What’s wrong with Patient Testimonials?

What's wrong with patient testimonials?

Here’s a multiple choice question for you:

Which post on the wall of the doctor’s Facebook page must be deleted? (Note: ‘Doctor’ can be replaced with ‘health professional’)

a. They made me wait for an hour and when I finally saw the doctor she rushed through the consultation and didn’t seem to care. I will never go to this practice again.

b. Thank you doctor for your kindness and excellent care. We are so glad our daughter has recovered; we will not forget what you have done for her.

The right answer should be: neither post. Good social media etiquette requires a response; deleting posts is generally not recommended. The real answer is: b.

By now most of us are familiar with the risks of social media. It is unfortunate that yet another peril has been added to the list: Australian Doctor magazine reported that doctors can be fined $5000 if a patient posts a testimonial on the doctor’s Facebook wall or other social media platform.

According to new advertising & social media guidelines from the Australian Health Practitioners Regulation Agency (AHPRA), post b is a testimonial and must be removed. The general message is: all testimonials are wrong. I argue this is not the case. The danger of AHPRA’s line of thinking is that health professionals are put off social media and will stop sharing health information with consumers. Let’s have a look at the pros and cons of testimonials.

The pros

  • Consumers share their experiences via testimonials. This allows others to make decisions about which products or services to choose.
  • Testimonials increase transparency by giving consumers a look behind the scene.
  • Customers are able to express gratitude via testimonials.
  • Testimonials are rewarding and motivate staff to continue to provide a quality service or product.
  • Just like complaints allow for negative feedback, testimonials are a way to give positive feedback.
  • Testimonials empower consumers.

The cons

  • Testimonials are subjective and do not always give a complete picture.
  • Testimonials can be falsified.
  • Information in testimonials can be misleading: e.g. incomplete, untrue or unsubstantiated.

I understand that AHPRA wants to protect the public. CEO Martin Fletcher said: “Our priority is making sure consumers have access to clear information so they can make informed choices about their healthcare (…)” Could it be that allowing the public to post testimonials about their health care experiences is not in conflict with this priority?

before-after pictures

There is a difference between traditional testimonials and genuine responses and exchanges of appreciation via social media. I’m not talking about before-and-after pictures. Source: Daily Mail

To be clear:  I’m not talking about e.g. before-and-after pictures or stories (see image). There is a difference between traditional testimonials and genuine responses and exchange of appreciation via social media – which is what most Facebook and Twitter users do every day. People ‘like’, ‘share’, ‘re-tweet’ and post information including their experiences all the time. These activities should not automatically be treated as testimonials.

On the Crickey Health Blog surgeon Dr Jill Tomlinson published an excellent open letter to the Medical Board of Australia, expressing her concerns about the new guidelines. In her response Dr Joanna Flynn, chair of the Medical Board of Australia, said about the total ban on testimonials:

Whether it is still appropriate in the 21st century, when there are a whole series of conversations taking place online, with different levels of control over who says what about who, is another question altogether. If there is appetite for change, this debate should be channeled into the forthcoming three year review of the National Registration and Accreditation Scheme, which we expect will include opportunities for feedback about aspects of the Law (…)

AHPRA has followed the letter of the law and does not make a distinction between different kinds of online patient feedback.

Sharing a positive experience via social media is not always a testimonial. The national law should only forbid false or misleading statements – not ban all of them. Yes, this is complex and challenging for the AHPRA watchdog, but it’s fair dinkum and will preserve the countless benefits of social media in health care.

7 thoughts on “What’s wrong with Patient Testimonials?

  1. My Facebook site is my personal space. When I did pose with my bow and a feral cat transfixed by an arrow I did get one of my Facebook “friends” suggest that as a doctor did I really think that this was appropriate!

    What I find interesting is that I did not find out about APHRA “Revised guidelines, code and policy released today, effective from March 2014” from APHRA. There was no mail out in my letterbox. There was no email in my in tray. I was yet to see mt hard copy of Australian Doctor (which really is a form of social media), in fact it was Edwin Kruys social media blog site that I first heard about this.

    My comment is that social media will continue to provide an important role in my medical life. It is a pity that AHPRA have failed to recognise and utilise this as a means of communication. It is all well and good writing on a webpage “Health practitioners urged to read revised documents now”

    PS

    I recently looked at someone’s Facebook site to fine several photos of myself and several other health professionals in thertre scrubs delivering their baby by Cesarean. Now, I have no recollection of giving permission to upload those pictures to social media. I didn’t sign a media release! I fact I don’t even recall the camera going off given I was concentration on the surgery. I wonder what APHRA stance on this is?

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  2. A few more thoughts

    “A practitioner must take reasonable steps to have any testimonials associated with their health service or business removed when they become aware of them, even if they appear on a website that is not directly associated and/or under the direct control or administration of that health practitioner and/or their business or service. This includes unsolicited testimonials.”

    I see some enterprising software nerd making $$$$$ in offering to dredge social media using a practice patient database to find unsolicited comments about the practice professionals. Then to send an email to ask that the comment be deleted.

    I wonder how much would you pay to stay safe from APHRA $5000 fine?

    ” ‘Appointment ran very late and magazines were old’, is not considered a testimonial as it makes no reference to the clinical care provided by a regulated health practitioner, business or service.’

    So a comment that the practice runs on time, magazines are up to date, free wireless internet and espresso is not a testimony likely to increase business??

    “However, a review on the same social media site that states ‘Practitioner was quick to diagnose my illness and gave excellent treatment’, is a testimonial which references clinical care and is considered in breach of the National Law.”

    This should be the EXPECTED standard of all GP’s so really it is not a testimony at all. It is akin to saying the doctor took my blood pressure and checked my prostate!

    I wonder if you reviewed every ECG on the internet that there would be a patient consent approving its use. This concept undermines free and open meducation.

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  3. Interesting discussion, thanks Ed (who may or may not be an excellent or average GP!)

    I can understand the complexity, and AHPRA is an appropriate body to dip their toes into these murky waters. It is reasonable to start thinking about these issues from an anti-advertising position, because an ad which includes a testimonial goes beyond the neutral ‘These are our practice hours and services we offer’, into the promotional ‘Our service is better than the one next door’.

    However, after starting from that position, AHPRA has decided it is all too hard, and so has lumped everything into the one basket in its warning. Clearly there needs to be a distinction made between advertising testimonials and allowing independent pleasant comments to remain online. AHPRA’s current solution is a lazy way of saying ‘We can’t work out all the variations, so it’s easier to ban everything, which will cover us if we need to admonish a doctor’.

    They will feel this is safe because, in practice, they only need consider blatant advertising claims, or cases where a complaint has been made. From their viewpoint, therefore, a broad-spectrum approach is simplest. However, it certainly creates headaches for doctors active on social media! AHPRA’s blunt hammer reflects a lack of effort, whereas this deserves a nuanced approach.

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