more aware of it. The online patient community exists in a few different incarnations, sometimes literal support groups for those dealing with a health condition and other times being a sort of "medical consumer reports" for would-be patients. They're all connected through the internet mainly through social media sites and web-forums, and at some level, exist to help out one another.
The online patient communities can be quite puzzling to physicians. In some more cynical respects, it plays off like an online repository of people, many of whom have no medical training to speak of, dispensing false health information to others. Disgruntled patients can also use the internet to slag on a physician they didn't agree with or had a bad experience with, warning others to stay well away from physicians with "rude wait staff" or "arrogant demeanors." And these comments are hurtful in a variety of ways.
To give a glimpse into the world of internet communities, I'm going to take you down a sordid path into one of the most vocal and aggressive fan communities in the entire existence of the internet: the Internet Wrestling Community. As the name suggests, this is a community of online users that identify as part of said-group strictly on the basis of a love and interest in professional wrestling. These fans range in age and vocation, some nerds and scholars and others just casual fans, many of whom have no formal connection to the wrestling business. They watch the weekly television shows, and critique the seasonal (monthly) pay-per-view events. They critique the show's artistic direction, the presentation, the production quality and of course, the actual wrestling itself.
They're an interest group worthy of folkloric dissection in and of themselves, self-appointed art critics and wrestling coaches casting in their two cent opinions over one of TV's longest-running episodic serials. And why? What makes wrestling fans happy? A good show. Something they can get giddy about, lighting up the wrestling message boards, sub-reddits and Tumblr articles. They praise it's many nuances, its attention to detail, the lighting, and rank it in terms of said praise. "Best episode this year!" or "most exhilarating PPV since '98."
When it's bad though. Oh brother. That stink is felt the world over. Internet wrestling fans begin grinding their axes on every internet platform they can procure. The Reddit threads get long, the Twitter feeds more aggressive and swear-ridden and the nefarious refrains of "how can they sell us this crap?" and "I'm canceling my subscription!" ring out. It's likely the phenomenon that's led to the sagely saying: when wrestling it's good, it's really really good, but when it's bad, it's great (for internet fans).
But why? Why does the Internet Wrestling Community seem to have a field day with the shoddy shows that annoy them? Taking to every place they can to air their disagreements and what in creation does any of this have to do with healthcare?!
Wrestling fans react the way they do because they feel like they've got a stake in the wrestling product they watch on TV. The way they see it, they've invested their money into it, in some cases over the course of several decades. They've bought tickets to the live events, ordered the monthly pay-per-views and have schlepped over money for various forms of wrestling merchandising left and right. Most valuable of all, they've invested their time (3 hours on a Monday evening minimum), which can never be given back. In that sense, they often feel that they deserve to see a wrestling product that rewards them for their continued patronage. When said product fails to live up to that unwritten contract, the internet fans revolt.
Who's Really watching?
Ok then, that's how the wrasslin' fans do it, but does healthcare have the same kind of "contract?" physician to patient? Not exactly. Here's an example of the idea of the "healthcare consumer" mentality starts creeping in. Because of the internet, patients have more options than they've ever had before in terms of HOW they receive their healthcare. Finding another physician, or even a service that's faster and more efficient than the traditional office visit are now well within the realm of possibility and so patients can literally "vote with their wallets" in choosing their preferred method of healthcare, much in the way they'd choose which food to eat or which hotel to stay in.
This can be problematic for physicians, who's job lies in administering information, sometimes information that's hard to digest and even unpleasant. Is it always the physician's job to give the patient what they WANT over what they need? Sometimes, physicians must dispense hard truths to patients, who may not want to hear them.
However, even further beneath, internet complaining bleeds into another principle that the Internet Wrestling Community understands deeply. When scorned, amidst all their whining, slandering, threats to pull subscriptions and terminate buyership forever, they know that on some level their voice will be heard and considered. It may not happen immediately or in the most detectable way possible, but deep down they know that if enough fans threaten to quit watching, to quit buying tickets to the live events and to (gasp) quit purchasing the monthly pay-per-views, the suits at the top of the wrestling business will take notice. Perhaps they'll abandon a storyline that everyone hates, or stage an attempt to soothe the fans and give them what they want. There's no question it's a very love/hate push/pull relationship. The fans keep the product in check with the "benevolent dictators" up top, and the guys in suits know where their bread gets buttered.
Does this principle exist outside of pro-wrestling fandom? Of course it does, I just feel like using examples close to my own heart. When a customer gets stinky service at an upstart Tapa's restaurant, they make sure to put it out on Yelp for all future would-be patrons to know firsthand. When their package is mis-delivered and must be intercepted in the bowels of a leaky and over-crowded post office, they warn all those in the city municipal to stay well away from it, and when they have a bad experience at the doctor's office, they're quick to drag Dr. so-and-so's name through the internet mud. They know, as does anyone who's trying to maintain a business in this mid-latter chunk of the 2010's, that if an idea gets enough "up-votes" it becomes ubiquitous, a sore thumb that no one can ignore. It's with this mentality that they hope for the business owners (be they shops, post offices or physicians) can see their complaints and make changes.
Customers are NOT always right
Oftentimes, people are most motivated to act online when they've got a jagged score to settle, emboldened by the experience of being slighted and ready to air out their grievances to a gaggle of anonymous, online perusers in similar predicaments to our own. This is a constant problem for physicians who are trying to encourage patients to leave positive online reviews for them. Many only feel energized and motivated to leave reviews when they are legitimately upset.
The problem is that patients, as inundated with the "customer is always right" mentality as they may be, are NOT always right. A Frustrating Patient and how this Affects Physicians, chronicles Dr. Lucy Hornstein's experience with a patient in desperate need of a lifestyle change due to high blood pressure and cholesterol. After showing the patient the facts and test results, and resolving to help the patient set a new goal for something healthier the patient simply "disagreed" with the physician's analysis and moved on. Is this truly the casualty of the internet generation? Surly and sensitive patientsversed in google analytics who can tell you what "SEO" stands for and have been WebMD-ing their symptomatic summer colds and Wikipedia-ing (they're verbs now) their college term papers. Those who know what they want and know 10 other apps that can get it for them. Customers who've bargained for cheaper tacos than this (so to speak).
If so, what are physicians? Just the fleshy conduits, sometimes staffed in inconvenient offices and crowded waiting rooms, to health information that they could just get online when the customers needed it?
Who Wields the Pitchforks?
In the world of healthcare, bad online reviews attract attention just like car-crash news outsells "feel-good stories" on the 6 o-clock news. In a time of diminishing reimbursement payments, when a physician has too many bad reviews, it can have a nasty impact on how much money they'll get from participating insurance companies. Plus, there's pressure on physicians to prescribe less, for more efficiency, which can often lead to aggressive patient reactions, and bad online press.
What to do with bad online reviews?
Some notable physicians (like Kevin Pho, MD) encourage physicians to deal directly with the online community of patients. Physicians can control their own SEO with their own social media pages and can bump up their own sites in the search rankings. Others keep the internet patient community at arm's length, keeping in mind HIPAA requirements and other security breaches that can occur between physicians and patients on the internet.
Regardless, physicians should still maintain awareness of their presence on the internet, even negative criticisms. Not all criticism is invalid, and at the heart of ever tangential internet rant, there's always a take-home for both parties. Furthermore, cloaked in anonymity and a little bit angry, online patients can often miss subtle behind-the-scenes obstacles that may have made their office visit unpleasant. They don't know about the computer system that went down or the receptionist who called in sick and how that gummed up the works that day.
My father would call it something like "entitlement" or that thing that people feel because they've got a never-ending and always available platform from which to scream their disgust from the rooftops. There's certainly some truth there, but I have a hard time believing that ALL criticism on the internet is inherently misguided.
It's the product of our age, and though it can be a giant, clumsy instrument to exact its ends, physicians shouldn't be too dismissive of the negative feedback they read here. If for nothing else, it's keeping them connected to their bottom line and their consumer desires. The customer may not always be right and neither is the internet, but then again, who is always right? As long as everyone's got a place to air their laundry.
Hornstein, Lucy. "A Frustrating Patient, and How That Affects Her Physician."
KevinMD.com. KevinMD, 8 Sept. 2014. Web. 12 Sept. 2014.
Kane, Leslie, MA. "Can a Good Doctor Just Say No?" Medscape.
Medscape, 29 Aug. 2014. Web. 12 Sept. 2014.