CONSUMER review sites like Yelp are a wonderful resource if you’re trying to find a reliable plumber or good hair salon. And they provide a great forum for customers looking to rant or rave. However, as these sites begin to cover more aspects of consumer life, complications arise — as, for instance, when people review confidential mental health care services.
As a psychologist, I worry that these reviews have the potential to harm both the provider and the patient.
It’s one thing to write online about your experience hiring a housecleaner, but posting about the treatment of addictions, sexual abuse, depression or chronic illness is a different matter. What patients might feel comfortable sharing today they might, tomorrow, wish they’d kept private. And while a reviewer can almost always delete or edit his post, it’s impossible to know who has already read it, or whether that information has been stored someplace else.
Of course, no one wants to be the subject of a bad review, but psychotherapy services are special. If you wait an hour for an appetizer, chances are that other diners will have a similarly bad experience. But unless a therapist regularly falls asleep during sessions, patients’ experiences in psychotherapy are more subjective. A certain treatment might help one person but not another. Something that works for one patient at a particular point in therapy might not work for him later, when his needs change. What makes one patient upset enough to write a bad review might not bother — in fact, might even help — another.
And psychotherapy can often bring up upsetting emotions. It’s important for patients to discuss their reactions, positive and negative, directly with their therapists. Even when someone decides not to return to a certain therapist, telling the therapist why can provide closure.
If a patient does post a bad review, a therapist, unlike a regular business owner, is unable to respond in any way that could violate patient confidentiality. Equally problematic: just the fact of a practitioner being listed on a review site can look like a solicitation for patient testimonials or ratings, which is forbidden by every ethics code in the mental health professional’s book.
I’ve run into this problem myself. As far as I know, I’ve never been reviewed by any patients, and yet my practice can be found on Yelp. (Presumably this is because the site combs search engines for businesses and posts the results to invite reviews.) I tried to get Yelp to remove my listing, but was told that it was public information. I know other colleagues who have been similarly dismayed to see their practices listed on the site.
Some doctors address this problem by requiring their patients to sign forms promising not to post reviews of services on Web sites. A company called Medical Justice, which helps doctors fend off malpractice suits, has encouraged its clients to have patients sign agreements giving the doctors control over Web postings mentioning their practices.
Neither of these approaches seems legally or ethically sound to me. One solution is for doctors to offer patients customer satisfaction forms, so they don’t feel that the only medium to express grievances is a public one. But people should be able to find good mental health care providers online, and to warn other consumers about bad ones. The popular consumer sites that already host reviews of these services just need to take more responsibility for protecting patients and doctors.
Such sites should create separate forums devoted to health-related services, modeled after health-specific review sites like HealthGrades. These sections should offer reviewers additional protections when sharing personal information, particularly by allowing them to post anonymously without linking to their regular profiles. This might also allow practitioners more freedom to respond to reviews without compromising patient identity.
The sites could also require users to include more meaningful data, such as the duration of their treatment, what they sought care for, how long they have had their particular health concern and whether they addressed any complaints with the care provider. In addition, it would be useful to know how many other practitioners they sought treatment from, and whether they eventually found successful treatment elsewhere. This information would help those seeking care for a similar problem, as well as put a bad review in context. Finally, the sites should direct visitors to their states’ licensing boards, in case a formal complaint is called for.
Consumer review sites have helped goad many businesses to make improvements. But in this case, they could use some improvements of their own.
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