The Review That Wasn't Written by the Patient
A practice owner, Dr. Lin, asks her front office to 'improve our online presence.' The office manager creates accounts on two review sites and posts five-star reviews for the practice using her own email, plus two reviews under the names of patients who had actually been treated (with their real first names and initials). She also responds to a genuine one-star review by writing, 'This patient repeatedly missed appointments and we suspect drug-seeking behavior.' The genuine reviewer had, in fact, missed two appointments but had no substance-use history in the record. The posts are traced back to the practice's IP address after the reviewer complains. Dr. Lin says she never read the posts and delegated marketing entirely.
1. Evaluate the fabricated reviews and the response to the negative review as potential unprofessional conduct. Which is more serious, and why?
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Fabricated five-star reviews: Deceptive. Creating reviews that appear to come from patients - especially using real patients' names - misrepresents the practice to the public and, for the named patients, discloses their status as patients. That is a privacy problem layered on a deception problem. Using staff emails for the other reviews is straightforwardly misleading advertising.
The response to the negative review: More serious, for three reasons:
- It discloses protected information - confirming that the person is a patient and commenting on their appointment history. Even a response that 'corrects the record' cannot reveal treatment facts without authorization.
- It states a clinical suspicion ('drug-seeking') that is unsupported by the record. That is not just a privacy breach; it is a false and stigmatizing statement about an identifiable person.
- It was public. The reach of the harm is greater than an internal note.
Conclusion: The fabricated reviews are deceptive but the negative-review response combines a confidentiality breach with a defamatory-flavored clinical assertion. Boards treat the latter as the graver unprofessional-conduct issue. Both are attributable to the practice.
2. Dr. Lin delegated marketing and never read the posts. Does that insulate her? What is the correct analysis of responsibility?
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No. Delegation does not transfer accountability for the practice's public statements.
- The practice owner is responsible for the conduct of the practice, including advertising done on its behalf. 'I didn't read it' explains the failure but does not excuse it; it actually establishes a failure to supervise.
- The posts were made using practice resources and the practice's identity, which ties them to the licensee.
- A board is likely to treat the delegation as an aggravating factor: the licensee set a task in motion and then declined to oversee the output.
What a defensible response looks like:
- Immediate removal of the fabricated reviews and the offending response.
- A written marketing policy requiring licensee review before any public post.
- Corrective outreach to the named patients where required.
- Honest acceptance that the oversight failure is hers.
Exam trap: The instinct is to argue 'the employee did it.' Resist it. The question tests whether you understand that supervisory responsibility attaches to the licensee, not the task.