One of your friends calls and tells you that he has come across some negative comments regarding your practice as a general practitioner on facebook. You check and realize that a Tom has written many negative posts about you and the way you practice and approach your patients. One of his posts is a detailed story about how mismanaged him on a sore throat 3 weeks ago. You check your files and you recognize him, a patient you treated for a viral pharyngitis and refused to give him antibiotics despite his insistence. Which one of the following is the most appropriate action you should take in management of this situation?

1. Inform your medical defense organization and seek advice.
2. Give feedback on his posts by explaining the nature of his condition and why    you refused his requested treatment.
3. Write to ask him to remove the post
4. Ignore.
5. Contact facebook and use its policies for removing the post.

Doctors have always been subject to reputational risks from negative comments or rumors.  Nowadays and with the enormous speed at which words are spread on social media, the risk is even more significant. The issue is not only how but whether the healthcare entity or an individual physician should respond at all. Such situations make a dilemma: responding to the patient/family could be a violation of patient privacy, even though the patient or family posted their own protected health information, but ignoring the issue could be perceived as an unspoken agreement with the complaints or lack of concern with the feedback. The desire to “correct the record” or give the other side of the story when faced with the negative online posting is natural. However, doing so may lead to an allegation of breach of confidentiality or other legal consequences.

When facing such problem, as a medical center or an individual doctor, there are options to consider:

• Ignoring by simply doing nothing.
• If the patient can be identified with certainty, contact the patient directly to discuss their concerns and see if they will remove the post.
• Use the website (facebook here) policies for removal of the post(s).
• Send a letter to the patient and/or website owner and request the and/or threaten that you will take legal action for defamation.
• Start defamation proceedings.

Depending on the situation and the nature of the posts and/or comments or whether the patient can be identified, any of the above options can be choice; however, it is very important that you seek advice from an expert colleague or your medical defense organization as the most appropriate initial step in the challenge (A is correct).

(option B) giving feedback on the post means that you are discussing the patient’s private information, released to you as his doctor based on the doctor-patient confidentiality, is a breach of this confidentiality and very incorrect. Unlike complaints that are made by a patient directly to an organization, many online complaints are anonymous. You may think you know who made the complaint, but it may have been made by a relative or friend who knows about the e patient not the patient himself, but consider how he may feel if he believes that his desire for privacy, confidentiality or anonymity has not been respected.

(Options C and E) these options can be your choice; however, the decision as to whether how to respond is best made after consultation with an expert colleague or medical defense organization.

(option D) In most cases, ignoring such negative comments and/or posts are advisable if the nature of such posts/comments are benign. However, in this case, where your reputation or that of the center you are working at might be at risk, the best action to take can be considered after consultation with more expert resources of advice.