Another submitted: "I will use this practice if I have no other option. Receptionist was lovely but the wait and then the doctor checking text messages and not seeming connected with us was disappointing." This was published as "Receptionist was lovely." The Australian Competition and Consumer Commission (ACCC) said selectively editing reviews could mislead customers, especially if the total body of reviews doesn't reflect the writers' opinions. An ACCC spokesman said it couldn't comment on a specific business. Patients can book an appointment and write a review using HealthEngine. The Australian Health Practitioner Regulation Agency (AHPRA) said a person who advertises a regulated health service or business in a way that is "false, misleading or deceptive or is likely to be misleading or deceptive" is in breach of the law. It couldn't comment on HealthEngine's practices. The start-up company's conduct is worthy of scrutiny as it is forging a digital path for the healthcare sector that's largely been reluctant to be compared and rated by health consumers.

Many doctors believe that patients don't have the medical knowledge to judge their performance and they shouldn't feel pressured to meet "customer" expectations when their aim is to provide the best treatment. HealthEngine has been caught deleting negative details in reviews and posting them as positive ones. But HealthEngine, backed by Telstra and Seven West Media, has argued that patients are "entirely qualified" to report on their experiences and reviews are "highly valuable". HealthEngine's chief executive Marcus Tan said they didn't publish negative comments because they ran an "aspirational" review system and they edited out identifying details and clinical information to comply with laws and AHPRA's guidelines. He acknowledged their employees could be editing reviews to different standards and said he was open to feedback and changing their practices if it benefited both doctors and patients.

"We do not believe this to be misleading, however, if the moderated reviews unintentionally create an overall inaccurate impression we would, once identified, happily remove them," he said. Illustration: Matt Golding "The subjectivity around some of our moderation of feedback to comply with guidelines is tricky but we are trying to balance providing a service to locate a good practice with trying to bring the health professionals along the journey to provide greater transparency." Patients are invited to submit a review after their appointment and informed that only positive reviews are published, their reviews may be edited, and when their review goes live. While many of the edits were minor, the analysis of edited reviews showed HealthEngine had blotted out comments on receptionists, the booking system, billing and even parking problems.

"A review used in advertising can be edited to exclude comments about clinical aspects of care so that the review does not breach the rules about not using testimonials in advertising. However, the edits must not make the review misleading or deceptive," an AHPRA spokeswoman said. "Supporting the public to make informed healthcare choices with the right information at the right time is extremely important as advertising can influence a patient’s decision-making around their healthcare needs." Fairfax Media was able to access original and edited reviews using the HealthEngine website's HTML code.

HealthEngine, whose revenue model partially relies on practices subscribing to its booking system, has 2 million unique visitors each month. Some clinics on its website now have more than 300 reviews each. The average number of reviews per clinic is 26. The Royal Australian College of General Practitioners would not comment on HealthEngine, but said GPs should not alter reviews to change their sentiment and urged patients to be respectful and remain factual when writing reviews. Loading “GPs who receive negative reviews are recommended to respond simply and politely to responses, and where offensive or derogatory seek their removal if practical," its committee chair Dr Nathan Pinskier said.