Respect patient confidentiality at all times.
Responding could make the situation worse.
Service providers can remove obscene or abusive material.
Seek MDU advice about correcting misleading information.

Unwelcome attention

Dissatisfied patients are increasingly ready to use social media and online ratings sites to post comments and complaints. Some of this feedback can feel unjustified and misleading and occasionally it can be abusive, defamatory or offensive.

Unfavourable mentions of the doctor will still be included in online search results, even if they occurred many years before.

Responding to online criticism

If you believe your reputation has been damaged online, your options include:

responding directly to the negative comment
complaining to the website and/or asking for the offending information to be removed
using the 'right to be forgotten online' to remove the page from search results
a defamation action.

All of these approaches carry risks, and doctors should seek specific advice from the MDU.

Factors to consider

Patient confidentiality

When misleading stories appear, it's often impossible to give your side of the story without revealing personal information about the patient.

The GMC accepts that it can be frustrating for doctors to see inaccurate or misleading information about their diagnosis, treatment or behaviour but says this "does not relieve you of your duty to respect your patient's confidentiality."

Elsewhere, the GMC says (para 18): "When using social media of any kind, you must maintain patient confidentiality and recognise and respect patients’ dignity and their right to privacy."

Can you respond positively?

Some practices reply to negative feedback on the NHS Choices site, thanking patients for their comments, apologising if they are dissatisfied with their treatment and inviting them to get directly in touch to discuss any concerns.

This approach is in line with the NHS complaints procedure, which emphasises the need to be open and honest with complainants and to learn lessons from complaints.

Can you avoid making matters worse?

Rebutting critical comments directly or attempting to have a post removed may inflame the situation and could prompt the person to re-post their comments on another site. The GMC says: "Disclosures of patient information without consent can undermine the public’s trust in the profession as well as your patient’s trust in you. Disputes between patients and doctors conducted in public can also prolong or intensify conflict and may undermine public confidence."

If you post a response, this could make the page more prominent in search engine results. Equally, taking legal action against a defamatory poster could generate further unwelcome publicity.

Service provider policies

Most websites and forums have terms and conditions that prohibit abusive or offensive material and allow users to report posts.

For example, patient feedback on NHS Choices should comply with its Comments Policy. Posts can be reported to the site moderators using the link provided alongside each comment. NHS Choices does not promise to remove such comments, although it promises to investigate as soon as possible.

Meta (or Facebook) says it may take action where material violates its Community Standards such as direct threats and hate speech but may allow content in some cases "even if some may disagree or find them objectionable".

Correcting misleading information

It may be possible to seek a correction, clarification and/or apology from a media outlet if a member feels their clinical practice has been misrepresented online.

As above, it's necessary to consider patient confidentiality and the risk of the offending content being made more prominent. The MDU press office can advise further.

Defamation law

Defamation occurs when a false statement is made that harms or lowers someone's reputation or is likely to seriously damage their reputation.

However, The Defamation Act 2013 provides several defences, including:

the matter imputed was substantially true
that it was an honestly held opinion
that it was a statement on a matter of public interest
the statement is in a scientific or academic journal and is protected by privilege.

Defamation actions can be lengthy, expensive and it's difficult to predict the outcome with any certainty.

In addition, the publicity generated often means the defamatory comment reaches a wider audience than the original statement. It's therefore not generally in the interests of MDU members to use our mutual fund to pursue defamation actions.

The right to be forgotten online

In 2014, the Court of Justice of the European Union (CJEU) ruled that search engine operators are data controllers and individuals therefore had the right to ask them to remove search results on privacy grounds if these 'appear to be inadequate, irrelevant or no longer relevant, or excessive'.

The ruling said 'a fair balance should be sought' between the right to privacy and the public interest, which may depend on:

the nature of the information in question and its sensitivity for the individual's private life
public interest in having that information, which may vary according to the individual's role in public life.

The 'right to be forgotten' (or 'right to erasure') was incorporated under UK law as UK GDPR when the UK left the European Union.

The major search engines Google, Bing and Yahoo have created web forms to request the removal of search results. Google says: "In evaluating your request, we will look at whether the results include outdated information about your private life. We'll also look at whether there's a public interest in the information remaining in our search results – for example, if it relates to financial scams, professional malpractice, criminal convictions or your public conduct as a government official (elected or unelected)."

When considering whether to make a request, you should also remember:

web pages and documents will not be removed from the internet, only the opportunity to access them via a search engine link
the judgment also only applies to EU countries. It may still be possible to navigate to the particular page by using a completely different search term or the same search term entered into a search engine outside the EU
having a website link erased may not be the end of the matter and may itself attract comment.

Dealing with online criticism

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