Six months ago, a practice manager called me in tears. “Our Facebook page is awash with hateful comments from patients,” she said. I’m paraphrasing and deleting some of the expletives here.

I looked. It was. Some comments were downright dreadful, despite the practice doing all the right things – i.e., posting regularly and giving updates on what they’d handled in the past week.

They were absolutely smashing it – taking care of most patients within ten days, even those with minor ailments, despite a massive increase in demand.

“Your online triage system is flawed!”

“You’re fudging the figures. My dad has been waiting weeks.”

“Any other business would just get extra staff. To say you’re doctors, you’re not very bright, are you?”

“I can see my dentist and BREATHE into his face but can’t see a bloody GP for five minutes!”

BUT there were lots and lots of really positive comments too.

Unfortunately, none of the comments, good or bad, had been answered.

The practice manager said the partners had asked whether comments could be turned off on Facebook and whether they should even bother posting what the practice had handled in the past week.

I took an extremely deep breath and asked if I could record a video for her to share with the partners about why this would be the worst thing they could possibly do and how I could help them turn this around.

For the record, I do primary care comms for a living. I ‘watch’ a lot of practice Facebook pages. I also spend quite a bit of time watching TV.

And if you ever saw ‘The Matrix’ starring Keanu Reeves, you’ll remember the scene where he starts to make sense of the green code on his screen – you know, the Matrix. Patterns and people all become visible to him. The same happened to me this year, reading comment after comment made on practice Facebook pages.

Unlike Keanu, I can’t do kung fu yet, but I think I’ve just about cracked how to deal with negative comments made online. And yes, some of them still make me want to ‘hi-yah!’ at my screen.

Why are people negative online?

Whether it’s a misinterpreted communication or a direct attack from a so-called ‘keyboard warrior’, most of us will know that online comments are often negatively received due to the lack of face-to-face interaction.

Not only does reading a comment online make us scrutinise every single word and the tone chosen by the author, but it allows individuals to hide behind their screen and say whatever they want, often without repercussions.

Then, of course, we have the age-old concept that people only review or comment when they have something bad to say. If your blood test with Julie, the practice nurse, is on time and goes to plan, what is there to say about it? Let’s be honest, you probably won’t say a word – just smile and say thank you as you leave. As humans, we sadly come pre-programmed for negativity.

Negativity bias is hard-wired and means we pay more attention to bad things and overlook good things. It comes from our cave people days.

Those of us who viewed the world more sceptically and paid attention to every rustle in the bushes were more likely to live to see another day. We’d yell and warn the others in our tribe. Sadly, these genes were passed down to you and me today and are just another way in which the brain tries to keep us safe.

So, when the internet and the world of social media came along, yelling and alerting others to perceived dangers and bad stuff just got a whole lot easier.

But does that make it OK to bash your GP practice? Not one iota.

It’s not what you say; it’s how you say it

Another thing to really hit home for me throughout the pandemic was health literacy. And how rife it is among people from all walks of life.

• Did you know that 1.7 million patients report being unable to explain symptoms or feelings over the phone?
• And did you know that 9 million people in the UK alone cannot use digital tools unaided?

This infographic from the Patient Information Forum demonstrates just how bad it is. With these numbers, it becomes marginally clearer how and why patients get so frustrated when they can’t speak to a GP or receive personalised support when they need it. But it’s not just people with low literacy skills.

When people can’t find satisfactory answers for themselves, they turn to the people they believe can help. But when the response is considered untimely or unsatisfactory, their negative thoughts can quickly find themselves online for validation or comfort from the perceived ‘hurt’ – often on a social-media profile or community page. It’s called a double deviation.

Things like being in pain, receiving bad news, or poor concentration come to mind. Or if you’ve just been reading any of our national newspapers for too long. These all take a temporary hit on your health literacy level. And they might leave you off-kilter and feeling negatively charged when you go online.

But is this cause for the kind of negative comments we’ve been dealing with in general practice? It’s still a big fat no! Yet it does give us a deeper understanding of where this negative mindset is coming from – and what we can do to keep it to a minimum.

What does this mean for general practice?

As practice professionals, is it really our job to fight this battle of online negativity too?

The short answer is no – and thankfully, on a national scale, we have great people like the IGPM and BMA fighting our corner.

But the longer answer is yes, and we must. Because nobody else is coming to fight specifically for your practice team. And you can do things to minimise your exposure to it and make your lives a little bit easier to manage.

After my first few weeks behind the Facebook pages of various GP practices who were really struggling with negative comments in early 2021, I began to test and adjust the way I responded to negative comments online. I tried to see which responses garnered the best reactions from the person who posted it and from other community members. I also noted the feedback and passed it on to the practice – though it was more understanding and constructive than some of the comments initially posed.

Another thing to note is that it’s just as important to respond to and acknowledge the positive comments as the bad ones. These lovely words will make the most difficult days easier to bear and remind you and the team why you do what you do, so don’t allow them to become background noise. They’ll also do wonders for your reach, showing your post to more people, and keep the Facebook algorithms happy.

Then there are the actions we can take in the face of patients themselves.

As you saw from the stats, the number of patients who feel unable to communicate via digital and virtual methods is higher than we could have imagined. We have to understand within practices that the negative comments from these patients are often coming from a place of worry and fear – whether that’s actual or perceived doesn’t matter. We don’t know the whole story, and that’s not in our control. And so, it’s up to us to communicate, educate and talk with patients, in a range of ways, as best and as regularly as we can.

This isn’t easy. We have hectic jobs, and the idea of funnelling even more focus into head-on patient communication can be draining and frankly overwhelming. But this is our best hope of dulling the negativity and ensuring that patients can exercise the kind of self-care that will allow them to feel safer and more secure without always needing a GP.

What can you do?

Nobody showed us how to talk and interact online; everything we do is learned behaviour. How we write online needs to sound like the way we talk in practice, with the same care, compassion and honesty that comes to us naturally.

You can reduce patient negativity both online and when they call you, if you consistently:

1. Show up on social media and show patients what you’re going through – the good, the bad and the ugly!
2. Take your time to reply to comments and sign each one off with your name, so people know a real person is behind the comment.
3. Remember, it’s not you that they’re pointing the finger at; it’s fear and anger that’s just misdirected, and most wouldn’t dare say it to your face. You’re on the same side, and both want the same things. You can only do what’s in your control, and communication is one of them.