Online Reputation Management (ORM) for Healthcare Needs Medical Affairs Leadership

Would you be okay starting a therapy with a 2.5-star rating for a condition where every moment impacts clinical outcomes? Now imagine coming across a negative patient review, or seeing a trusted HCP publicly question its effectiveness or highlight side effects.

Even in oncology, where treatment decisions are guided by HCPs, what patients read online can shape their perceptions of a drug’s efficacy and safety, as well as of the provider recommending it.

If a patient begins therapy already expecting it to be harmful, they may become more attuned to every discomfort. This is so-called the nocebo effect, where negative expectations increase the likelihood or intensity of perceived side effects. In treatments that are already difficult to tolerate, this often results in high non-adherence rates.

This is why online reputation management is so crucial for improving patient adherence. Yet, it is still treated as a commercial team function, rather than something that is also within the responsibility of Medical Affairs.

What Is ORM for Healthcare?

Online reputation management (ORM) in healthcare focuses on building trust and credibility among patients, healthcare professionals, and regulators across search engines, AI platforms, social media, and review sites.

It includes monitoring brand mentions, analyzing sentiment, addressing misinformation and bias through content, and leveraging search engine optimization (SEO), and, more recently, generative engine optimization (GEO) to ensure evidence-based information is visible to relevant audiences.

Today, the decisions of patients and HCPs are shaped by online information, making ORM a key priority for life sciences brands, especially those addressing chronic, serious, or rare conditions.

ORM Is Correlated with Adherence Rates

Commonly cited drivers of non-adherence include cost, side effect burden, treatment complexity, forgetfulness, and limited health literacy. Yet, the literature has largely overlooked the digital content patients are exposed to between prescription and initiation of therapy.

For every 100 prescriptions written, only 50–70% are filled, 48–66% are picked up, 25–30% are taken as prescribed, and just 15–20% are refilled. Ineffective ORM is one of the factors behind the devastating cascade of declining adherence rates in pharma.

Only 51% of patients globally trust their healthcare system to deliver optimal care, with levels as low as 15% in some countries, reflecting a significant decline in healthcare brand trust. Patients are already skeptical before they even search, meaning they are more likely to be influenced by misinformation online.

When they come across a negative review or a critical opinion, it only reinforces their pre-existing beliefs. Patients don’t always say they’ve stopped. They tend to disengage quietly, leaving brands in the dark about their actual reasons.

Yet, if brands look closely at the data, they can notice that the moment when patients are most likely to read reviews often overlaps with the moment when non-adherence begins.

Patients tend to search for information right after leaving the doctor’s office, when the prescription has just been written but no action has been taken yet. It’s a fragile point, where intent hasn’t turned into behavior. Studies show that up to 31% of patients never fill their first prescription, and up to 34% of those who do don’t return for the second.

Medical Affairs people don’t instinctively see themselves in the digital reputation conversation, as their work focus more on scientific exchange, clinical education, and key opinion leaders (KOL) engagement. But given the correlation between online reputation and adherence, the medical team should begin to focus on patient impact as well, asking: What happens when these study findings are viewed without clinical context? Where is the evidence being simplified, and by whom?

Do Study Findings Corroborate?

A scoping review published in late 2025 by Wreyford et al., synthesising 25 NLP studies of cancer patient-generated online content identified four drivers of non-adherence: unmet emotional needs, subpar information and communication, misalignment between patients and HCPs, and, importantly, online misinformation and perceived clinician bias.

An analysis of more than 130,000 posts from 10,000 breast cancer patients over nine years showed that fear, especially fear of side effects, was a prevalent emotion throughout the treatment journey. Completion of therapy was instead associated with positive emotional states, including joy.

In an analysis of prostate cancer patient conversations online, perceived physician bias was associated with poor adherence. When patients felt their specialist’s information was incomplete or biased, they were less likely to stay aligned with recommended treatment.

For pharma brands, this requires Medical Affairs to collaborate with commercial teams on messaging that reassures patients before and during therapy. These narratives should be compelling enough to reduce the impact of misinformation or biases during treatment.

A patient who abandons therapy because of what they read online is a clinical event. Calling it healthcare reputation risks only costs lives and misallocates the resources needed to fix it.

Why Commercial ORM Is Structurally Insufficient

Commercial teams have legitimate reasons to care about online reputation. When search results show plaintiff attorney press releases above clinical data, it can reduce prescriber confidence. Low ratings on patient review platforms can also lower the chances of new prescriptions.

Commercial ORM is typically focused on protecting brand value through strategies like SEO and GEO. However, identifying, interpreting, and responding to clinical signals in patient-generated content is primarily the responsibility of Medical Affairs.

Plus, commercial teams operate under a constraint that makes reputation management impossible. Anything they say publicly about a drug’s safety or efficacy profile is a promotional act, subject to regulatory review and fair balance requirements.

When a patient posts that a drug gave them headaches, the brand team cannot respond with clinical context. When a physician tweets skepticism about a trial design, the commercial team cannot respond properly. The regulatory firewall that protects patients from misleading promotional claims also prevents online engagement.

Meanwhile, Medical Affairs shares clinical data, discussing real-world evidence, engaging with published literature, which is exactly the capability that online reputation, seen as a clinical and scientific problem, requires.

The KOL and DOL Problem: When Medical Affairs and ORM Must Work Together

Nowhere is the limitation of a commercial-only ORM approach more evident than in how negative statements from KOLs and Digital Opinion Leaders (DOLs) are managed.

When a KOL who has been closely associated with a drug’s clinical narrative, changes their mind, publicly questioning its efficacy or expressing safety concern, the reputational damage is palpable. In some cases, no amount of brand team content can beat skeptical comments from a credible clinical voice.

A patient DOL with 90,000 followers sharing why they stopped a drug, describing side effects, or information they felt was withheld, may reach people when they are deciding whether to continue treatment. Unlike a KOL’s criticism, which travels primarily through HCP channels, a DOL’s post lives where patients already are: the social feeds, forums, or search results.

And the patient influencer’s words can be persuasive. Some patients trust other patients more than they trust institutions, largely because they need someone who knows what their experience feels like.

Medical Affairs has formally taken ownership of proactive DOL engagement in many organisations, and rightly so. The scientific, non-promotional relationships Medical Affairs manages with KOLs is also the right model for engaging DOLs. However, owning engagement is not the same as owning crisis response. And this is the area most companies have not yet built properly.

When a KOL or DOL goes negative, four things must happen simultaneously, owned by four different functions: 

Medical Affairs’ scientific credibility is what makes it the right function to rebuild trust: 

• with patients who feel they were given incomplete information 

• with HCPs who suspect the data they were shown was selectively presented 

• with those who only sought out evidence that confirmed what they already believed 

• with prescribers whose clinical judgment was shaped too heavily by the first study they encountered. 

While Medical Affairs should lead the healthcare crisis management, it cannot own it alone. How well safety, legal, communications, and ORM functions coordinate in the first hours determines what gets said and whether the company is trusted or doubted by the audience. 

How to Get ORM Right 

What gets measured gets done. If Medical Affairs doesn’t have KPIs tied to its expertise, there’s no accountability on their side and it’s unlikely to get involved. 

Today, medical teams are typically measured on scientific exchange quality, advisory board engagement, publication output, and Medical Science Liaisons (MSL) field coverage. But these KPIs don’t relate directly to ORM. As a result, the link between reputation signals and non-adherence is not evident.  

A practical solution is to create a joint MA-ORM committee. This group would monitor KOL and DOL sentiment, manage response protocols for negative public statements, connect digital reputation data to patient adherence metrics, and report to both the Chief Medical Officer and the Chief Marketing Officer. Dual reporting sends a signal that both functions must be accountable for the outcome. 

The Question Your Organisation Might Struggle Answering 

Here is a simple test of whether your organisation has solved this problem. 

When a DOL posts a LinkedIn article questioning your trial design, who in your organisation is responsible by 9 AM tomorrow? What are they allowed to do? Who approves the response? How does it get coordinated across medical, legal, communications, and ORM? 

If you cannot answer that clearly, you have your answer. In a world where nearly 50% of patients, regardless of their conditions, don’t adhere to prescribed therapy and fear of side effects is a major driver, companies need a coordinated response protocol to be ready for a reputational crisis.  

Medical Affairs is the scientific conscience of commercial teams. Some conversations with HCPs and patients are too nuanced and clinically sensitive to be left to marketing alone. ORM is exactly that kind of conversation. A patient abandoning therapy because of what they read online is a clinical failure which requires medical teams’ intervention.