Restraint, Response, or Retaliation: Dentists Need to Think Carefully Before Responding to Negative Online Reviews

Dentistry may be a unique profession with a proud history, but online, a dental practice is no different than a dry cleaner, restaurant, mechanic, or liquor store. That is because dental patients are just as likely to post a review of their experience on Yelp! or other online review sites as are customers of other businesses. And, as is the case for all businesses and professions, customers who have negative opinions tend to share those more often, and more adamantly, than those who have positive things to say. And Mary Alberti recently had a lot to say about her experience with a Buffalo Grove, Illinois endodontist.

As outlined in a defamation lawsuit the endodontist filed against Alberti, his former patient engaged in a concerted internet smear campaign to destroy his good name and reputation by posting “post after post” on Yelp!, Google, and other sites that contained false, defamatory, and anti-Semitic comments. He is seeking more than $4 million in damages, while Alberti has moved to have the case dismissed.

While the allegations in the Alberti case represent an extreme example of an angry, vindictive, and prolific patient using the internet to smear a dentist with an otherwise impeccable record, even one negative review can have a significant impact on a dentist’s practice and reputation.

Can You Sue for Defamation? Sure. Whether You Should Is a Much Harder Question

On more than one occasion, a panicked and indignant dentist or other client of mine has called me to ask whether they could and should sue their former patient for defamation as the doctor in the Alberti case has done. The answer, of course, is that you are well within your rights to sue “IHateYourDentalPractice123” or whoever it is that is trying to take a wrecking ball to your career. You can sue anybody for anything. Whether such a lawsuit will be successful or has any legal basis is another matter entirely.

The fact is that even the most scathing negative online review, if susceptible to the principle of “innocent construction” (meaning the allegedly libelous statement is given a non-defamatory interpretation because it is deemed ambiguous) or is composed of opinions rather than demonstrably false allegations of misconduct, will likely not qualify as actionable defamation in Illinois. Furthermore, such lawsuits can expose the offended dentist or other professional to backlash, ridicule, and bad publicity in the fast-moving and fickle world of social media.

If you look to hold online review sites and other platforms responsible for false and defamatory information posted by reviewers, you won’t get terribly far. While you may be able to get a website to remove a particularly egregious post, Section 230 of the federal Communications Decency Act largely immunizes such sites from claims based on comments or reviews posted by third party users.

A High Bar to Prove Defamation in Illinois

In order for a dentist to prove defamation under Illinois law, including a claim based on an online review, he or she needs to show that:

• the patient made a false statement about the dentist;
• there was an unprivileged publication of the false statement to a third party;
• fault by the defendant amounting to at least negligence; and
• the patient’s publication of the review caused damage to the dentist.

As to that last element, a defamation plaintiff does not need to prove actual damages if the statements are deemed inherently damaging. Defamation per se, as it is called, includes making such false allegations that the plaintiff:

• committed a crime;
• is infected with a loathsome communicable disease;
•  is unable to perform or lacks integrity in fulfilling his or her professional responsibilities;
• lacks the ability to perform their professional duties, or otherwise harms the plaintiff in their professional reputation
• has committed fornication or adultery.

Is It a Subjective Opinion or Factual Allegation?

The most common issue that arises in defamation cases based on online reviews is the question of whether or not a statement was false. Only false statements of fact can form the basis of a defamation claim, not opinions, no matter how histrionic or counterfactual they may be.

 A statement of fact is one that can be objectively proved or disproved. Consider the two following hypothetical reviews of a dentist:

“She was rude, impatient, and treated me disrespectfully. It was perhaps the worst experience I’ve ever had with a dentist in my entire life. She is horrible.”

“He stole money from my purse and touched me inappropriately while I was under sedation.”

The former is non-actionable opinion, as the dentist will not be able to objectively prove whether or not she was, in fact, rude, disrespectful and the cause of one of the worst experiences in the patient’s life. Contrast that with the latter statement that accuses the dentist of specific actions and misconduct that can be proven or disproven with evidence.

Context Matters

Illinois courts have also focused on the context in which an allegedly defamatory statement was made when determining whether it can be the basis of a defamation claim. Even if one comment in a lengthy online rant is arguably a statement of provable fact, it may not rise to the level of defamation if a reasonable reader would see it merely as hyperbolic invective.

Consider the 2013 case of Brompton Building, LLC v. Yelp, Inc., in which a building management company filed a defamation suit against an anonymous former tenant who had posted an over-the-top, relentlessly negative, and extremely lengthy review online. Even though the rant contained a few objectively disprovable statements, the Illinois Appellate Court found that those comments could not support a defamation claim because they would not be understood to be actual factual allegations in the context of the full review. As the court stated, "The context of the defamatory statements is critical in determining its meaning. In determining the context of the defamatory statements, we must read the writing containing the defamatory statement 'as a whole.'"

Dentists Need to Consider Patient Privacy and Professional Ethics

When faced with negative reviews, dentists need to make sure that their response doesn’t make a bad situation worse or make them appear petty and vindictive. Additionally, dentists who do decide to respond to a patient’s negative review publicly may inadvertently reveal confidential patient information in their attempts to refute allegations of poor or substandard care. Such HIPPA violations can have catastrophic licensing and regulatory consequences for dentists.

As infuriating as negative online reviews can be, it is the rare dentist who can make it through their career without leaving at least one patient dissatisfied or unhappy with their treatment. When a patient shares those feelings with the world, it can be easy to let it get under your skin, especially if the attacks are as relentless, ongoing, and full of unsavory allegations as appear in the Alberti case, which we’ll be monitoring to see if the court protects the endodontist from what seems to be a clear case of defamation. But sometimes, restraint can speak louder than a retort.