7 trigger points that infuriate fertility patients and lead to bad reviews for doctors

By Griffin Jones

What should fertility doctors say or not say, do or not do, to avoid angry reactions from patients on the internet?

observation, not advice

This is tricky. I can help practices increase their positive reviews, but I will not tell physicians how they should talk to their patients, because I am not a physician. I write prescriptions only to medicine I’ve swallowed myself. The reason I feel comfortable telling clinics to invest in Facebook ads, is because I have had success reaching new patients through Facebook ads. I’m comfortable telling fertility specialists how to respond to negative reviews online because I have improved doctors’ online reputations from the way I respond to reviewers.

I have never delivered a fertility diagnosis inside a consult room. I’ve never told a couple that their prospective IVF cycle has a 10% chance of success or called someone to tell them that their 3rd IUI was not successful. I have an idea of how I think I would communicate with patients, but I have little tolerance for arm chair quarterbacks. 

navigating the mine field with compassion

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What I can show you, however, are patterns that I’ve observed from upset patients: what I call “landmines” or “trigger points”. These are common themes that, when received a certain way, tend to send patients’ thumbs into a blaze of fury to light up their IVF center on the internet. By being aware of how patients recount certain interactions, you may better prepare for them.

“It’s not what we say, it’s what people hear.”—Frank Luntz, PhD

1). Body Mass Index
When a patient visits an IVF center, her initial testing may reveal that her body mass index (BMI) is too high for a fair probability of IVF success. Patients may first be referred elsewhere to help decrease their BMI. While I cannot tell you how to deliver this news, I can show you how it is sometimes received. Comments like, “he called me fat” or “they refused to even see me because I’m too fat,” are common on social media and review sites. I wouldn’t suppose that the physician used those words, but in a very difficult moment, this is what the patient may hear. 

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2). Age and Diminished Ovarian Reserve
“She told me I was too old to ever get pregnant”. The quality or quantity of a patient’s eggs may be low, and a physician may issue caution about the probability of successful treatment. What could be a very honest move, certainly in patients’ best interest that they not spend money and energy on unwise surgery, can send patients to their keyboards in anger when received the wrong way.

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3). Low probability diagnoses
Patients occasionally feel that their doctor is rooting against them, or shows no compassion for them when going over their diagnosis. Reviews commonly include boasting that the patient got pregnant, even though their doctor said they would not. This article articulates what patients sometimes write about their doctor after they have seen more than one specialist. 

4). Contact availability
“The two week wait” (#2ww) is one of the most notorious chapters of fertility treatment and it is only one of many anxious periods patients have to face. When one doesn't receive a call when she or he was told to expect one, more stress is added to the patient experience.  Failing to call with test results, not responding quickly enough to patient calls or e-mails, and not being available via the media which patients use to communicate are all landmines for patient reaction.

In fact, I would be very curious to know what percentage of negative fertility center reviews come during moments when the patient is waiting for correspondence from the provider. When worries about treatment monopolize a person's mental bandwidth, the wait for answers turns seconds into hours. It is a feeling of helplessness and desperation in which lashing out against the provider online may be an attempt to regain a sense of control.

5). Face time with doctor
Smaller fertility practices frequently claim that individualized care is their edge over larger practice groups. It is an advantage, if in fact, the patient gets to spend more time with the provider. Rarely seeing one’s physician is a very common pain point that leads patients to say things like “baby factory”, “only in it for the money”, and “looked at me as a dollar sign”.

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6). Punctuality and preparation
Doctors are very busy people. So are patients. With high demand from patients, and a nearly infinite number of scenarios that can arise at any moment, the need for providers to maximize their time can make timeliness impractical. Still, patients feel slighted when they are not seen on time because their time is valuable too. The same goes for when they feel the doctor has not read their chart, not taken the time to thoroughly answer their questions, or rushes through their appointment. 

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7). Absolutely anything to do with billing
If these scenarios are landmines for fertility center reviews, the billing department is a minefield in and of itself. Billing issues might account for 1/3 to ½ of your negative reviews. In short, the billing department is arguably the greatest liability to a fertility practice’s online reputation. Patients often feel ambushed by the costs that they incur during the course of treatment. Insurance coverage (or lack thereof), reimbursements, deductible requirements, and variability in medication costs are pain-points unique to healthcare. Patients may lash out against their practice in a public forum because they do not experience these annoyances in most other consumer categories.

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To make matters worse, prospective patients receive very little education about IVF costs prior to treatment. In fact, some practices refuse to detail any cost information on their websites because they are afraid that it will dissuade people in need from seeking a consultation or that it will give a competitive advantage to other IVF centers. Many fertility clinics would rather bury their heads in the sand and hope for the best, than properly use digital media to educate patients about the headaches of insurance and billing.

Setting the stage

As a fertility specialist, you are walking into a minefield of patient anxiety and frustration. I don’t think it would be possible to tip-toe around every possible pressure point. Instead, what may be more prudent, is to disarm the tension as much as possible from the very beginning. Of course, I can’t tell you what to say to patients. From what I observe from their accounts, however, is that many patients do not hear their concerns addressed in this way:

“What you are going through is extremely difficult at times, and that is perfectly normal. You’re not alone because we’re here to help you with everything we can and connect you with resources for those things we can't control. We wish we could wave a magic wand and make everything better right now, but there will likely be parts of this process that are very frustrating.

"Billing, medication costs, and insurance can be a big headache. You may see a charge for a service and think what the heck is this? Just ask, we're here to help you through it.

"There may be times when we don’t call you back as quickly as we want to because our nurses are helping other patients in the same way we want to help you.

"We always try to be on time for our appointments, but every now and again, a patient needs a little extra time with her doctor, and we want to extend that same level of care to you.

"We often have to be the bearers of very delicate news. We balance optimism and our eagerness to help you have a healthy, beautiful baby with our duty to inform you of the implications and realistic outcomes of your different options.

"You don't have it easy and neither do we, but the plus side is that we’re working together. We hope you’ll tell us if we are falling short at all during this process because we need your help to do our best for you".

Satisfaction equals experience minus expectation

By setting expectations abundantly clear ahead of time, you may be able to prevent negative reactions when, not if, issues arise. Some patients develop their own expectations, regardless of what you do to help set them. It’s okay if some people are not satisfied with your practice and staff as long as the dissatisfied number is the lowest it can be. There are certain pressure points that must be approached with empathy during the already tense fertility journey. By setting the stage and disarming the mine field, you can reduce the number of complaints about your practice and doctors, and increase patient satisfaction.

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If it's too late and you need examples on how to respond to negative reviews, read chapter 4 of the Ultimate Guide to Fertility Marketing