Infographic – Pharma marketing to physicians

The vast majority of physicians today are digitally active, accessing multiple devices and networks as part of their day-to-day activities. Physicians are increasingly interested in video and social media for personal and professional use. These trends have numerous implications about what pharma cannot miss in creating its marketing plans.

  • According to recent studies 72% of physicians use social media sites for personal and professional reasons. Based on current trends 81% of doctors will own a smartphone by the end of 2012.
  • 73% of physicians use their smartphones to search content online while 55% of them use mobile apps.
  • 35% of physicians said they think tablets are a useful tool for pharma reps. According to their answers they find presentations a lot more effective when carried out with the help of a tablet device.
  • Online videos are also more and more popular among physicians. 82% of them prefer video content on WebMD while 50-50% of them watch videos on pharma websites and YouTube as well.

 

(Source: publicishealthware.com)

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Consumer use of social media in healthcare

Social media is becoming a bigger part of the collection of health information, but it varies by health condition and treatment options how patients use social channels during their online search. The more serious the condition, the more time patients spend online researching with social media tools as part of the equation.

This is one of the findings of a recent qualitative research project designed and carried out by Rich Meyer, an experienced DTC marketer working in the pharma industry for over 10 years now. The study showed other interesting trends about how consumers are using social media for seeking healthcare information and how it influences their decisions as well.

Here are the key findings of the research:

  • Seeking health information online is often triggered by health concerns of a patient or family member. People usually do not search for health-related information proactively. The search is initiated after experiencing the symptoms.
  • There is not one online source that is the most popular when it comes to searching for health info. There is no ultimate source. People in older age groups usually start with search engines, and often mention being overwhelmed by the sheer volume of health-related information online. One of the main problems for internet users is complexity, the often feel frustrated when not finding answers to more simple questions.
  • While some people use social media sites during their search, they rarely trust the accuracy of posts. The main reason to go to social media sources is to read about others’ experiences with the same health concerns. This is trend is more dominant with more serious conditions.
  • People are concerned about personal and data privacy, so they are usually not comfortable posting their medical information on social media sites. This was even a bigger of a concern for older demographics.
  • Before making a healthcare-related decision, women usually do more research online and go to a lot more websites than men.
  • While physicians are still a very important source of medical information, the need for a more cooperative approach to healthcare is obvious. Participants stated that they would like to discuss different options with their doctors.
  • Another interesting and possibly worrying aspect of the study is that during focus groups participants didn’t mention pharma company websites as a health-related online source at all. This might be due to the fact that they questioned the trustworthiness of pharma companies all together.

(Source: Pharmaphorum.com)

How Do We Spend Our Time Online?

A recent infographic from Go-Gulf presented striking numbers about just how much time people spend online. Social networking is the most popular activity by internet users while Google has the highest number of unique visitors monthly, followed close by Facebook. With 30 percent of the world’s population online the average time spent globally on the internet in one month only adds up to a mind-blowing 3,955,444 years.

According to the infographic below looking for health-related information online is the third most common activity among internet users. Only emailing and using search engines top its popularity. But looking for and finding valuable information can be two very different things. So do we trust online health info? Based on a new survey carried out by Wolters Kluwer Health people do trust the medical content they find on the internet. And this means a huge responsibility for every online publisher who create and distribute health-related information on the web. According the the survey:

65 percent of those seeking medical information online say they trust the information they find and 63 percent say they’ve never misdiagnosed themselves based on something they read online.

A recent post on KevinMD.com points out that Twitter can be a valuable medical resource for patients and their relatives as well. With many doctors, patient groups and health services providing help and information on the micro-blogging site, there is a pool of knowledge that could be tapped into after getting used to the idea of sharing and co-creating a knowledge base with only 140 characters at a time.

To think that only a decade ago we didn’t even have the term social networking, using Facebook, Twitter and other social media sites didn’t play any part in our everyday life. It’s safe to say that these fast paced changes in technology remodeled the way we look at medical information and diagnosing conditions entirely.

 

(Source: Mindjumpers.com, FierceHealthIT, KevinMD.com)

 

Advertising On Health Websites

Mayo Clinic’s recent decision to include paid advertisements on its website stirred up a heated debate. As the face of healthcare social media and effective patient education for a long time Mayo Clinic received a lot of criticism for its bold move to venture into the field of featuring ads next to important health-related issues.

I personally think in an economic climate like today’s no one can really argue with a financially smart decision if it is rightly done. Which means that in my opinion paid advertisements can have a place next to health information without taking away credibility and reliability. Unless they are placed poorly. And that is where Mayo Clinic made a mistake. Mark Schaefer, marketing consultant and author took to his blog to express his disbelief and disappointment about ads trying to sell children’s clothes next to an article about a condition during pregnancy that in most cases results in the death of the unborn child.

Here is a word I rarely use on my my blog: Stupid.  But I think it is an unavoidable description when an organization sells the soul of their brand for a few advertising dollars with a mindless strategy of advertising children’s clothes to women who have just lost their child.

I think the question is: was the placement of the ad intentional? I hardly think so. This is an organization that is involved in treating patients, conducting research, launching healthcare start-apps, using social media for better patient education and communication and operating a major platform for publishing reliable health-related content. I think by now they are aware of the sensitive nature of the different topics they are discussing.

I also think it is a case of not paying attention to detail and not making sure the content and the ads on the site are in sync. Placing ads can mean major funds for a website. Misplaced ads can mean angry and disappointed readers that have all the right to feel that way. And while a lot of times advertising agreements are a little loose when it comes to the content of the ads, a website specializing in healthcare content has to make sure to monitor and influence the ads appearing on the portal.

(Source: Businessgrow.com, Medcitynews.com)

Pharma Websites Among The Most Effective Online Platforms

There is another reason why titles like “Pharma is behind on the web” and “Pharma doesn’t get e-health” are getting outdated. According to the Bowen Craggs Index published in the Financial Times the websites of Roche and Novartis are in the top 10 most effective portals among corporate sites. Other pharma companies were also included – AstraZeneca took the 13th and Sanofi the 17th place on the list.

One can read numerous articles about how pharma is the slowest industry to adapt to digital and online solutions and still, some companies like Roche and Novartis managed to be relevant and secure better positions than robust corporations like Nestle, Microsoft and Coca-Cola. This means that other pharma companies cannot use the industry’s bad example anymore for their own lack of online initiatives.

In its study Bowen Craggs & Co points out several issues that pharma companies with less effective web presence have in common. Most of the time portals operated in the United States are supposed to work as the corporation’s global site but it lacks information about worldwide initiatives and activities. Another issue is that pharma companies are trying to put together their websites as an iPad app, but these sites only look like apps, they don’t operate like ones. If the functionality of the application setup is missing, there is no point in turning our portals into applications.

There is another issue concerning mobile trends – out of 81 companies analyzed in the study only 25 of them had separate mobile versions. Among the numerous pharma companies only four of them, namely Bayer, Boehringer, Pfizer and Shire have websites accessible on mobile devices without a problem.

While I don’t necessarily think that one single index number can describe a company’s online efforts, but it is certainly helpful in creating an environment a little more competitive. This way pharma companies can see how well others are doing and realize – an industry is not behind in general. There are teams and organizations within the industry that are up-to-date, using cutting-edge solutions and have no problem adapting to new and creative online solutions to be more effective.

(Source: PMLiVE.com)

Why Social Media? – Andrew Spong Shares His Thoughts With H2onlinehu (Part 1)

With this post we would like to start our first interview series on H2ONLINEHU. Our aim is to discuss the idea behind pharmaceutical online communication and the recent trends of the field with experienced professionals and influential experts. And what better way to start, than to talk about the importance of social conversations in pharma with one of the founders of #hcsmeu, healthcare social media Europe, Andrew Spong.

Anyone that is involved in the field of health and social media knows you mainly from your key role in healthcare social media Europe. Could you talk about the idea behind building this particular community and having the weekly Twitter chats?

I think the story behind healthcare social media is quite well-known now, so I will just re-cap it really briefly. I was looking in the Summer of 2009 for health conversations on the social web, and I didn’t find that many at that time. What I did find however was a lady, called Silja Chouquet (@whydotpharma). We found that we were using the same key words, searching for the same sort of health-related things and, as a consequence we found each other. However, what we didn’t find at the time (although the case is very much altered now) were the sort of regular conversations about social health that we were looking for. Or rather, we didn’t find any systematically organized or regularly held contexts for those conversations to take place on the social web in Europe.

We therefore decided to launch a tweetchat. We thought we’d call it Healthcare Social Media Europe, and use the hashtag #hcsmeu following the example of #hcsm, the healthcare social media conversations started by Dana Lewis (@danamlewis) in the US. Within 10 days of our initial conversation we had the first #hcsmeu chat. We promoted it quite widely through our own networks, and were delighted when a dozen or so people turned up at 1pm CET on Friday 7th August 2009 on the #hcsmeu hashtag. And that was in August 2009, and now of course we’ve had two real-life hcsmeu conferences, we’ve had a healthcare social media global conference, and nearly 120 weekly events now which take place every Friday as you know at 12:00 UK time, 1 o’clock European time.

To an outsider, how would you describe health conversations on the social web? Why social media, what are the advantages of this platform compared to other channels for health-related conversations?

The advantages of social media in connecting people are numerous really, but let’s just focus on a few of them. First is the instantaneous nature of the connection. To find and identify people – assuming that their bios are properly formed and feature the relevant keywords – and immediately connect with people across the world, but also with people in our own geographies around Europe who share our interest in the health conversation on the social web. So in terms of building community, social media has been I think crucial for all the healthcare stakeholder groups. What has been also very interesting is the way that social media has enabled those different stakeholder groups (patients, healthcare professionals, the industry, public health providers and so on) to find new ways to interact and new spaces to interact in, to share and to address some of the issues which we consider when we ask „What does improving the quality of care look like?”. Immediacy, speed and also availability of one-to-one connections is something new and something that social media fosters very effectively, I think.

You mentioned a couple of key words that stood out to me: interact, share, address issues. Why are these crucial? Why is it important for pharma companies especially to be involved in social media when it comes to health conversations?

While there are similarities across the different stakeholder groups, there are clearly differences as well. From pharma’s perspective, for example, the opportunities that social media offers include the rebuilding of its reputation, the building of a level of trust in its activities, and to credential itself in such a way as to offer tangible evidence of its commitments to patients and providers rather than some of the more abstracted and esoteric claims that pharma companies are prone to make on their websites along the lines of ‘wanting to make the world a healthier place’. That’s great, but really: who doesn’t want that? In short, you are far more likely to be convinced by a company’s claim to want to do that if they can actually demonstrate to you that they are doing it rather than just telling you that they’re doing it.

Thus perhaps the biggest opportunity possibly for the industry is to reach out, to credential itself, to build trust, and build credibility. However, that is also its biggest challenge, because when levels of trust in the pharmaceutical industry are as low as they currently are from an observer’s perspective, it is always going to be difficult for any given company to make that first step. It can be problematic for companies to find the most appropriate context within which they can begin to build all those adjacent benefits that we just identified. Being a heavily regulated industry as it is, pharma has not always found an easy route into this conversation. It is noteworthy that the companies that have succeeded such as Roche, Pfizer, and Boehringer have been those that have been most willing to put themselves out there. Not in an irresponsible way, but clearly, these companies understand that this is an experimental environment, and that unexpected things can and will happen. Let’s not forget that the conversation on the social web that Twitter drives has only been happening for five years. Twitter as a platform is only five years old, and whilst it is only the first generation of real-time information networks, what’s qualitatively different about the interactions that it creates and about what the industry is consequently having to learn to do in order to participate effectively is to get involved in a dialogue rather than merely making pronouncements, although at this time there is still far too much push messaging taking place.

Within European online health communication how do you see the position of pharma companies and agencies located in Eastern-Europe? Based on your past experiences what kind of advice would you give them?

I think from a Western European perspective we’ve seen evidence of interest arising across stakeholder groups including pharma, but on an individual level it hasn’t been a great deal of evidence, at least among English-speaking circles – obviously language is an issue – of affiliates within Eastern Europe coming online in a systematic way at a corporate level. So whilst individuals are beginning to mobilize, there hasn’t been a great deal of evidence of wider initiatives. Coming back to language issues, it is note-worthy that those conversations are conducted in English. However, I think that encouragement should be taken from the fact that companies like Pfizer, Boehringer and Roche are beginning to attempt to support their affiliates by supporting the bringing together and launching of local-language social media presences. And I think Pfizer is probably the leading example of this at the moment. They developed best practices from the head office in the US which have been expertly filtered out to European affiliates and they have been really supporting local colleagues in their desire to connect with the customers that matter to them in their geographies.

We know that the internet has no boundaries, so effectively everything they publish could be theoretically read by everybody. If they take it upon themselves to identify a need within their own territories, within their own geographies, in their own language then the more progressive companies are seeing that they have a responsibility to support those affiliates and help them grow those presences themselves. So, there’s not a massive amount of evidence thus far, but you get a sense that the conditions of possibility are being created to support the development, the emergence, and the blossoming of pharma social media in Eastern Europe.

And finally, how would you evaluate 2011 in terms of health conversations on the social web? What do you foresee for 2012?

I wrote a blog post about this subject recently. I believe that we are in this three-stage process of identifying trends that are slipping away, trends that are dominating, and trends that are emerging so it is interesting to watch this organic process take place. I’ve only been paying close attention to and participating in the social web since 2008, it was my third Twitter birthday in November. So I’ve personally been on Twitter for 3 of 5 years of its life, and do not possess a complete contextual framework from which I may speak to this question with any more authority than anyone else who has been using the platform. However, it is my observation in the three years that we have seen what were considered fundamental issues for the industry, when it was more focused on trying to orient itself rather than participating, we have seen these issues like listening and engagement becoming less important. That’s not to say that you don’t need to listen and you don’t need to engage, but it’s a prerequisite of maintaining an effective presence on the social web: that one listens, and listens well and continually refines one’s listening strategy. So it’s pointless to talk about that, you have to be doing that anyway. And similarly if you’re not engaging on the social web than what are you doing? So these are trends that I think are disappearing.

I’m hoping that we will talk rather less about mobile next year because it is beginning to seem  superfluous. Almost everything is mobile now and therefore to have a mobile strategy is a redundancy. You should be taking Google’s lead by looking to serve the interests of the mobile user first and allow everything else to follow on behind this. So we need to focus on mobile, but we don’t need to separate it from everything else that we do on the basis that is becoming the core focus of the consumption and therefore (ideally) the publication of content. Hopefully we’ll just take it for granted that mobile is integrated and incorporated in everything that we do.

I’m also hoping gamification and anything game-related will prove to be rather less fascinating for us next year. There was a fantastic paper by Chia Hwu (@chiah) who delivered a paper entitled ‘Three Major Trends in Healthcare: Social, Mobile and Games‘ at an Ideagoras conference recently. She made some great points about games – gamification doesn’t work, games do work, she was saying. You don’t want to be taking game elements and trying to integrate them into a user experience or user interface but if you can find a way of conveying a message through a game that’s appealing then maybe you’re on to something.

Search remains important as the way that we are searching and what we are searching for and the environments within which we are searching for the information is changing constantly. We all saw that statistic last year about effectively Facebook being the world’s biggest search engine because more searches are entered to Facebook than to Google because Facebook, although it does link out into Google it links to its own content first. People are looking for health information for example within Facebook. And the quality of information that they’re going to find more often than not at this point of time is very poor. So if we believe that the whole purpose of healthcare is to improve patient outcomes, then there are issues there regarding search. So search is critical, the question of where patients, healthcare professionals are looking, the environment in which they are searching for information, to inform their practice and to inform their shared decision-making and the co-creation of their healthcare.

The things that I think are important in 2012 are two-fold. I’m really interested in influence. By which I mean I’m not interested in whether Klout is better than PeerIndex or Kred, and that shouldn’t matter to any of us. Rather, what is important is the fact that secondary services are appearing now which are harvesting and processing social metadata, ‘Big Data’ analyses of the totality of our activity across the social web and they’re doing something with it. Now in the case of Klout they are just putting a big number on it, but if Klout for example becomes a trusted measure of influence – it has done a great job making itself untrustworthy recently – but let’s just say they managed to have done that, then it becomes an issue for the industry. People’s opinions of brands and companies will increasingly be informed in part by the way that the platforms harvesting, analyzing and discussing their social metadata present them.

The industry therefore will need to be growing importance of presenting itself consistently through the content that it publishes all across the web. This is not going to be easily achieved, but it needs to be something which senior employees or those with a global perspective begin to look upon as a pressing issue: to make sure that data and messages are consistent. A great start from the point of view of your readership and your geography is just to make sure that everything that they do within their own geographies is consistent. So they don’t have many different people tweeting things from different accounts. It’s not a complex matter, but there has to be a plan that everyone is aware of, takes ownership of, and that is coherent. Big Data is another emerging trend. Patient communities are – like CureTogether, like PatientsLikeMe – beginning to have access to relatively significant numbers of pieces of patient reported information which allow us to say interesting things about symptoms and treatment options for patients.

Finally, the industry has to be absolutely transparent about the reason why it is using social media. If it’s trying to represent itself in such a way as to simply redefine how it believes it may be able to control messages – which it cannot – then it will be found out and made to look foolish. Pharma needs to take a new approach to the way in which it represents itself within social web environments. Credibility is another trending issue in 2012. Direct messages are the last thing patients want to see. The social web is not for pushing messages, and it’s also not for selling. I’m hoping 2012 is going to be the year within which some of my fundamental questions – which underpin the financial planning and the growth of companies – around marketing are interrogated because to me it seems that an expectation endures that ideas forged in the offline world of the last century can simply by transposed onto the social web as if they had some sort of universal value, significance and bearing upon the fundamentally different dynamics of the social web. It is my opinion that they do not, and that they do not belong there, and that is why I advocate discussion about the subject via the #postmarketing hashtag. I think we are in a post-marketing era – people don’t want to be sold at on the social web, neither do they want to be tricked, or cajoled or persuaded. They want to converse, to be informed and they want to be heard. But they do not, for sure, want to be sold at. The transition from monologue to dialogue and all the expectations that inhere within it from the perspective of the way that businesses need to present themselves and think about their customers’ perceptions of their activities are key characteristics of the social turn in communication.

(Connect with Andrew Spong on Twitter or on STweM.com)

Pharmaceutical Industry In Hungary And The Challenges Of 2012

The Hungarian pharmaceutical industry had a rather hectic year, and 2012 seems to promise some new challenges as well. The different steps of healthcare reform have been summarized by the Semmelweis- and Széll Kálmán Plans. These proposals introduced and initiated numerous arrangements, that change the basis of healthcare, as well as the internal operation and marketing strategy of pharmaceutical companies. Not only have the target groups of communication changed, but even the nature of communication channels directed and applied to them are new.

The previous one-way communication directed only towards physicians is being replaced by a new strategy with more performers, including pharmacists, patients and customers, who all have an important role in the communication process.

Observing the different channels of communication, the significant growth of the role that the internet plays is obvious. In our experience the members of the market are interested, more or less open to online solutions, but at the same time uncertainty is prominent mainly because of the lack of experience in Hungary.

The new legislative regulations in Hungary are essentially strengthening the digital trends. Because of the forced axes on the number of representatives finding other, alternative sales activities to substitute the work of reps is crucial.

There are numerous tools for companies when it comes to sales and communication, but it is also very important to find the right toolkit – with the appropriate form and content – to meet the needs of the target audience. The opinions and attitudes of physicians about alternative channels are typically known, majority of them are open, or can be convinced about the advantages and possibilities provided by these new tools. In the meantime in-depth research to segment, and to observe the special needs of the target groups is going to be even more valuable.

Are you open to getting information through the following, new channels?

Multimedia presentation showed on tablet/iPad during personal visits

Source: Szinapszis MediJournalTrack 2011 (n=909)

Pharmaceutical decision makers also realize the necessity of online communication with physicians and patients, but their high level of mistrust toward this area is obvious which is typically caused by the lack of experience in Hungary. In the future agencies providing online solutions will have to try to ease the anxiety and to answer the emerging questions of decision makers.

(Katalin Kiss)

Pharma Websites Can’t Be Just A Formality

Reading the long list of articles about predictions for 2012 it is clear that the pharmaceutical industry has no chance to skip out on integrating valuable digital solutions and to spend time and energy re-thinking their marketing strategies. You just can’t escape online posts about social media integration, mobile health, social games in healthcare, the role of tablets in pharma. But it is worth to take a step back and go back to the basics before getting overwhelmed by all the different ways to go digital.

No pharma company can claim to be a pioneer in digital marketing while not taking care of its own website. It has been stated many times before: content is king. This is not only true to patient education sites or specific product-related portals. It is also true when it comes to the own websites of pharma companies. A company website plays a key role in creating and maintaining a reliable, trusted profile.

So here are a few steps toward an authentic, user-friendly company website:

  1. Plan ahead – Having a strategy for maintaining a website means having a clear idea how frequently to publish content, what kind of content to publish, what kind of target audience to aim your content to, and what type of sources to use for getting valuable information. These steps of planning are even more crucial when it comes to health-related content.
  2. Simple and accurate content – Using too complicated terms, long and way too detailed descriptions won’t help readers to find the important information they are looking for. Pharma companies should keep in mind that their audience may not be familiar with medical terms or certain pharma-related abbreviations.
  3. Reliable sources – Keeping a website active and frequently publishing new content doesn’t necessarily mean constantly writing original articles. There are many useful sources on the internet that could help patients find more information about numerous health-related issues. Obviously this can’t result in violating copyrights or neglecting original content altogether.
  4. Being up-to-date – It gives a website a good “flow” to write about current health-related news. It also helps pharma companies to maintain a well-rounded, expert image as well as to help patients follow important health-related events.
  5. Patient-education – Although patient education requires independent, comprehensive strategies and programs within a pharma company’s digital marketing efforts, it is also useful to include some content directly targeted to patients with certain conditions on pharma websites.
  6. Contact info and other basic elements – No website can be trustworthy without a few main elements like correct contact information, copyright data, a short introduction of the company and its mission. It is also crucial to include all the links to social media platforms where patients and other visitors can connect and communicate with the pharma company. These are obviously static parts of the portal, so they don’t require constant updating, but they have to be available and accurate.

(Source: World of DTC Marketing)

What Makes A Health Website Trustworthy?

In an earlier post we discussed the importance of online content in the internet age and how health websites have the responsibility to meet high standards when it comes to accuracy and comprehensive information. That sometimes means sacrificing being the first to report something or getting the most hits on a given article.

An American study also highlighted some of the readers’ considerations when choosing between different health websites. According to the findings the most trustworthy platforms are the ones recommended by a physician while publishing scientific articles about research is also proof of being an accurate source. 39% of respondents said that the information has to be easy to understand to be considered worthy to read. This also supports earlier findings suggesting that long, overly complicated content is not well-received and not user-friendly.

This brings us back to responsibility. But who has the responsibility to provide trustworthy health content? Who is responsible to make it available, to make it easy to understand, to make it accurate? In healthcare where content is published from many different sources people can’t afford to point fingers. Everyone who creates content has to be responsible. Let the platform be a hospital website, a pharmaceutical Facebook page or a physician’s blog.

And as the study pointed out physicians play a key role in directing patients to trustworthy online content by choosing the accurate ones to recommend. In this sense doctors have an even more crucial part being the gate keepers of health-related information in the digital era. This is why the increasing popularity of the internet or the growing number of online health websites don’t threaten the job of a physician. It only adds another one to the list of daily tasks.

Physicians Shouldn’t Shy Away From Online Reviews

There have been reports about physicians trying to avoid a negative online reputation by getting their patients sign a contract where they give up their right to provide any information about their doctor on any internet platform. This is only a way to turn our backs to the issue and not concentrating on the main goal of a practice: to provide quality patient care where the doctor doesn’t have to be afraid of bad reviews.

Since in healthcare people are treating people, the patient experiences are not going to be black and white. But if the majority of patients are satisfied, even a few bad reviews can’t destroy one’s reputation. This is one case where prevention is not better than cure.

There is information about your practice whether you like it or not, mostly reviews provided by your patients online. Portals focusing mainly on patient experience are getting more and more recognition and attention. They are rapidly becoming the top search results on Google. Physicians have a choice to make: try to stop this trend or monitor and contribute content themselves.

Let’s be honest: stopping patients to look for and spread healthcare-related information on the internet is a task more fit for an imaginary character with unlimited time and energy than for a doctor with a busy schedule. There is no sign that suggests the decline of interest in patients-created anecdotes online. People like to search for information about a physician and usually they get what they’re looking for in patient-created content.

So instead of trying to put a stop on people turning to the internet with healthcare-related questions (obviously this is out of a physician’s power), doctors should be proactive and provide useful information about their practices. Having a user-friendly website about their practice and monitor online content about their work is not optional anymore. Whether physicians take part in it or not, whether they try to discourage patients to review them online, they can’t erase their online presence. But they can choose to have a say in what is there to be found about them on the internet.

(Source of image: Manage Your Online Reputation)