The Subscription Business Model: Patient churn is killing your clinic’s profitability.

The single most important determining your success and profitability is how well you do one thing; create value for your patients.

Most providers don’t actually understand that sentence very well. They see ‘value’ as the effort they put in to provide good medical advice – but that’s just a tiny part.

When you don’t provide value and build relationships in the ways that your patients want – especially in cosmetic medicine – they’ll drift off for greener pastures – and that loss (patient churn) destroys the long term value of your business.

Here are the numbers.

The gap is just as wide in cosmetic medicine as in other areas because it’s competitive. The fact that your staff is friendly and offer free sparkling water is no longer enough to set you apart. It’s expected, and discounted as a basic requirement.

So what can you do to set your clinic apart in what’s become a hyper-competitive marketplace.

That’s actually simple to understand, but difficult to work through – you need to do the things that patients want AND that your competitors are unable or unwilling to do.

That is NOT EASY, because the top 3 things patients want demand TIME – and you don’t have any.

Here’s what patients want:

And you can’t deliver what patients want because you can’t simply work more hours and spend more time without impacting your practice and profitability.

There’s a reason that you’re working 70 hours a week but only spending 27% of that time working at the top of your licence.

Fortunately, there are now technologies that are coming into the market that let you automate much of the time-sucking, redundant manual tasks that keep you doing everything manually.

First, telehealth came along. That was good but all of the first telehealth solutions were built around insurance reimbursements. That meant that they were manual too, and didn’t save you any time as a provider. Patient’s no longer had to drive to your clinic and sit in your waiting room, but they didn’t really save you time as a provider – you were just trading 15 minutes in a treatment room for that same 15 minutes on a video call.

You added during Covid but you’re probably using a free telehealth service like Skype or Zoom, or a slightly upgraded version like Doxy, and none of these solve the base problem; there’s only 1 of you and you can’t be in 10 places at once.

Fortunately, technology doesn’t sit still.

The newest telehealth platforms integrate both your in-clinic care with on-demand access that allow you to automate almost all of the myriad of things you’re doing that are completely redundant and manual.

These new technologies were built for large health systems and clinical trials, but have become available to smaller clinics and individual providers, and they solve exactly the problems you need solved; How do I replace the low-level redundant tasks with automation in the ways that patients love.

Read that last sentence again because it’s important. The technology has to be loved by the patients, not just be another hoop to jump through.

These new technologies were designed outside of the insurance reimbursement ecosystem. They were designed for clinical trials and drug discover where it’s critical for patients to be engaged and love interacting with caregivers. The average cost of 1 patient in a clinical trial is now $3,600! There’s no way you can afford to lose patients in these ecosystems or you’re dead in the water.

And that’s exactly the problem you have.

These new platforms allow you to create ‘care pathways’ that automate any use case; new patient onboarding, triage, treatment, followup.. whatever you want. Best of all, your patients don’t differentiate between interactions on these new systems and live interactions. You can build these care pathways, and you can charge for them.

That means that you really can be in 100 places and once.

And because you can built it once and charge for it over and over, it opens up entirely new revenue streams and business models that allow you to scale your practice and business in ways that haven’t ever been available before.

Here’s what this looks like as recurring or subscription revenue over time.

If you’re interested in creating subscription or recurring revenue for your cosmetic practice or medical spa, you can learn more here.


Links if you want to dive in further:

Advisory Board. (2018, February 12). Your staff is underperforming. Now what? Retrieved from https://www.advisory.com/daily-briefing/2018/02/12/c-performers

Bailey, D. (2017, June 27). Unicom Teleservices, Inc. Retrieved from https://www.unicomcorp.com/blog/tips-to-increase-medical-practice-profits/

Brinker, B. (2017, November 26). 10 Warning Signs of a Disengaged Employee. Retrieved from https://www.aventr.com/blog/10-warning-signs-disengaged-employee

Carter, A. (2012, March 20). Front Desk Profits. Retrieved from https://empoweringyouconsulting.com/2012/03/20/front-desk-profits/

Easy Pay. (2014, October 16). Patient Payments Blog. Retrieved from http://www.easypaycollect.com/blog/5-front-office-staff-best-practices

Gooch, K. (2016, April 26). Patients' No. 1 complaint? Front-desk staff. Retrieved from https://www.beckershospitalreview.com/hospital-management-administration/patients-no-1-complaint-front-desk-staff.html

Hamilton, K. (2017, November 18). 7 Surprising Reasons Why Your Medical Staff is Unhappy. Retrieved from https://getreferralmd.com/2013/09/medical-staff-employment-tips/

Nijjer, R. (2018, August 29). How Negative Reviews Impact SEO. Retrieved from https://www.searchenginejournal.com/how-negative-reviews-impact-seo/265991/

Quora. (2018, April 26). Why Soft Skills Are So Important For Medical Professionals. Retrieved from https://www.forbes.com/sites/quora/2018/04/26/why-soft-skills-are-so-important-for-medical-professionals/

Russell, P. (2016, October 13). Do Receptionists Keep Some Patients From Medical Care? Retrieved from https://www.medscape.com/viewarticle/870272

Sinsky, C. (2008, October 01). 10 Big Ideas That Could Make Your Practice Better. Retrieved from https://www.aafp.org/fpm/2008/0900/p33.html

Thomas, C. (2017, August 11). 11 Tips to Create a Profitable Front Desk at Your Salon Spa. Retrieved from https://www.linkedin.com/pulse/11-tips-create-profitable-front-desk-your-salon-spa-chris-thomas/

Vanguard Communications. (2017, November 10). Online Doctor Complaints Primarily About Customer Service | Vanguard. Retrieved from https://vanguardcommunications.net/patient-complaints/

Wiggins, K. (2017, March 16). How employers 'manage out' unwanted staff. Retrieved from https://www.ft.com/content/356ea48c-e6cf-11e6-967b-c88452263daf

How to Get More Positive Reviews

medical-spa-md-podium-review-marketing-2.jpg

Receiving one negative review can affect your medical spa marketing and sales?

Some clinicians believe that a couple of negative reviews are common and to counter that, you just need to receive more positive reviews. That’s easier said than done...

Some stats:

According to Vendasta, you get an 18% bump in sales when there are reviews that customers see. 

Based on Robert Cialdini’s research 77.3%, people are inclined to follow through with a favor when you ask them for help. Influencing your patients to leave a review will make a difference, so you should be making it a point to ask for reviews from your patients.

In an infographic by Website Builder, 84% patients submit online reviews to rate physicians. Review Trackers, on the other hand, find that most patients would leave a review after a negative review, and only 24.8% of patients will leave a positive review.

Here are the do’s and don’ts in getting more positive reviews.

Do Not: Disregard Any Review You Receive

You will need to find where most of your patients post about you, and start from there. 

Regardless if it’s positive or negative, you need to know where you receive them. As for responding, a simple thank you would suffice. Don’t get too carried away, choose your replies. Reply only to around 25-60% of reviews that are 3 stars and up.

However, if a negative review surfaces, it’s better to contact them directly offline than engage with the patient any further.

Do: Claim Your Listings

As such, wherever you have a listing, claim it. 

Facebook, Yelp, and Google are the best platforms to have reviews for business in general, and in Website Builders, ZocDoc, RateMD, and Healthgrades are the top 3 review sites for physicians. So you can have at least SIX different websites to have a listing on. Up to you then, which would be strategic on your part.

Do Not: Depend on One Review Page

If you want patients to come to your medical spa, then you will need visibility. Google is definitely your best bet to be noticed, although it would take a while, with some traction from other sites, you are on your way to acquiring new patients. 

You may need to consider Google Reviews as your primary channel for reviews. Through Google My Business, you can control the reviews that you receive from your patients. You would easily be found via Google provided you have complete information (i.e. website, schedule, contact details, and reviews).

Do: Add a Testimonials Page on your Website

Another channel where you can post reviews is on your website. These could be in a form of testimonials or reviews from other sites. Many physicians apply this strategy, and it is effective because it could also help arouse more interest in you and your medical spa. Adding a testimonials page would also add value to your website.

Do Not: Resort to Posting Fake Reviews

Posting fake reviews are definitely a no-no. You can detect fake reviews if there is no pro and con, if it uses uncommon terms, and if multiple reviews come in a short amount of time. Don’t be afraid to ask from reviews from your patients, even if they are family or friends.

Do: Automate Your Reputation Management

There are many reputation management software in the market, and if your medical spa does not have one yet, you may be missing out. Many businesses have seen an influx of reviews ever since installing a software. Not only that, you could control the reviews you receive and prompt the patient to write a review 

Medical Spa MD’s partner in Reputation Management -- Podium -- is in and has helped businesses receive more reviews. Your medical spa can benefit greatly by saving $1257 when you are a member of Medical Spa MD.


Supporting research and reading:

Bassig, M. (2017, August 04). Patients More Likely to Review Their Doctors After a Negative Experience. Retrieved from https://www.reviewtrackers.com/patient-reviews-doctors/

Bassig, M. (2018, April 04). Did You Know? 67 Percent of All Yelp Reviews are 4 or 5-Star Reviews. Retrieved from https://www.reviewtrackers.com/know-67-percent-yelp-reviews-4-5-star-reviews/

Bloem, C. (2017, July 31). 84 Percent of People Trust Online Reviews As Much As Friends. Here's How to Manage What They See. Retrieved from https://www.inc.com/craig-bloem/84-percent-of-people-trust-online-reviews-as-much-.html

Bonelli, S. (2017, February 08). 70% of consumers will leave a review for a business when asked. Retrieved from https://searchengineland.com/70-consumers-will-leave-review-business-asked-262802

BrightLocal. (n.d.). Local Consumer Review Survey | The Impact Of Online Reviews. Retrieved from https://www.brightlocal.com/learn/local-consumer-review-survey/

Christopher, E. (2017, June 14). 5 Proven Ways to Get More Customer Reviews On Google and Facebook. Retrieved from https://www.entrepreneur.com/article/295655

DashBurst (2017, November 02). Why Positive Reviews are So Valuable to Small Businesses. Retrieved from https://smallbiztrends.com/2017/04/importance-of-online-reviews.html

Shrestha, K. (2018, February 06). 50 Important Online Reviews Stats You Need to Know [infographic]. Retrieved from https://www.vendasta.com/blog/50-stats-you-need-to-know-about-online-reviews

Walker-Ford, M. (2018, May 06). How to Make a Website that Influences People: 9 Web Design Psychology Tips [Infographic]. Retrieved from https://www.socialmediatoday.com/news/how-to-make-a-website-that-influences-people-9-web-design-psychology-tips/522884/

Websitebuilder (n.d.). [User Reviews is The King: Why Online Reviews Can Either Make Or Break Your Business] [Infographic]. Retrieved from: https://smallbiztrends.com/wp-content/uploads/2017/04/58ba1a5ea43c71e16d55cd7f.full_.jpg

How To Reuse Your Clinic's Patient Reviews As Content

 Focus on how to be social, not how to do social.

“A brand is no longer what we tell the consumer it is – it is what consumers tell each other it is.” – Scott Cook, Founder, Intuit

You've spent a lot of time investing in getting your patients to leave some sort of review or comment. So, the question is, could you repurpose those reviews?

Read More

5 Ways To Turn Negative Reviews Of Your Medical Spa Around

If you're a dermatologist, plastic surgeon or medspa you've probably and you've been in business for a while, you've probably had some comments or reviews posted about you online that are less than flattering.

Cosmetic medicine seems to suffer from 'perfection expectations' more than other practices and with the advent of the internet and patients increasingly savvy use of it, it's easy for a less than perfect outcome or lapse in customer service to become a public event that's driving away new patients and tarnishing your online reputation. 

It's important to remember that even when 20% of all medical spa reviews are fake, that these are actually opportunities that you can use to both expand your reach and come across as a real person (which can actually help you considerably), but before you start penning a groveling apology let's take a look at how we can do some comment-judo and see if we can't turn these hurtful words to our advantage.

Here are 7 things that you can do turn around negative reviews of your clinic or medspa.

1. If the criticism has merit, apologize fast and accept responsibility.

We've all dropped the ball in some way. The more 'real person' and human you seem the more forgiving others are. Respond quickly and mean it, then outline what you're going to do to fix it now and in the future. Getting this right will position you as a clinician who cares rather than a defensive and patronizing jerk.

Had to wait too long to see someone? Wouldn't match the other local medspa's pricing? Couldn't use a Groupon after the expiration date? Admitting a negative has a strong psychological association with the truth, and you can use a small admission to actually increase your trustworthiness. Just be sure to do it fast, completely, and without that hint of sarcasm or patronizing tone that can often creep in.

2: Use it as real feedback and an opportunity to improve.

The worst reviews are the middling reviews of three thats that don't illicit enough emoitional response to even let you know where you're falling short. At least a one star review and an outpouring of profanity lets you know that you have a real problem that you can address rather than a festering wound that goes unnoticed but is continually costing you patients and damaging your reputation. So, if you get lampooned, take it as an opportunity to track down the real issue.

From Shmula: Henry David Thoreau said “There are a thousand hacking at the branches of evil for every one striking at the root.”  His statement was a commentary on the human condition but, I believe, describes quite well the state of most companies: companies launch initiatives that don’t actually attack root causes of business problems, instead their aim is on the branches — we need to pay Taiichi Ohno’s 5-Why’s a visit and remember that surgically attacking statistically validated root causes is the only way to solve problems, improve the customer experience, and improve the enterprise.

Taiichi Ohno is known to have said that “having no problems is the biggest problem of all.”  He viewed problems not as a negative but as a “Kaizen opportunity in disguise.”  Whenever problems arose, he encouraged his staff to investigate the problem at the source and to as “ask ‘why’ five times about every matter. Here's one of his favorite examples:

1. “Why did the robot stop?”
The circuit has overloaded, causing a fuse to blow.
2. “Why is the circuit overloaded?”
There was insufficient lubrication on the bearings, so they locked up.
3. “Why was there insufficient lubrication on the bearings?”
The oil pump on the robot is not circulating sufficient oil.
4. “Why is the pump not circulating sufficient oil?”
The pump intake is clogged with metal shavings.
5. “Why is the intake clogged with metal shavings?”
Because there is no filter on the pump.

The purpose here is to follow through and discover what's going wrong with your processes that can be fixed or improved. in many cases it's easy and relatively simple.

1. “Why did this patient feel the need to post a negative review?”
She was upset that she couldn't book her regular appointment for Botox.
2. “Why couldn't she book her regular Botox appointment?”
The front desk couldn't schedule her treatment at the time she requested.
3. “Why couldn't the treament be scheduled?”
The front desk software showed that there were no available appointments.
4. “Why were there no avialable appointments?”
The software won't make appointments of less than 15 minutes and won't allow double-booking.
5. “Why can't we double-book in the software?”
Because we haven't taken the time to change the settings in the software.

Perhaps that example doesn't fit you but the idea is clear. Track your issues back to the root with purpose and take care of them.

3: Overcompensate with your response.

Going overboard in your response can position you as someone who will do almost anything to please your patients. If you do it right you'll come across as one of the good guys who, even in the face of a disgruntled or angry patient, can respond with level-headed care. Using Twitter or Facebook to reach out to a (justifiably) disgruntled patient and offering them a free product, service or treatment (or more) is worth far less than it would cost for all the free advertising and congratulatory press you can get. Remember to be reasonable and don't pinch pennies or go so far overboard that it feels contrived.

If you are successful with this tactic you can reuse it across the board. Publish photos of this patient being treated in your medspa along with a few sentances and perhaps a testimonial (if you can win them back).

4: Humor always wins if it's done well.

Humor is the great equalizer that can take the sting out of any attack, especially if the attackers go overboard. Take a look at this video published by Bodyform in response to criticism on Facebook about periods being over-hyped with beauty shots.

In 2012, Bodyform received a well written complaint on their Facebook page lamenting how tampon adverts always presented an idyllic lifestyle rather than the less pleasant experience of real life... and his post was racking up likes. Instead of taking it lying down, Bodyform responded with a well-produced sarcastic apology that generated over five million views and received an overwhelmingly positive response.

5: Never leave it alone.

Any of the tactics above can work depending upon the circumstances, but the primary thing you want to do is make sure that you respond appropriately as soon as you're aware there's an issue. Any response is better than no response at all.

More reading:

Bad Reviews Of Your Medical Spa? Yelp Accused Of Extortion

Are you being extorted to keep your medical reputation clean?

Wired.com posted a story about a complaint filed in California that the online review site Yelp.com manipulates the reviews, and therefore the business ratings, through business practices that amount to extortion.

From the story:

 “Yelp’s sales tactics amount to high-tech extortion,” said plaintiff attorney Jared Beck in a press release. “The victims tend to be small businesses, such as our client, who often have no choice but to pay Yelp exorbitant sums in order to prevent further harm to their livelihoods.”

Yelp released a written statement in response to the lawsuit.

“The allegations are demonstrably false, since many businesses that advertise on Yelp have both negative and positive reviews,” the statement read. “These businesses realize that both kinds of feedback provide authenticity and value. Running a good business is hard; filing a lawsuit is easy. While we haven’t seen the suit in question, we will dispute it aggressively.”

Read the entire article here

Your reputation is one of your most valuable assets. If you're looking to protect and control your reputation in a real way, check out this review marketing product from Frontdesk.


Medical Spa MD Members get a Podium patient review marketing account and save $1,257

Protect your reputation. Get new patients. Medical Spa MD Members receive a special, full service Podium account that includes: no setup fee (save $300), a 10% discount forever (save $330/year) and on-demand patient review marketing training for your entire staff ($597 value).  This offer is not available anywhere else.

Reputation Management Part 1: Understanding What Not To Do

Physician Reputation ManagementPart 1: What is your reputation online and what can you do that will burn it to the ground?

As a physician or clinic, managing your reputation online can be a tricky task. Online review sites like Rate MD, blogs and social sites like Twitter and Facebook give patients a much louder voice and longer reach than they used to have. Worse, a couple of individuals who really don't like you can have a disproportionately large voice since - unlike your generally happy patients - they're the ones who are really motivated to talk about you. 

There are ways that you can manage and control your reputation successfully, and then there are the most common responses that do much more harm than good. By way of example, here's is an example of exactly what you don't want to do and why people do it anyway.

Case study: IMD Lasers In Toronto

A few months ago, IMD Lasers in Toronto was named in an online discussion thread on Medical Spa MD with patients calling it a "horror" and saying it should be shut down... Not what you want people to be saying but, as those who are literate in the ways of the internet know, to be expected at some point if you're treating hundreds or thousands of patients a year. The problem wasn't really that IMD had some harsh comments posted about them, it was that they were unprepared, unrealistic, and unprofessional in their response to...

Read More

Medical Spa MD: Online Defamation FAQ For Physicians

Understanding what is libel or defamation and what is protected speech.

Your medical spa, plastic surgery practice, or professional reputation are are open to criticism and 'reveiws' online. Here's what you need to know about what's protected free speech, and what might cross the line into Libel.

Here are some links about these kinds of CyberSlapp suits and where the law comes down on free speech and other issues around this:

Chilling Effects Clearinghouse: A joint project of the Electronic Frontier Foundation and Harvard, Stanford, Berkeley, University of San Francisco, University of Maine, George Washington School of Law, and Santa Clara University School of Law clinics.

DefamationThe law of defamation balances two important, and sometimes competing, rights: the right to engage in free speech and the right to be free from untrue attacks on reputation. In practice, the filing or even the threat to file a lawsuit for defamation has sometimes been used as a tool to shut down legitimate comment and free speech on the Internet.

John Doe AnonymityDo you post to a public message boards or discussion areas on websites such as Yahoo, AOL or Raging Bull? Do you use a pseudonym, fake name or a "handle"? Has someone asked the host of the discussion or your ISP to turn over information about you or your identity? If so, then the John Doe/Anonymity section may answer some of your questions. 

Protest, Parody and Criticism SitesThe Internet, which offers inexpensive access to a worldwide audience, provides an unparalleled opportunity for individuals to criticize, protest and parody.

The following is long but you'll come away with a much better understanding of what this all means and what speech is protected in the U.S.

Need to protect your reputation? Check out Frontdesk's Reputation Protection for Physicians

Online Defamation FAQ

Question: What are the elements of a defamation claim?

Answer: The party making a defamation claim (plaintiff) must ordinarily prove all four elements:

  1. a publication to one other than the person defamed;
  2. a false statement of fact;
  3. that is understood as
        a. being of and concerning the plaintif; and
        b. tending to harm the reputation of the plaintiff. 
  4. If the plaintiff is a public figure, he or she must also prove actual malice.

Question: What defenses may be available to someone who is sued for defamation?

Answer: There are ordinarily 6 possible defenses available to a defendant who is sued for libel (published defamatory communication.)
1. Truth. This is a complete defense, but may be difficult to prove.
2. Fair comment on a matter of public interest. This defense applies to "opinion" only, as compared to a statement of fact. The defendant usually needs to prove that the opinion is honestly held and the comments were not motivated by actual "malice." ( Malice means knowledge of falsity or reckless disregard for the truth of falsity of the defamatory statement.)
3. Privilege. The privilege may be absolute or qualified. Privilege generally exists where the speaker or writer has a duty to communicate to a specific person or persons on a given occasion. In some cases the privilege is qualified and may be lost if the publication is unnecessarily wide or made with malice.
4. Consent. This is rarely available, as plaintiffs will not ordinarily agree to the publication of statements that they find offensive.
5. Innocent dissemination. In some cases a party who has no knowledge of the content of a defamatory statement may use this defense. For example, a mailman who delivers a sealed envelope containing a defamatory statement, is not legally liable for any damages that come about from the statement.
6. Plaintiff's poor reputation. Defendant can mitigate (lessen) damages for a defamatory statement by proving that the plaintiff did not have a good reputation to begin with. Defendant ordinarily can prove plaintiff's poor reputation by calling witnesses with knowledge of the plaintiff's prior reputation relating to the defamatory content.

Question: Can an opinion be defamatory?

Answer: No — but merely labeling a statement as your "opinion" does not make it so. Courts look at whether a reasonable reader or listener could understand the statement as asserting a statement of verifiable fact. (A verifiable fact is one capable of being proven true or false.) This is determined in light of the context of the statement. A few courts have said that statements made in the context of an Internet bulletin board or chat room are highly likely to be opinions or hyperbole, but they do look at the remark in context to see if it's likely to be seen as a true, even if controversial, opinion rather than an assertion of fact dressed up as an opinion.

Question: Is there a difference between reporting on public and private figures?

Answer: Yes. A private figure claiming defamation — your neighbor, your roommate, the guy who walks his dog by your favorite coffee shop — only has to prove you acted negligently, which is to say that a "reasonable person" would not have published the defamatory statement.

A public figure must show "actual malice" — that you published with either knowledge of falsity or in reckless disregard for the truth. This is a difficult standard for a plaintiff to meet and especially if you're running a business that engages in any marketing or advertising that effectively makes your business 'public'.

Question: Who is a public figure?

Answer: A public figure is someone who has actively sought, in a given matter of public interest, to influence the resolution of the matter. In addition to the obvious public figures — a government employee, a senator, a presidential candidate — someone may be a limited-purpose public figure. A limited-purpose public figure is one who (a) voluntarily participates in a discussion about a public controversy, and (b) has access to the media to get his or her own view across. One can also be an involuntary limited-purpose public figure — for example, an air traffic controller on duty at time of fatal crash was held to be an involuntary, limited-purpose public figure, due to his role in a major public occurrence. 

Examples of public figures:

  • An attorney for a corporation organized to recall members of city counsel
  • A psychologist who conducted "nude marathon" group therapy
  • A land developer seeking public approval for housing near a toxic chemical plant
  • Members of an activist group who spoke with reporters at public events
  • Your medical spa or clinic...

Corporations are not always public figures. They are judged by the same standards as individuals.

Question: May someone other than the person who originally made the defamatory statement be legally liable in defamation?

Answer: One who "publishes" a defamatory statement may be liable. However, 47 U.S.C. sec. 230 says that online service providers are not publishers of content posted by their users. Section 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law. 

Question: Can an ISP or the host of the message board or chat room be held liable for
defamatory of libelous statements made by others on the message board?

Answer: No. Not in the United States.

Under 47 U.S.C. sec. 230(c)(1) (CDA Sec. 230): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection against defamation or libel claims made against an ISP, message board, blog comments or cummunity forums where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer: 47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law. 

CyberSLAPP & John Doe Lawsuits

Question: How is Internet anonymity affected by John Doe lawsuits?

Answer: Often called "CyberSLAPP" suits, these lawsuits typically involve a person who has posted anonymous criticisms of a corporation or public figure on the Internet. The target of the criticism then files a lawsuit so they can issue a subpoena to the Web site or Internet Service Provider (ISP) involved and thereby discover the identity of their anonymous critic. The concern is that this discovery of their identity will intimidate or silence online speakers even though they were engaging in protected expression under the First Amendment.

Question: Why is anonymous speech important?

Answer: There are a wide variety of reasons why people choose to speak anonymously. Many use anonymity to make criticisms that are difficult to state openly - to their boss, for example, or the principal of their children's school. The Internet has become a place where persons who might otherwise be stigmatized or embarrassed can gather and share information and support - victims of violence, cancer patients, AIDS sufferers, child abuse and spousal abuse survivors, for example. They use newsgroups, Web sites, chat rooms, message boards, and other services to share sensitive and personal information anonymously without fear of embarrassment or harm. Some police departments run phone services that allow anonymous reporting of crimes; it is only a matter of time before such services are available on the Internet. Anonymity also allows "whistleblowers" reporting on government or company abuses to bring important safety issues to light without fear of stigma or retaliation. And human rights workers and citizens of repressive regimes around the world who want to share information or just tell their stories frequently depend on staying anonymous – sometimes for their very lives.

Question: Is anonymous speech a right?

Answer: Yes. Anonymous speech is presumptively protected by the First Amendment to the Constitution. Anonymous pamphleteering played an important role for the Founding Fathers, including James Madison, Alexander Hamilton, and John Jay, whose Federalist Papers were first published anonymously.

And the Supreme Court has consistently backed up that tradition. The key U.S. Supreme Court case is McIntyre v. Ohio Elections Commission. http://www.eff.org/Legal/Cases/mcintyre_v_ohio.decision

Question: What are the typical claims behind a CyberSLAPP suit?

Answer: The most common complaints by CyberSLAPP plaintiffs are defamation, trademark or copyright infringement, and breach of contract. Speech that involves a public figure - such as your medical spa or practice - is only defamatory if it is false and said with "actual malice." It also must be promoted as being factual rather than an expression of opinion. In the US, because of our strong free speech protections, it is almost impossible to prove defamation against a public figure.

Trademark and copyright complaints typically claim that defendants have violated intellectual property rights by using the name of a corporation or its products, or by quoting from some of their copyrighted materials such as an annual report. In reality, the First Amendment includes a clear right to criticize and discuss corporations and their products, and the law includes clear exceptions for the "fair use" of protected material for those purposes.

Breach of contract suits often involve a claim that anonymous speakers might be employees who have violated a contract by releasing confidential information. Of course, the right to anonymous speech is meaningless if a corporation can unmask your identity at will because you might be an employee breaking a promise of confidentiality.

Question: What other resources are available?

Answer: Web sites dealing with this issue include:

www.aclu.org
www.citizen.org
www.johndoes.org
www.casp.net
www.cybersecuritieslaw.com,
cyber.findlaw.com/expression/censorship.html

Question: What are the key federal decisions involving anonymous speech?

Answer: 1. Buckley v. American Constitutional Law Foundation (1999) 525 U.S. 182, 197-200;

2. McIntyre v. Ohio Elections Commission (1995) 514 U.S. 334. In that case, on page 357, the Supreme Court said:

"[A]n author is generally free to decide whether or not to disclose his or her true identity. The decision in favor of anonymity may be motivated by fear of economic or official retaliation, by concern about social ostracism, or merely by a desire to preserve as much of one’s privacy as possible. Whatever the motivation may be, . . . the interest in having anonymous works enter the marketplace of ideas unquestionably outweighs any public interest in requiring disclosure as a condition of entry. Accordingly, an author’s decision to remain anonymous, like other decisions concerning omissions or additions to the content Amendment.
* * *
Under our Constitution, anonymous pamphleteering is not a pernicious, fraudulent practice, but an honorable tradition of advocacy and dissent.

3. Talley v. California (1960) 362 U.S. 60. (holding unconstitutional a state ordinance prohibiting the distribution of anonymous handbills)

4. Lamont v. Postmaster General (1965) 381 U.S. 301, 307 (finding unconstitutional a requirement that recipients of Communist literature notify the post office that they wish to receive it, thereby losing their anonymity);

5. ACLU of Georgia v. Miller (N.D. Ga. 1997) 977 F. Supp. 1228 (striking down a Georgia statute that would have made it a crime for Internet users to “falsely identify” themselves online).

Question: Aren’t people required to explain why they’re subpoenaing my identity and other information?

Answer: Not with the initial request. The reasons for the subpena are only provided if the subpena is challenged, through a motion to quash. In opposing the motion to quash, the person seeking the information must demonstrate, at a minimum, that it is likely to lead to the discovery of information that would be useful in a lawsuit.

Question: I signed a confidentiality/privacy agreement with my ISP that provides that they will not release my information. Doesn’t that protect me?

Answer: No. Most privacy agreements state that information will be turned over in response to legal requests, and a subpena is such a request. Even if the agreement does not say so, a legally issued subpoena overrides such agreements as a matter of public policy. Each ISP has a different policy about notifying users when their information has been subpoenaed, but they cannot simply ignore a subpoena under the law without risking legal santion themselves.

Question: What does "respond" to the subpena mean?

Answer: Usually, it means that the ISP will give the requested information to the requesting person. In some cases, ISPs have resisted requests for information on behalf of their customers, but this is not the norm. Unless specifically told differently by your ISP, you should assume that your ISP will turn over your information as part of its response.

Question: Can an ISP or the host of the message board or chat room be held liable for defamatory of libelous statements made by others on the message board?

Answer: No. Under 47 U.S.C. sec. 230(c)(1): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection
against defamation or libel claims made against an ISP, message board or chat room where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Can my ISP or the host of a message board be held liable for defamatory statements I make on the grounds that they are a "publisher" or "republisher" of the information?

Answer: No. Federal law provides: "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This has been interpreted to protect hosts of discussions between other people against defamation and libel claims as a "republisher" of the information. Note that this protection does not extend to claims under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

Question: My ISP tells me it's been asked to turn over my name as part of a lawsuit against hundreds of "John Does" in a faraway state. What can I do?

Answer: You should probably contact a lawyer, and suggest that the lawyer take a look at arguments raised by the EFF, ACLU, and Public Citizen in one of these suits (e.g.,http://www.eff.org/IP/P2P/RIAA_v_ThePeople/JohnDoe/20040202_UMG_Amicus_Memo.pdf)

Need to protect your reputation? Check out Frontdesk's Reputation Protection for Physicians

Keeping Your Aesthetic Patients Happy Is Good Business

Keeping patients happy makes sense, both to avoid problems and build your reputation and referral base.

Not all patients that state they had a poor experience from another provider are signaling the proverbial red flag. Most of these patients HAVE had an experience of poor treatment outcome.

And to add salt to their wound,the previous treating provider could care less!

We must keep in mind that for most of our patients, coming in for Medical Aesthetic treatments is an exciting and much anticipated experience.

The number one reason patients state they no longer go to their previous provider is, "He was a jerk!" Oddly enough, the number one complaint I hear regarding a female provider is "I had to wait too long." This is not to say there are no female jerks or that patients don’t have to wait too long to see a male provider. These statements are simply the most common that I hear from (from) my patients.

No one is perfect. I don’t care how good you are at fillers, Botox, lasers, and surgery. We’re human, and we have bad days too. Bottom line: If you did achieve a less than desirable outcome, fix it for heaven's sake! With a smile on your face. If you're running more than 15 minutes behind, be prepared to apologize profusely and don't let it happen again. At both our clinics over 50% of our new patients are by referral. The most common reason for these referrals: “They're so nice!” Patients in general have a sense of helplessness when it comes to being treated by a provider. Do not tell a patient what they have to do. This is not life or death nor a dictatorship. Our patients know that we truly love what we do and we care. You don’t have to be all hugs and kisses, but, you'd better have a smile and a few jokes up your sleeve. You must keep in mind that this is the grown up version of a trip to Disneyland. It’s an E ticket ride with a high price tag. This is not an area of medicine of need.

This is completely a "WANT" this treatment situation. We encourage our patients to tell us what they are looking to have done and then offer safe, sane treatment options for them. This gives the patient a greater sense of control, and a decreased sense of possibly being pressured. If they can't afford all of the treatments at one time, what ever you do, never pressure a patient! If they like the one treatment you do and you personally, they’ll be back. And that’s how you keep your patients.

Dealing With Anonymous Patient Reviews As A Physician

Reputation Management for Doctors

The internet is a double edged sword to the Plastic Surgeon.

Patients from near and far can read about and research our skill and services but at the same time a handful of malicious people can significantly tarnish a great reputation which we have strived to achieve and maintain.

As a surgeon and as a human I have always strived to maintain the highest ethical and moral pathway. Most of us went into medicine to help people. What we do as cosmetic surgeons may not save lives but it does save quality of life and that is evident in our patients' smiles and behavior after successful cosmetic surgery. As doctors we strive to achieve and maintain a pristine reputation but as in anything else in life, it is impossible to please all the people all the time.

The internet has given a voice to everyone but it seems like angry, bitter, malicious people take advantage of this soap box and platform much more often than normal happy folks. You can see this on comments on YouTube or blogs or chat rooms of all kinds - not just medical or plastic surgery related.

But in our field, we depend on our reputation and while you may have thousands of happy patients, a small handful of unhappy ones can affect your reputation. Personally I have seen that the vast majority of my negative online anonymous patient reviews or ratings are from people who I have either never seen in my office or have seen but refused to operate on as patients. I recently had a "1 star negative review" on YELP from a person who has never even come to my office nor met me but decided that she did not want to pay $100 for an hour of my time for a consult and felt obligated to give me a negative rating for not offering free consults! We have all had such occurrences. But how do you deal with it?

My method has always been dealing straight forward with any and all comments.  If it is out there then it begs clarification and a reply from my staff or office managers or even myself.  There has to be accountability.  In the restaurant industry, restaurants can actually review and rate their patrons, not just vice versa! As physicians, we have to respect patient confidentiality and HIPAA but that does not mean we must be silent and let any anonymous person's comments go without a reply or clarification especially when most of us work so hard to do the right thing and practice with skill, ethics and integrity.

Resources for physicians:

Dr. Steven R. Feldman, Dermatologist & Founder Of DrScore.com

An insider peek on how he started to care about the quality of health by creating a start up online business.


Dr. Steven R. Feldman DrScore.com

Name: Steven R. Feldman, MD, PhD
Location:
Winston-Salem, NC
Website:
DrScore.com

About: Dr. Steve Feldman is a professor of dermatology, pathology and public health sciences at Wake Forest University Baptist Medical Center in Winston-Salem, N.C.  His research studies into patients’ compliance with their topical treatments helped transform how dermatologists understand and manipulate patients’ use of topical medications over the course of chronic disease.  Dr. Feldman’s work has been published in over 500 articles in peer-reviewed journals.  He is the author of Compartments: How the Brightest, Best Trained, and Most Caring People Can Make Judgments that are Completely & Utterly Wrong (Xlibris) and Practical Ways to Improve Patients’ Treatment Outcomes (Informa), he founded the www.DrScore.com

View our free webinar on "How To Protect Your Reputation As A Physician" under our Free Deals area.

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Free Webinar: How To Protect Your Professional Reputation Online

Reputation Webinar

Free Webinar: How To Control & OWN Your Business & Personal Reputations Online!

While I'll be teaching this for any business or professional who needs to own their own reputation, this is especially important for physicians.

Reputation management has become an incredibly hot and relevant topic with the rise of all of the review sites that are filled with flaming physician reviews. So, I'm going to be teaching a number of techniques and strategies for physicians who need to protect and control there reputations.... By the way, this is you.

Your business or medical reputation can be hijacked in seconds by a one unhappy patient, disgruntled employee or nasty competitor... but in just one hour, you'll discover exactly how to protect and OWN your personal and business reputations online without needing a phD in geek.

Here's some of what you'll learn:

  • What you should NEVER do when you're flamed online (but what almost everyone does)!
  • How to get negative reviews and comments removed!
  • What you should do IMMEDIATELY when your reputation is attacked!
  • How to make negative reviews and comments impossible to find!
  • What legal options you have!
  • The insider tips and tricks that the pros use to protect their own reputations!
  • How to get your existing patients to give you RAVING reviews!

This is a must-see webinar for any professional or business owner.

Thanks to Ryan over at Frontdesk for putting these together and getting everyone on board.