Did you know that your online reputation is in the hands of just a few people? Only 1 out of every 20 patients posts an online review of his physician, but nearly half of all patients use the Internet to learn about prospective physicians and other healthcare providers, according to a survey by the Pew Internet and American Life Project. Google yourself. If you don't like what you see of your online self, read on.

Online mosaic
Online ratings, blog postings and information on websites are pieces of the "reputation mosaic" that Daniel J. Solove so well describes in the book, The Future of Reputation: Gossip, Rumor, and Privacy on the Internet (Yale University Press). Unfortunately, all it takes is a couple of bad pieces to mar the mosaic.

Most physicians equate a tainted online reputation with a direct loss of business. But a damaged online reputation can result in much more damage than fewer patients scheduling appointments. You can have credentialing problems, and the information could be a liability against you if you end up in a malpractice case.

Currently, 27 states have a recognized cause of action for negligently credentialing a physician. Given this liability, credentialing committees often perform detailed background checks using all available search tools, including the web and social networking sites. If you're involved in a medical malpractice action, you should assume that the attorneys for the other side will check your online reputation by looking at online rating sites, news articles, social networking sites, and blog and forum postings.

And lawyers are not the only actors in the courtroom who are using the Internet. Judges and attorneys have discovered jurors doing independent research via cell phone during trials. One juror even held an online poll on Facebook after posting information presented in the trial. "I don't know which way to go, so I'm holding a poll," wrote the democratic juror. Fortunately, he was dismissed from the jury before the trial reached a verdict.

Protect your online reputation
So how can you protect your reputation online? Develop a strategy. It doesn't have to be overwhelming. Here are some steps to get you started:

• Find out where you stand. Do a simple Internet search to see what comes up when you enter your name or the name of your facility in a search engine. Type your name, in quotes, in Google, Yahoo, Bing, Twitter and Facebook. These should encompass the vast majority of things posted on the web.
• Stay informed. Subscribe to a service that will inform you when new content is posted about you. You can create "Google Alerts" for free or hire a firm such as Medical Justice (www.medicaljustice.com), which offers a service specialized for physicians.
• Own your name. Purchase your name or your facility's domain name. You want to control this. The last thing you want is a disgruntled patient or a competitor owning a domain name based on your name and creating a website that could harm your reputation. Spend the small amount (usually less than $20) to secure a domain name from a domain registration site, such as www.godaddy.com.
• Generate good publicity. Recognize the scope of information your online reputation may have and begin to positively influence your reputation. Consider asking your patients to review your facility on a reputable website. You may also consider asking your patients to sign an agreement as to any future postings they may make on the Internet. The content and use of this type of an agreement vary from state to state, so check with your state Board of Medicine. Once you have an acceptable agreement letting you post a patient's testimonial, you'll need to review the website's terms and conditions to see if third-party postings are permissible.

What if I find a major online problem?
It can happen. In just a few minutes a disgruntled patient, former employee, competitor, ex-spouse or upset neighbor can post wicked, nasty comments about you all over the Internet. It hurts and it's clearly malicious. Practical and legal constraints make it difficult to deal with malicious postings. With anonymous posts, it takes a significant amount of effort to learn the true identity of the poster.

Federal laws such as the Communication Decency Act and HIPAA limit the options a physician has when addressing an online problem. For example, HIPAA keeps a physician from disclosing medical facts and describing treatment related to a patient who has posted a negative comment online. As much as a physician may want to say, "Mrs. Smith's comments arise more from her psychosis than from my treatment," this would be a bad idea with serious legal repercussions. However, you can address the problem. Here's what you should do.

• Have the comments removed. Look for the "Terms and Conditions" section of the website where the comments are posted. If the comments violate the site's terms and conditions, you can e-mail the webmaster and ask that the comments be removed. Also, consider asking satisfied patients to post positive comments on the site. A more accurate sample size will dilute the negative outliers and better reflect your patients' true opinions.
• Get professional help. Firms such as Medical Justice and Reputation Defenders (www.reputationdefender.com) have sophisticated programs to address serious problems. These firms typically offer ?? la carte services such as search engine optimization (SEO) strategies, website evaluation and design and legal review of contents for compliance purposes. The cost of these services begins at several thousand dollars.

If the comments are truly defamatory, enlist the help of a lawyer who specializes in online issues to determine the identity of anonymous posters and take action. However, this is an expensive and time-consuming process. To do this, you must initiate legal action. Typically federal subpoenas must be issued to websites in order to secure IP addresses of posters. Once these addresses have been disclosed through the court, you can proceed with additional legal actions.

• Improve your online image. If your image has become tarnished, you can create new positive content and use SEO techniques to de-emphasize negative news articles, past lawsuits and other unfavorable content. Common SEO techniques can re-order information that online users retrieve during an Internet search so that positive content appears at the top of the results list. SEO has become a field of expertise in its own right and many firms specialize in this. You can also read much about it online.

Shoppers, snoopers and stalkers
How many times have you gone online to decide on a plumber, a movie or a restaurant? Patients are doing the same thing for surgical services. You need to guard your online reputation. Although he said it more than 300 years before the Internet came into our daily lives, Benjamin Franklin's observation still rings true: "It takes many good deeds to build a good reputation, and only one bad one to lose it."