Can Therapists Fake Their Own Online Reviews?

With respect to the psychotherapist question and answer, as seems to be usual these days the Ethicist has responded with a wishy-washy and noncommittal, albeit long-winded, answer. It seems to me that the answer to this is simple: the therapist should not have signed up on the site in the first place. The therapist must have known how the site worked before signing up, so cannot claim to be surprised at the need to invent reviews. Moreover, I am not a therapist but even I know that what your patients tell you about how much they like you means nothing. How many people tell their doctors to their faces how they really feel about them? Moreover, I am seriously worried about the competence of this therapist, who seems to have forgotten about transference, a phenomenon that might well color how patients talk to their therapists about how they feel about them. What makes this therapist think that what patients actually tell them is how they really feel? What nonsense.

I wrote a note that was highly critical of the advice to the blood donor - based on medical knowledge - when there were zero comments here. The Times has not published the comment. Is there any chance that the Times will publish - in print, on Sunday, in the Magazine - an opinion from an expert re the blood donor's letter? Or shall we look forward to reading opinions here and in other sections of the Times from unqualified, irresponsible writers like the Ethicist? Does the Times consider Mr Appiah's advice to be legitimate based on "alternative facts"?

I read the reviews of a psychiatrist I had seen for some years. (I stopped when I realized he was abusing drugs and had a previous record from two other states.) There was one realistic patient review, rated low, that was followed immediately (by date) by an over- the-top review that seemed clearly planted, and then a third review dated exactly one month later, also over-the-top, which used this doctor's favorite phrases about himself--again, clearly planted. His planted ratings counteracted the original lower rating. The harm in this? Patients are in a vulnerable state when they consult mental health professionals To get better, they may have to suspend some of their usual reactions to open their mind, and trust the therapist's judgement to reach a new perspective. Fake reviews betray their decision process. They are very harmful if the therapist is a narcissist ("genuinely believes he may be able to help") or manipulative and has tricked the patient with the fake information. The writer says the worst harm would be if someone meets with him and decides he's not the right fit. No. The fake reviews would influence a vulnerable patient to question his own perceptions in favor of the false positives said to be from others. A good therapist and an ethical practitioner would be aware of this possibility. Only a corrupt therapist would do this.

Frankly, the more I think about LW1's behavior the more I am reminded of "fake news," including the alleged establishment of websites, spreading rumors about Clinton, by people in Russia during our Presidential campaign. And maybe Trump is somewhat right: fake news does abound. Not where he is looking for it but in what he reads, hears and believes?

Is the therapist's behavior a pale relative of that of the purveyors of non-fact-based internet trolling? Those people have an end in mind--maybe one that some perceive as rightas may the therapist. But, really, hasn't the internet engendered a whole culture of falsity in which many participate to one degree or another?

Take the darn reviews down.

There is another possibility for the low iron test at the doctor's office: the lab she sent the sample to may be wrong. Before the endoscopy and colonoscopy, the physician should submit a new blood sample. The recent Theranos scandal tells us that labs make mistakes.

Blood banks will reject a candidate who is not anemic if her iron level is likely to be low after the donation.

Another thing to look into is that although the blood banks will verify with you that you haven't given blood during the last two months, you are not supposed to donate more than five times per year. After I had been donating every two months for 18 months, I failed the iron level test and the phlebotomist told be to take a few months off: it is unusual for them to run across people who don't skip a couple of donations, so they don't have procedures in place to check that someone has given six times per year.

Donated blood is a huge money making operation. https://www.forbes.com/sites/erincarlyle/2012/06/27/blood-money-the-guys...

I'm 78, and in July of this year will have been regularly donating blood for 60 years (I have a doctor's age-related okay on file and actually donate more often now - every 8 weeks - than in times past). About 6 months back, for the first time in 59 years, my blood appeared not to have enough iron, so that I was turned down. A week later, I tried again, the iron was fine, and the blood was taken. But I also learned that very often when this happens, the nurse can get two different iron readings just by taking a second sample from your other hand, so maybe it is also possible that a more experienced nurse may be able to take a more representative blood sample than the first one. Having done this for so long, I can assure you that there has been nothing I've been exposed to in my life that is more thorough than such blood-testing and blood donations, and in the course of 59-plus years the process for giving has been incredibly simplified while the process for judging the 'worthiness' of the blood has undergone similarly incredible increased scrutiny. In this case, the donor's fears are, I think, unwarranted, because they aren't going to take any blood with even the slightest possibility that there is something 'wrong' with it, and since such blood is usually used in operations and the like, it is good to remember that a pint of some even slightly iron-deficient would be more than offset by its benefit to the recipient; after all, you're living well with a body full of it!

CORRECTION! I just wrote it and claimed that I give blood 8 times a year. I meant 6 times a year, approximately every 8 weeks. Mathematics was never my strongest suit!

The psychotherapist should enter a single review under his or her own name, explaining that professional ethics prohibits requesting patients to submit reviews. This is assuming the therapist can get clear in his or her mind the Ethicist's note that "on the one side, is a wrong; on the other side, a bunch of excuses."

Some prospective patients might actually be looking for a therapist who values professional ethics and who can subsequently be expected to honor proper doctor/patient boundaries.

I find it mind-boggling that in today's world, a therapist needs to "advertise" for patients. I've had a few therapists over the years, and would NEVER see someone because of an online recommendation. Pizza joint, maybe, but never a consultant of any kind. I just assume the blerbs are made up.

While I agree that no one should be allowed to donate blood if iron is low, donating by itself would not cause that issue in an otherwise healthy individual. One can donate whole blood only every 8 weeks. That time is sufficient for an individual who gets enough iron in the diet and has no source of blood loss to recover completely. The writer is a woman. If she is pre-menopausal, she must have some iron intake (meat or supplements or both) in order to keep her levels up. Men and post-menopausal women need less iron intake. Interestingly, Cream of Wheat is an excellent source of dietary iron...

The only thing wrong with this week's column is that the answers are so obvious. Of course it's unethical for the psychotherapist to post phony reviews of his own practice. And yes, the blood donor should notify the hospital that its staff may be manipulating test results from potential donors.

Perhaps next week the column could discuss whether armed robbery is an ethical way to fund a nicer vacation.

To Prof. Appiah and all the purists who object to self-written reviews:
We may not like the world we live in, but on-line reviews are everywhere now, even for medical practitioners. They can hurt a practioner's business unfairly, when a customer/patient writes an overly critical review because of disappointment with results, even if it was not the practitioner's fault. Furthermore, for many people, having no reviews can be as bad as having bad reviews. In this context, the LW's approach seems like a responsible compromise: use actual comments of actual patients as the reviews, so long as nothing personally identifiable is revealed. Once real reviews are posted, he can take down the self-posted ones. I agree with Richard of Michigan, however, that the LW should have resolved this issue before he joined the website. But I do not find what the LW did to be repugnant.

Therapist
-----------
Quoting your patients without their knowledge or consent is a serious violation of confidentiality. If they read up your profile they might recognise their quote. You should know that.

If you want to drum up business there are better ways. You could boast that you do not elicit testimonials or fake them. You could advertise for money in community magazines or give talks.

Blood tests
--------------
If a pathology result is abnormal, it is routine practice to repeat it. Statistically, if you retest after an abnormal result, the next test will probably be closer to normal. That is counterintuitive but due to what is called regression towards the mean.

It makes sense that someone might get a result that is 1) more correct and 2) higher by digging the lance in deeper. Digging deeper will get a higher ratio of blood to interstitial fluid and therefore more iron per unit of volume. If your iron was truely low, they would not be able to raise it just by retesting it.

You will see that the border between low iron and normal iron is (probably) a round number. That is because there is no hard and fast border between normal and low iron. Low iron is not the same as anaemia. Where I am, women's iron is almost always low. So much for the reference ranges. So much so that low iron does not trigger them being scoped but does trigger a man being scoped.

I donate blood regularly. Occasionally, I am unable to donate because of insufficient iron. Sometimes the person doing the screening will take a second sample and test it again (and sometimes get a different result, sometimes not). Other times, I am thanked and sent on my way.

Ultimately, though, they take a sample of your blood and put it in a machine. I don't understand how the chemical properties of your blood can be changed by the manner in which the sample is taken (or going "deeper," for that matter--they use a tiny lance, which is not really capable of plunged into your finger at great depth).

Finally, you can only give blood every 12 weeks, I believe, which also seems to suggest donation would be unlikely to be the true cause of severe anemia (unless this writer gives every 12 weeks, religiously, and gets a "dishonest" phlebotomist each time).

Doesn't a robust ethics system allow someone to balance (small) lies against possible large benefits, in this case to the patient who finds the expert therapist, and thus to allow the act while holding the nose?

I have given blood quite a few times - 8 gallons before I ventured into a black plague zone (during the Vietnam evacuations) and was forbidden to donate for three years. I am an experienced nurse. I have worked at a good number of blood drives, always as a volunteer. Yes, there are techniques that can be used to have a greater chance of finding blood with a little more iron. They are in this case wrong, wrong, wrong. The Red Cross does screening to find out who should not give. If the nurse finds someone barely passing some requirement, that potential donor should be scrutinized closely and rejected if appropriate. Trying to pass someone who has barely failed is OK in some other circumstances but here is NOT allowed. The ethicist's advice to notify the hospital is correct.

Regarding the blood donor:

I don't buy the explanation given about the second prick (not saying Ms. Toomey heard it wrong, just that it might not be the real reason). "Poking deeper" shouldn't affect the blood that comes out (was the second prick any different?). From my experience donating blood, a second test is permitted if the first one does not meet the standard (might require being close enough to the threshold on the first try). It might be that the second attempt needs to be performed/administered by a different person, and the "poking deeper" bit is just an easier/humorous way to explain it. I've never liked "testing to compliance" but if it's allowed, so be it.

The standards for donor eligibility, like so much of the rest of our world, are determined by statistics. The statisticians determined that someone whose finger prick yields a certain amount of iron will yield transfusable blood XX% of the time. They also considered the allowance of a second prick.

The blood will be tested before being transfused, so the risk to the patient of getting bad blood is much much lower than the risk to the donor of losing needed blood. Still, the practice should be reported to the donation organization so they know about it and can take measures if necessary.

Last, I take issue with "blatantly manipulated". That's not necessarily what happened. Manipulation would require more than doing another finger prick.

From the question

"The staff nurse pricked my finger and told me my iron was too low but then said something along these lines, “Oh, let me get so and so, she can always get the proper reading.” Just like that, my iron level was high enough to donate, which I did. "

So with one reading the persons 'iron level' which is a hemoglobin level, was below the 12.5 g/dl. The next test came above that, apparently, if we take the story at it's word

This section is from the red cross website.

"Blood Donation hemoglobin level
The Red Cross checks your hemoglobin level before every blood donation to protect your health. Currently, all donors must have a hemoglobin level of at least 12.5 g/dL. Effective May 2016, the criteria will be changing for male donors and will require a minimum hemoglobin level 13.0 g/dL."

It talks about hemoglobin levels to protect the health of the DONOR, it says nothing about recipient.

The Ethicist states

"You should indeed notify the hospital that runs the bloodmobile. It may be too late to stop your blood from being used, because it’s not going to be stored for more than six weeks. But sharing your experience with the relevant officials could help prevent this abuse of the proper protocols from continuing"

Where did the ethicist get the idea that the blood would be harmful to the recipient? I think it's incumbent on the ethicist to get the facts correct, as columnist that is his ethical duty.

This on- line review stuff is a scam. Pay to play. Don't participate, save your dignity. Do good work and they will come.

"The staff nurse...told me..." Nurses don't staff bloodmobiles. Phlebotomists do. Please stop characterizing all those who wear scrubs as "nurses." Most aren't.

Receiving "iron poor" blood is generally not a health hazard. The recipient will be given blood until his or her hemoglobin level rises to a certain point. That may simply require a small amount of additional blood, although in practice I have never seen this happen. Blood banks are VERY thorough in screening the blood supply for transmissible disease- HIV, hepatitis, etc. I think the ethical quandary here is a PhD playing doctor, and insufficient evidence regarding what really happened at the blood bank. It may well have been that a more experienced person was needed to perform the test, and that is was accurate. Bad karma to suggest that donating or receiving blood is likely to harm you.....

Well, call me gullible but I would never have thought therapists would write reviews of themselves and have others do so to "prime the pump." LW 1 tries to show him/herself as one adhering to professional ethics by saying it violates those ethics to solicit reviews from real patients. Are professional ethics completely turned off when a newer method for marketing is used? Surely the professional societies in the field would not endorse fake reviews.

Too, LW1, consider this:would you reveal to those same patients from whom you will not solicit reviews, that you wrote fake reviews using their words? If you are so concerned about the therapeutic relationship and dynamic between client and therapist, what would happen to that relationship if these patients discovered what you are doing? Better yet, would you be comfortable revealing it upfront?

If you feel you must keep it hidden then you are ashamed of it and know it is wrong.

This is not Amazon or TripAdvisor. I get that you want to build a bigger patient base, but compromising your own ethics is not the way to do so...

One issue I have run into with frequent blood donations is that my blood count is normal and meets whole blood donation guidelines, but iron stores, as measured by ferritin level, are low. This can cause a number of issues, including cognitive problems and restless leg syndrome. The American Association of Blood Banks and the Food and Drug Administration are aware of low iron stores in frequent blood donors and are looking at ways to address the problem: ferritin testing, iron supplement recommendations and increasing the interval between blood donations. Mayo Clinic increased the donation interval to 12 weeks in recent years, as compared to 8 weeks at Red Cross and Independent Blood Centers in the U.S. The National Health Services in the UK have just completed a two-year interval study for thousands of blood donors to determine the ideal blood donation interval that protects health of donors to avoid anemia and low iron stores.

It is unethical for American Blood Banks to continue to collect blood from frequent donors without monitoring their iron stores. It is as important to protect the health of donors as it is to protect the health of those who receive blood transfusions.

Ms. Toomey, please do alert the teaching hospital immediately. I'm aghast at the risk to you as a donor unaware of a potentially serious health condition, let alone the recipients who are equally if not more vulnerable. If you don't receive a swift and appropriately serious response from the hospital, go above their heads to your state health officials.

Consider this: If these people aren't accurately handling the diagnosis of your blood products, who's to say that they aren't missing even more serious abnormalities and putting more people in greater danger?

Wow, I actually agree with the ethicist 100% this time. Well-thought out, careful answers. That's what we want!

Sympathies. I remember telling my analyst how I evaluated a car repair garage and noticed that he seemed slightly hurt. Thinking it over I realized that he must have felt that he couldn't compete is that way. His patients generally don't brag about the quality of his services or refer their friends.

I feel for the plight of the psychotherapist, but this could have been avoided with more research into the nature of the site. The site creators should be chastised for creating a platform that tempts widespread ethics breaching like this. But, if you were my therapist and you took my words out of context and put them online, even anonymously, I would consider that a breach, and I'm not sure how it's not understood that this is dishonest and still, in spirit, a violation of the assumed confidential relationship. As Appiah said - "a bunch of excuses." The only thing I've learned from this is that I should be further suspect of online reviews and stick to good old word of mouth.

As an aside, this is another illustration of why we need socialized medicine. The ethos of capitalism and the ethos of medicine are fundamentally at odds with each other. When a profit motive is introduced into patient care, it is not strictly patient care anymore. It is a racket, on some level however small and however brilliant and compassionate the practitioner, whether you like it or not.

RE: the mental health professional: just state that you are not soliciting testimonials from your patients for the above reasons. it's honest and i would prefer someone who acts outside the box w/ integrity.

The private practice of psychotherapy has become virtually impossible outside of a few very fortunate settings. Except in very affluent communities not many people can pay enough out of pocket to keep a practice running, especially a solo practice. The overhead in time, documentation, and information technology imposed by third-party payers and their intrusiveness makes insurance participation unrewarding. One practice I know found that it was less costly to turn away insured patients and make a charitable contribution when one appeared, than to participate in insurance contracts! They survive on contract work with public agencies. An acquaintance with a doctoral degree, thirty years' experience, impeccable skills, and great energy, compassion, and interpersonal talents found that she could make $60k working 55 hours per week: an elderly parent to support, old car, little retirement, and no home. Hard times.

In this environment the temptation to rig the market with phony endorsements is compelling. Of course this is unethical to the point of repugnance. But what is even more repugnant is the submission of health care( including psychotherapy) to market economics in the name of a faux free market. This sort of transgression is and will remain pervasive until the system is reformed. We have had several chances to fix all this; perhaps one day we will succeed.

Can therapists fake their own online reviews? What have we come to that this question can even be asked?

Unreal! This "therapist" gives the profession a bad name.

Jus a note on the blood donor. It is not unusual to have a second test when donating -- altho' I can't explain the reason - but it is not for nefarious reasons, but because the finger prick doesn't always give an accurate read. I wouldn't jump to conclusions.

I also have had low blood iron which popped up in the last couple of years, absent any bleeding, which kept me out of the donor pool for a while. (In my case it seemed to be related to eating a vegetarian diet, perhaps combined with being older and maybe not absorbing nutrients as well).

1) "The helping professions may themselves be in need of help: That seems to be the lesson of the day."

Whaa? The health profession, the most lucrative public welfare industry in the US, could be ethically challenged? in which doctors prescribe drugs by companies that pay them to promote them, in which researchers conduct studies to show the benefits of products by industries that fund their labs?

Can I Fake My Own Online Comments?

I too am caught between competing ethical requirements: how I really feel vs. getting published in the NYT.

My comments are often rejected by the NYT moderators. I can either modify them according to the standards and tastes of the NYT, or write honestly of my reaction.

What should I do?

'Cause I have a few things to say about therapists who fake patients and patient reviews.

" Still, I’m wondering about the ethics of depriving potential patients of the ability to find me...and to see if I might be able to help them."

"Physician, heal thyself"
~ Luke 4:23

It sounds like the therapist could use a little help with his Narcissistic Personality Disorder --

Also - how refreshing to see the Ethicist/Philosopher enlighten his own reply by quoting passages from the O.T.

Iron levels: Men are allowed to donate blood with an 11.5 hematocrit; women must be at 12.5. There is no exception for post-menopausal women. the explanation given to me is that it would be bad for the donor. Of course, my doctor told me my levels were normal (at 12.3 or 12.4) and there was no need to over-react. There is no fooling around at UCLA or the Red Cross, and after being rejected several times, I quit donating blood.

You are a professional and you are asking if it is okay to "toot your own horn" by faking evaluations. Seriously?

The anonymous therapist writes, "Psychotherapy isn’t a simple commercial transaction.)"

Exactly why many people turn to life coaching when they want support but don't have a mental illness requiring drugs.

Any time money changes hands you have a commercial transaction, though not always a simple one. Medical people try to avoid this reality because they want to be retain power over their "patients" and avoid accountability for rudeness and mistakes. I've been known to cross out the word "patient" and put in "customer."

These days people want to see reviews before buying a service, unless they get a word-of-mouth recommendation. They can google their therapists and sometimes meet them on social media.

What IS a concern is that therapy remains stigmatized so people will be reluctant to leave their names and be identified. As a result, the ratings are worthless, as Anonymous says.

Professionals who want to build their practices should consult with marketing specialists instead of signing up for expensive referral services. There are many ways to gain credibility, such as creating a blog, speaking, making videos, writing for the popular press, and more. And if you hire someone to develop your website (especially writing the copy), and trust their expertise, you'll be ahead of most of your competitors.

I had exactly same experience when donating blood and ending up having an endoscopy and colonoscopy as well, when my doctor found me to be anemic. But it's not necessarily the case that my blood was iron-deficient when I donated, even though, like the writer, I didn't meet the standard on first try. Blood centers set a high standard for iron in the blood to protect the donor. If you don't meet it, you may not be anemic, just not high enough to donate. However, donation can push you over the edge into iron-deficient anemia, as it did for Maura and for me. So the blood center was unethical because it caused iron-deficiency anemia in the donor and caused her to have unnecessary medical tests, but it didn't necessarily endanger the blood supply.

Slippery slope. More "alternate truth". Next up; Can therapists fake their credentials?

"Psychotherapy isn’t a simple commercial transaction." It was a mistake then and it continues to be a mistake to treat it was one. Professional ethics require that you leave any ratings up to patients, but you are trying to get approval for a way around that. It can't be "just a little" unethical. Sorry about the expense from the referral service, but it wasn't made for you.

By the time they get a volunteer to show up at a blood drive, do all the registration and testing, the staff probably feel that they have a lot invested in each drawing. Providing a lower quality result with low-iron blood, despite the basic desire to do good, is fraud. Each transfusion is a risk to the recipient, and one hopes that the best possible product (hemoglobin-rich blood)is being used. The hospital pathologist might be the one to test the quality of the blood donated. The situation might be a one-off, but if it is a pattern, there is a real risk to patients.

Here is what the Ethicist said:

"You should indeed notify the hospital that runs the bloodmobile. It may be too late to stop your blood from being used"

Under what medical basis, did the ethicist use to determine that the blood could not be used? An ethicist is not normally trained in this subject.

If the Ethicist referred to a source, like a book or an expert, that source should be referenced.

Without that, it seems the problem is not telling the woman to go see her doctor if her iron levels are low. Then again, maybe it was so close to the number needed, that they did not bother.

*Please, Please, don't proffer advice based on a lay persons judgment. You have a duty as a writer of a column to get your facts correct.

"That you are embedded in this ethical morass is not, of course, your fault."

Worst. Analysis. Ever.

Of course it's Dr. Disingenous's fault. Unless I'm grossly misreading his (I'll assume male at this point) explanation, it's more than reasonable to assume he joined the referral service only after reading through it and researching whether it would be a worthwhile investment. He therefore would have known about the patient reviews. He also must have known, even before he discussed the issue with fellow clinicians, that pretty much any online rating system garners a combination of real and fake reviews.

There's another ethical issue that probably is beyond the scope of this column. I'm a retired psychotherapist. If I had learned about another therapist's doing what he did, in a situation like this where there's no supervisor per se, I would tell him he could either delete his "reviews" or I would file a report with his professional licensing and/or ethics committees. A related ethical issue, then, is whether he is obligated to do the same with those fellow clinicians he mentioned.

Dora was right about Freud.

The psychotherapist who needs new patients does indeed have great - ethical - tools available for recruiting, but they require work. S/He might give talks on his work to groups, clubs, and health forums. He might write helpful articles for a local newspaper. He might visit GPs to highlight his expertise or contribute expertise to online forums. Resorting to fudging ratings is the pits.

Find another referral service or a better way to get referrals.

Not only is faking a review lying, people always know when a review is self-generated. Trust me on that one. Writing your own review is a double whammy. Not only are you lying, you reveal yourself as a liar.

I'm not convinced that what went on at the blood donation was "blatant manipulation". From my experience, a second attempt is allowed for certain of the pre-donation tests. Some organizations might require a different person administer the second attempt. If that is the case, my guess is that the "poking deeper" comment is just a humorous explanation for it. I doubt "poking deeper" gets blood that is much different that poking regular depth. I'm not much a fan of "testing to compliance" as some like to call it, but it's apparently allowed.

Like so much of the rest of our world, acceptability is driven by statistics. The statisticians said that someone whose finger blood has a certain amount of iron (or whatever proxy is used) in it will yield suitable blood XX% of the time. I'm sure they consider the case where one sample is OK and one sample is not, as well as some non-conformance to standard procedure ("poking deeper"). I bet there's a safety factor on there, too.

The blood is also tested before it is transfused into the patient for a myriad of parameters/problems. Therefore, the risk of a recipient receiving bad blood (which may be better than no blood if the blood is just weak), is much much less than the risk to the donor of losing needed blood (which is also considered and safety-factored).

From the information given, I'm not convinced the blood-letters did anything wrong, bloodwise. Were numbers actually misreported?

LW1 I'm sitting here in shock. I can't believe it. Are you really a therapist? Not one I would ever want to see. LW2 That's why you have a doctor to discuss things like this.

Regarding the psychotherapist:

If you have to ask, you probably already know the answer.

Another idea may be to simply write review that say that the practice is new to the site and won't pointedly ask clients/patients to write reviews so the review is merely to get exposure.

It's probably best to leave the site and find other ways to get exposure.