[Editor's note: This is the first part of a two-part series on issues surrounding social media and ambulatory surgery. In this issue, we give you some horror stories and tell you how to avoid them. We tell you how to be proactive about your online presence, as well as how to develop a social media policy. Next month, we discuss legal issues and employee training.]

Patients with unrealistic expectations, overworked staff, and the increasing popularity of social media have converged to create a perfect storm of tirades — at least some untrue — against surgery providers and facilities on the Internet. Reputations are destroyed with a few keystrokes. What can be done?

Very little, according to experts interviewed by Same-Day Surgery. "You can choose to be part of those conversations or not, but you can't keep from having those discussions happen," says Ben Dillon, vice president and eHealth "evangelist" at Geonetric, a Cedar Rapids, IA-based web software solutions company that focuses on healthcare.

Consider these recent examples of online attacks:

  • After a patient underwent a facelift by Barry Eppley, MD, plastic surgeon, Indianapolis, IN, she claimed that the procedure caused obstruction in her airway and breathing difficulty, Eppley says. He consulted other experts, none of whom had heard of this complication, he says. She created websites to post negative comments or direct potential patients to negative comments, according to Eppley. She posted a negative video about him on YouTube that attracted hundreds of thousands of hits. The patient was featured in an HBO documentary titled "Plastic Disasters." Eppley says he addressed her concerns for a year before he stopped contact with her due to "bizarre and irrational" behavior. The judge ordered her to remove the "false and offensive statements" and fined her $40,000, but the patient had committed suicide the day before the ruling, according to Eppley. Some of her comments still are posted on web sites that are not under U.S. jurisdiction, he says. (For more on this case, see story, below.)
  • An Arizona plastic surgeon and his physician wife were awarded $12 million after a patient created a website to criticize the physicians and question their credentials. The patient also put negative postings about them on websites that reviewed doctors. The patient, a jazz singer, developed a serious skin condition that she claimed disrupted her life. She submitted several complaints to the state medical board. The physicians said she posted incorrect information and caused their $4.5 million practice to drop to two patients a week.1
  • A former nurse complained that staff members were being allowed to take photos of sedated patients and post them on Facebook. She subsequently was fired. She claimed violations of the Health Insurance Portability and Accountability Act (HIPAA), among others, and has sued the hospital for more than $15 million over her firing.2

Social media cannot be ignored, says Paul A. Anderson, ECRI Institute's director of risk management publications.

"First, people in their communities, current patients and their families, and even staff members are already using social media, and some of them are probably talking about the organization on social media," he says. "Without a social media presence, the organization won't know about what's being said, and won't be able to respond if that's appropriate.

Secondly, social media offers another public relations opportunity, he emphasizes. Dillon agrees. "Remember that you're living your brand every day and you should do that in social media just as you do when answering the phone or greeting patients in the waiting room," he says.

Patients are researching potential providers and their facilities prior to their first visit, says Kim Woodruff, vice president of corporate finance and compliance for Pinnacle III in Lakewood, CO, which develops and manages single and multi-specialty ASCs. "Maintain an ever-present awareness that everything you put on your site will either support, promote, or damage your reputation," Woodruff says. "Social media is free exposure; therefore, you have to be prepared to deal with the bad as well as the good comments you may receive."

You can't control what is said about you, "real or imagined," says Neal R. Reisman, MD, JD, FACS, chief of plastic surgery, St. Luke's Episcopal Hospital, and clinical professor of plastic surgery, Baylor College of Medicine, physician at Plastic Surgery Specialists, and attorney at law, all in Houston, TX. "I have heard stories of competitors and even reputation defense companies posting bad reviews to discredit the doctor, or generate business," Reisman says.

In fact, many states and one territory have SLAPP (Strategic Lawsuit Against Public Participation) legislative or judicial protection, he says. (See list, below.) The legislation/court rulings protect comments on a public interest issue in a public form, and they include the awarding of attorney's fees, Reisman says.

States and Territory with SLAPP**

Here's where to start

Actively monitor your online reputation, social media experts advise. Even if you choose not to create new content, at least be aware of what is being said about your facility, Anderson says.

"By creating free profiles on the most common free services — Facebook, Twitter, Google+, for example — the organization's staff can get familiar with them and keep an eye on what's going on," he says.

Set up alerts at from Google.com/alerts and Socialmention.com that will tell you if your facility's name has been mentioned in social media, provider advises. Woodruff says, "Be vigilant about checking out what's being said, especially on physician ranking sites which you don't 'own.'"

Also, use a search engine to search for your facility's name, and go to the web site GoDaddy.com to purchase all domains with your name, such as your name.com, yourname.me, etc., suggests Patrick Ambron, cofounder and CEO of BrandYourself.com.3

ECRI Institute, which recently published a free guide to social media, suggests that you assign one person or group to post content on social media, monitor its use, ensure execution of a social media plan, and monitor for violations. (For information on ordering the ECRI guide, see resource at end of this story. For more on developing a social media plan, see story,below.)

"Remind users of social media that they must in all circumstances be honest and respectful toward other users," ECRI advises.

Address any potential damage as quickly as you can, Woodruff advises. "Being caught unaware is likely worse than having never established a social media presence in the first place," she adds.


  1. AlltuckerK. Scottsdale doctors awarded $12 million in defamation case. Singer had defamed Scottsdale plastic surgeon on website. Arizona Republic; Dec. 16, 2011. Accessed at http://bit.ly/rTf8Y5.
  2. HealthLeaders Media. Nurse accuses hospital employees of posting Facebook photos of sedated patients. Accessed at http://bit.ly/vZ2qc3.
  3. Manage Your Online Reputation. Parade. Feb. 19, 2012.


The ECRI Institute. has published a free guide to the social media. Web: http://bit.ly/ya9WgL.

The American Medical Association has a policy on professionalism in the use of social media. It is available at http://bit.ly/bswKCB.

'The worst nightmare' any person can experience

MD shares lessons learned

When a plastic surgeon tried to assist a patient who requested revisional surgery, what followed was "the worst nightmare any person can experience," says Barry Eppley, MD, plastic surgeon, Indianapolis, IN. The patient created web sites to criticize him, posted a video on YouTube, and even was featured in an HBO documentary.

"All I did was try to help a lady, and it cost me endless amounts of money, time, and damage to my reputation, and I did nothing wrong," Eppley says.

He later learned that the patient's original physician had to issue a restraining order against her after he experienced similar retaliation, Eppley says. "One mistake I made, I learned from it and will never repeat … is that when you have a plastic surgery revisional patient that comes from afar, call the original doctor," he says.

Here are other tips he shares:

• Trademark your name.

Any physician or surgery facility can trademark a name, says Eppley, who eventually took this step that allowed him to sue in federal court for trademark and copyright infringement. Otherwise, it's virtually impossible, short of a federal court order, to have negative information about you removed from the web, he says.

However, Eppley and others agree that legal recourse isn't the best place to start. Ben Dillon, vice president and eHealth "evangelist" at Geonetric, a Cedar Rapids, IA-based web software solutions company that focuses on healthcare, says, "I don't think that it's practical for a start, and I doubt that it will be effective. Heavy-handed approaches make your organization look like the bad guy and tend to ultimately backfire."

Most complaints or negative comments can't be resolved via social media, admits Paul A. Anderson, ECRI Institute's director of risk management publications, says, "What organizations can do on social media, however, is reach out [on the same social media] to those who have concerns or complaints, let them know that you've heard their concern, and invite them to contact the organization to discuss the issue further. Doing this consistently can help emphasize the idea that the organization is patient-focused."

• Be proactive.

Whether you like it or not, your reputation is being forged on the Internet, Eppley says. "You can contribute to it and shape it, or let everyone else do it for you," he says.

Unhappy patients are 16 times more likely to make comments than those who have positive experiences, Eppley says. However, don't ask patients to sign a pre-surgery waiver that says they won't post negative comments after surgery, he advises. Many legal experts believe it is illegal, and it also gives a poor impression of your practice, Eppley says.

Instead, "there are a variety of ways you can create your reputation," he says. Have a Facebook page, and monitor the comments that are posted, Eppley says. Employees can post positive comments, but they should disclose their relationship with your organization, Dillon says.

Let the information that gets indexed and searched on the Internet be the information you help create, Eppley advises. "That's the single best thing you do."

That advice is seconded by Kim Woodruff, vice president of corporate finance and compliance for Pinnacle III in Lakewood, CO. "One way to minimize the impact of negative posts is to ensure the positive, informative, current content you are posting is deep enough to 'push down' the relatively few, hopefully, naysayer comments that appear in the search engine queue," Woodruff says.

Forty percent of Internet users don't go beyond the first page of a search engine's results, and almost 85% don't go beyond the second page, she says. "The negative comments do not go away; they just become more difficult for people to find," Woodruff says.

How to create a social media policy

According to a recent guide to social media published by ECRI Institute, you should establish a policy that defines whether and how the organization will reply to criticism, complaints, and compliments posted on social media.1

"From a compliance perspective, a social media policy is absolutely essential," says Kim Woodruff, vice president of corporate finance and compliance for Pinnacle III in Lakewood, CO.

Most organizations should have policies to address the official social media channels of the organization and the use of social media by other employees, says Ben Dillon, vice president and eHealth "evangelist" at Geonetric in a Cedar Rapids, IA.

A good starting point is a flow chart from Wexner Medical Center at The Ohio State University, which is based on one from the U.S. Air Force, Dillon says. (That flow chart is included. To access that issue, go to same-daysurgery.com. You will need your subscriber number from your mailing label.) Here are some principles from that flow chart:

• Never disclose any patient information.

"This typically means that you need to move discussions off-line," Dillon says.

• Never attack the person making the claim.

"Maintain an understanding and professional demeanor at all times, Dillon says. "Remember that reacting inappropriately in a public venue is often more damaging than the original comments."

• Understand the commenter's motivations.

"There are people who just enjoy trying to get a reaction from individuals and organizations," says Dillon, who adds that such people are commonly known as "trolls." "The worst thing that you can do, when dealing with such an individual, is to respond at all, he says. "This is a hard thing, but ultimately it is sometimes best not to respond at all."

If you think that the individual has a relevant concern or there is some other issue, such as incorrect facts, then "respond to the extent possible without doing anything to violate the patient's confidentiality," Dillon says. He gives this example: "I'm very sorry to hear about your negative experience. I have contacted our patient advocate, and they will be contacting you to discuss the situation."

"[T]his sends a clear message to other readers of the discussion that you care about patients and are taking action to make things right," he says.


  1. ECRI Institute. Social Media in Healthcare. Healthcare Risk Control, November 2011, Supplement A.

States and Territory with SLAPP**States and Territory with SLAPP**