Everything and everyone is rated these days. Your flat white, your Pilates class, your dinner and your plumber. 1 star to 5 stars. And its undeniable that those stars will influence the decisions people will make about using a service (or drinking that flat white).
Ratings are perhaps most prevalent on Google. But of course there are ratings on Facebook, on specific sites and booking services for restaurants and cafes, travel sites…and pretty much any online shopping platform allows pretty much every product to be rated. You can rate the quality of a particular bloody screw on the Bunnings website if you really want…and obviously people do want!
So, what about rating or reviewing medical services, and in particular (to me), plastic surgeons?
Well, like most other aspects of the medical profession, there are a variety of rules and regulations which determine the appropriateness or otherwise of ratings for surgical services. It kind of falls into the same basket as advertising I guess, and there is a very good reason for that.
The Medical Board of Australia makes it clear surgeons must not use testimonials (ie. reviews) in any form of advertising material, whether that be on their own website or any online platform over which they have control.
So, that explicitly prohibits things like Facebook reviews on a surgeon's business page, or republishing any form of review or testimonial from other websites to our own website or social media platforms.
Of course, there are an abundance of platforms that are outside of our control where patients can choose to provide a rating or a review of their surgeon. And there is nothing illegal about patients posting (or being asked to post, by their surgeons) to those platforms.
What we’re talking about here are things like Google (obviously) but also platforms like "Realself", and closed forums or social media pages that are not controlled by the surgeon. With the proliferation of patient-controlled forums which are frequent sources of information when patients are researching a particular operation or a particular surgeon, that means there are ample opportunities for patients to read - and be influenced by - reviews and ratings prior to surgery.
So what is the problem with that?
Well, it comes back to questions of whether the information, or the individual, behind those ratings/reviews is trustworthy. I think it is worth breaking this down a little.
We certainly need to ask a few questions about what drives patients to leave reviews.
Obviously, it is entirely possible that a patient may leave a review simply based on their satisfaction or otherwise with a procedure. That’s fair, right? Can we argue that a patient is ever really wrong for leaving a negative review if they have had a bad experience, or they have ended up with a result that they don't like? After all, a review is always subjective. But what if the outcome for a patient is objectively good? But they still leave a negative review, perhaps because their perception of that outcome, and the perception of their surgeon (or indeed, anyone else) differs. Then what? Who's right?
Already, we can see that this is a topic that gets a little tricky.
So what about genuine gripes, poor practice and bad outcomes. Surely patients are justified in leaving some comment reflecting their displeasure. It’s certainly hard to argue with that position.
Unfortunately we know that there are vexatious ratings, and spurious negative reviews. How common are they? Hard to know. There have been a few high profile cases recently where Google has been sued (and lost!) by surgeons after false negative reviews were left by vexatious patients with an agenda. Google have always maintained that they cannot be held responsible for the content of reviews…but perhaps they can?
This isn’t just a commentary though on negative ratings. Because as much as someone is influenced by the 1-star ratings, they are perhaps even more influenced by the 5-star ratings. We all want the best, and when it comes to surgery, you can’t try before you buy!
There are plenty of surgeons who carefully guard their 5-star reputations on Google and elsewhere. They may not be able to actively promote those ratings or testimonials, but they know as well as you and I that there will inevitably be a magnetic quality to that rating which draws patients to their practice.
The thing with those 5-star reviews though is that they can indeed be solicited, incentivised and they can be entirely meaningless.
And that can take us into uncomfortable territory where we are forced to consider the really troubling business practices that abound in how those reviews are solicited. And there is a nasty flip side to this situation too. That is the intimidation of patients, who may have concerns, with certain threats (like forcing patients to sign "non-disclosure agreements" as part of their consent form) to minimise the likelihood of a patient leaving a negative review. Not making this stuff up...it happens. Gotta keep that 5-star average, right?
Solicitation of positive reviews is one of those issues that is rarely discussed. Technically, I would say it is a total no-no. Surgeons can’t incentivise patients to book for surgery by offering them freebies – for example, if a surgeon offered a patient free botox if they book breast augmentation surgery, that is quite clearly not permitted by Medical Board guidelines. But there isn’t anything specific about soliciting reviews, even though the guidelines are very clear about using those reviews to promote one’s self. Oversight? I think so.
I have no idea how prevalent this stuff is, but we know it happens. I hear about it, and sometimes even see evidence of of it in certain aspects of my work. The fact that such things are happening at all is bloody disturbing. And we haven't even gotten into the fact that some surgeons employ people to manage their online reputation, using tactics like "dummy profiles" to post positive content to counter any negative reviews. Yikes.
To address the elephant in the room: are we aware of our "ratings" online? Of course we are. We have to be. Given the way the world works, we naturally want to protect our professional reputation online.
So sure, whilst we certainly don't ever ask for reviews, we know what some of our patients have been kind enough to say on Google for example. It is also true to say however that we have absolutely no idea what is being said about us in other forums. It is entirely possible that we have been "reviewed" somewhere in less than glowing terms. Can I, or do I want to do anything about that? Not really. Where does it stop? This is just a fact of life now and it would be madness to think that we can control everything that is said or written about us.
Anyway, I guess what it comes down to is this: don't make your decision to have surgery based entirely on a review! It is neither right nor is it wrong for a surgeon to be "rated" online, but being aware of the fallibility of such things is just common sense.