Thanks, but no thanks: The downside of recommending a doctor online

If you’ve found a good doctor, think twice before you reveal their skill on facebook. Under the latest guidelines from the Australian Health Practitioner Regulation Agency (AHPRA) leaving a positive comment about a health professional on social media may count as a testimonial for their services – something that’s banned under law. So instead of doing a favour to the doctor whose praises you’re singing, you could be leaving them facing a $5,000 fine.

This restriction on recommending a health professional’s services may seem strange when a common starting point for finding a doctor, dentist or physio has always been word of mouth. After all, it’s often hard to find someone you feel comfortable with and trust – so it makes sense to find out the opinion of like-minded people.

But while discussing the pros and cons of a certain doctor or dentist around the relative privacy of the workplace water cooler remains ok, the latest AHPRA Guidelines draw something of a distinction between traditional word of mouth and making an online recommendation.

From 17 March 2014, new Guidelines for Advertising Regulated Health Services come into effect across the country. These help health professionals interpret the national laws which regulate their conduct. The national laws, in turn, provide that “a person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that uses testimonials about the service or business”.

Unfortunately, the laws don’t go on to define exactly what’s meant by ‘testimonial’. Instead, the guidelines simply suggest that it should take on its ordinary meaning of ‘a positive statement about a person or thing’. The guidelines also differentiate between a ‘testimonial’ (which is not ok) and a ‘review’ (which is), because under its definition a review only comments on the non-clinical aspects of the service.

Sounds confusing? It is. But our interpretation is that under the guidelines it seems that it’s fine to post an online comment which says “The décor in Dr Smith’s rooms is modern and there is free tea or coffee available while you wait”. And if you’ve had a bad experience, it even seems okay to post a negative comment, such as “Dr Smith rushed through the consultation and did not do the tests he should have done”. (It’s doubtful, after all, that anyone would consider that a testimonial for Dr Smith’s services.)

But when a comment goes from being ok to being a testimonial is when it includes positive remarks concerning clinical care. For example, saying something like “Dr Smith was polite, attentive and listened to all my concerns, before giving me a thorough examination and referring me to a specialist,” would fail under the guidelines.

AHPRA’s stated reason for making these distinctions is to ‘protect the public’. To this end, the guidelines argue that ‘testimonials can distort a person’s judgment in his or her choice of health practitioner’.

It sounds, on the face of it, like it might be a legitimate reason to ban positive comments after all. But we think there are serious flaws in this sort of reasoning.

To begin with, it’s hard to know how serious a problem this actually is – how many people rely on social media comments to choose a doctor to their detriment? Is it not better for someone to choose their doctor based on someone’s view that they communicate well with patients, rather than on their office décor? And why are negative comments acceptable if they can’t be balanced by positive ones?

In this new age of digital openness, what does AHPRA suggest is a better way to choose a doctor than through the experience of others, even if it is online, particularly when – on a platform like facebook – they’re the recommendations of people they know and trust? After all, it can be very difficult to know whether a doctor has had any issues with their practice or registration. (Recent media attention on rogue medical professionals proves that). Isn’t it a consumer’s right to know this information before entrusting them with their healthcare?

As the law stands, if a health practitioner becomes aware that someone has posted a testimonial about them they must take reasonable steps to have it removed. If they don’t, they could be left with a fine or face disciplinary action. The maximum penalty for any individual contravening these provisions is $5,000 and it rises to $10,000 for a body corporate – such as a medical practice. The registered health practitioner whose services are praised may also face disciplinary action for unprofessional conduct.

In short, while it’s understandable that AHPRA wants to discourage testimonials or the selective publishing of comments, it’s harder to see how genuine feedback on a healthcare professional’s level of care could distort a person’s judgement – especially in an environment like facebook where people have equal power to post both positive and negative comments.