How the web threatens GP reputations

Magnus Boyd

A doctor’s most valuable asset is his or her reputation and the potential for that reputation to be damaged is increasing all the time. The speed with which inaccurate and unfair allegations can be published to a global audience means that a reputation that may have taken years to build can be destroyed in the time it takes to open an e-mail or read a headline.

The latest threat to doctors’ reputations comes from the growing number of websites that exist for anybody, but particularly patients, to post their comments about doctors.

Many of these websites are geared towards specialist areas such as plastic surgery and the experience so far has not been good for doctors. For example, www.lookyourbestuk.com has hosted a number of postings containing inaccurate, misleading and defamatory comments about the treatment and care provided by some surgeons. Whilst there is a clear public interest in the exchange of information between patients on such websites there is an equal responsibility on those who post and host such websites to ensure that what will be read by others is scrupulously fair and accurate.

I have recently acted on behalf of a group of 37 doctors concerned about the website iwantgreatcare.org. The doctors I represent are concerned about the potential for defamatory allegations to be published on the site and I have written to the founder of the website, Dr Neil Bacon, to outline their concerns.

My principal anxiety is that the site allows comments to be posted without being moderated first. Dr Bacon has stated that potentially libellous comments will be removed within hours of being put up. Such a policy is inadequate as irreparable damage to a doctor’s reputation can be done in minutes rather than hours. What’s worse, however, is that such a policy would be unnecessary if Dr Bacon employed moderators to filter the postings before they were put up in the first place. The NHS Choices website revealingly employs a team of 16 moderators to filter offensive or potentially libellous postings. It also has a clear and explicit policy not to allow patients to rate individual doctors. The same approach is adopted by Patient Opinion, which is overt about its moderating and does not accept comments on individual doctors.

The problem with sites like iwantgreatcare is that they are wide open to abuse. The site risks being used as an opportunity for harassment or for doctors to ask their pet patients to post comment about them for marketing purposes. Comments can be posted anonymously or through pseudonyms and via multiple e-mail addresses to create the impression of a campaign against a doctor. What is to stop colleagues rubbishing each other under the guise of being a concerned patient? It is ominous for doctors that the General Medical Council has refused to rule out anonymous comments being used in disciplinary hearings.

Ratings websites add yet another layer of pressure on doctors to treat the patient’s whims rather than the patient’s symptoms and avoid provoking a negative posting on a website.

Some doctors have contacted me with screenshots of the iwantgreatcare website demonstrating the practical risks associated with such a site, such as evidence of inconsistent and delayed moderating, the wrong clinicians being identified and, in the case of doctors with common names, the risk of being libelled by association. The Picker Institute has doubts about the ability of iwantgreatcare to provide the accurate patient feedback they think is required and NHS Choices is distancing itself from the site as it does not want to be perceived in the same way.

Many doctors feel trapped between the devil of defamatory postings and the deep blue sea of taking steps to remove them. They are worried that in taking action against such websites they risk drawing more attention to the allegations. Doctors are also concerned not to be portrayed as overly sensitive to comment on their skill or negative towards patient feedback.

As doctors become increasingly aware of the potential risks to their reputations they are unfortunately being met by a lack of support. Colleagues frequently distance themselves so as not to be tarnished by association. PCTs find it almost impossible to justify directing any resources to deal with the problem when it arises. The main insurers are loathe to cover defamation claims. The various medical professionals’ unions also take the view that libel claims are not worth supporting in the same way as employment tribunal proceedings or other forms of litigation that safeguard their members. Doctors can quickly find themselves isolated.

For ratings websites to gain credibility they must quickly demonstrate that they are not being abused as a platform for irresponsible patients or misused by colleagues making mischief. The best way to avoid such traps is to establish a clear, open and consistent protocol for moderating postings before they are published. In areas outside of medicine these sorts of websites have been used to add real value to public debate by sending comments to the relevant people they are about and inviting comment. The posting and comment are then published together to provide a context.

My advice to doctors dealing with ratings websites is to accept criticism when it is fair and accurate and to take steps to have it removed from a website if it is misleading, distorted or false. Time is of the essence and you must act quickly. It is worth asking someone to monitor some sites if you are ever away for any length of time. Doctors should have no qualms about taking whatever steps are necessary to have a posting removed if it is defamatory and to seek a timely and prominent correction from the website. Afterall, it is not in the public interest for the public to be misled.

Magnus Boyd is a partner with media and human rights lawyers Carter-Ruck and specialises in reputation protection, defamation, privacy and breach of confidence.