One thing that has changed in medicine over my career is the emphasis on patient reviews. As time has passed, more of what we do as physicians has been attached to various metrics, and our identities and success or lack thereof have been defined by these metrics. A huge part of these metrics is patient reviews. In speaking with many of my fellow physicians and seeing numerous comments on physician social media sites, it seems that the level of importance of these reviews determined by one’s employer directly correlates with the level of dissatisfaction and burnout in medicine. The more emphasis placed on reviews, the unhappier the doctor.
I can completely relate to those who approach the regular (in my case, monthly) Press Ganey or similar types of reports and comparison to peers with extreme dread. I used to be one of those people. I would get very tense, try to avoid the emails, often hit delete without reading them, or other times force myself to read them with a pit in my stomach and end up questioning my worth as a physician. It was a horrible experience repeated month after month. Even when the majority of the reviews were positive, I would obsess over those one or two comments from the unhappy patient.
But that was before I learned a better way to approach negative reviews and, more specifically, how to think about them.
I now have a very different reaction and approach to negative patient reviews, which I think many physicians may find useful.
Before I get into how to approach negative reviews, I want to point out the different types of reviews I’ve encountered. There are three main types of negative patient reviews that I’ve seen over the years. I am limiting these categories to those involving actual interactions with the physician, not ones that have to do with staffing or parking or waiting rooms or wait times or other factors that may be totally out of a physician’s control. As frustrating as those reviews can be, they do not usually sting as bad for most physicians as when it comes to someone saying something directly about us.
Three types of direct negative patient reviews:
Type 1: You did everything “right,” and the patient is still unhappy.
Type 2: There are things you could have done differently or better, and the patient noticed and is unhappy.
Type 3: The patient claims you said or did something you didn’t say or do, and they are unhappy.
When you read a negative review, it’s natural to feel defensive, a normal and common reaction that helps protect you from danger. What I’m going to suggest, however, is to try to stay curious. Being curious enough to explore the review from a place of interest will allow you to use these reviews as an opportunity to grow as a physician and as a human being in the best possible way.
When evaluating your interaction with a patient, the most important question is the following: What was I thinking?
This is so important because what you think at any moment determines the feelings that drive your actions. These all become part of what your patient experiences during your visit.
You want to be very honest with your answers here. If you examine your thoughts and you don’t like what you see, you can choose to shift them in a future encounter with your patients. This is learning and growth at its finest.
The three types of negative patient reviews are associated with three categories of thoughts:
- Clean thoughts
- Not so clean or “dirty” thoughts
- Mismatch (a.k.a. misinterpretations and lies)
I recently went through this with a client of mine who received a negative review. The patient was frustrated that they came for a second opinion and ended up with the same diagnosis that they received in the past, stating that their visit was “a waste of time.” They also criticized the physician’s line of questioning, particularly questions about their mental health history. When discussing the interaction with my client, it was clear that she took a careful history and asked appropriate questions that led to an independent diagnosis of the patient’s condition. Most importantly, her thoughts during the patient encounter were focused solely on achieving and explaining the diagnosis, and her goals throughout were to help the patient. The physician was upset that the patient was upset, even though she would have done the exact same thing again.
This is an example of having clean thoughts in your patient interaction. Your mind was in the right place, and you are happy with how you showed up.
In the situation where your thoughts were clean and your mind was in the right place, and you would do the same thing again if given a chance, here are some new thoughts I will offer:
People have a right to be unhappy.
What others think of me is none of my business.
I can be comfortable with my patients’ discomfort.
Being a patient can be scary and hard.
Part of my job is telling people things they don’t want to hear.
My biggest job is to be an agent of health and healing.
There are a million other thoughts that could generate a feeling of compassion for your patient and yourself, but these are some that I like that allow me to acknowledge my patients’ experience while still having my own back.
Not so clean or “dirty” thoughts
A client of mine had a negative review where the patient felt rushed. We discussed the interaction and particularly her thoughts during the visit. She admitted that while she did start the visit late due to a prior complicated visit running late, she tried hard not to make the patient feel rushed. But when I asked about her thoughts during the visit, it was clear that she was already worried about the patient’s perception of the late start before she walked into the room. She was also thinking about how she would get out on time to get where she needed to go after the visit. Despite the doctor’s efforts, the patient perceived this during the visit and called her out on it in the review.
In such situations, you can find the truth in the criticism but not beat yourself up for it. After all, you are a human being in an imperfect system doing the best you can in your environment. You can acknowledge where your thoughts may not have been so “clean” and inadvertently tripped you up and see if there is any room to shift them. Some thoughts to consider in this scenario are the following:
I’m allowed to be human and not always at my best, but I always want what’s best for my patient.
When I focus more on them and less on me, everyone benefits.
The final category of direct negative reviews and associated thoughts involve patients describing a physician interaction that the physician disagrees with. Your patient experienced one thing, and you experienced something completely different.
I had an upset client who received a negative review that claimed she said something that she absolutely believed to be false and denied saying.
As painful as this type of review can be because it’s so one-sided and you don’t have an opportunity to state your perspective, my suggested thought in this scenario is very simple and goes as follows:
People are allowed to be wrong about me.
There’s so much freedom in allowing others to judge, criticize, misinterpret, and even lie about us. When we give others permission to do these things and not react, their words lose power over us, and we strengthen our self-concept and identity. That is ultimate confidence and leadership, all qualities in a great physician and a great human being.
So whether a patient is unhappy because you told them something they don’t want to hear, you showed up as your not-so-best self, or they misinterpreted an interaction or even flat-out lied, you can always choose to remain curious and compassionate for them and for you. You can try to remember that just as the best doctor can have a bad day, the best patient can too. One of the greatest privileges and challenges of being a physician is seeing people at their worst, which also means getting negative reviews. The longer you are in practice and the more people you encounter, the more negative reviews you are bound to receive. Dealing with negative reviews was likely not part of your medical school curriculum, but it’s never too late to learn to shift your thinking on this common part of practice.
Sofia Dobrin is a neurologist and physician life coach.