I had an interesting experience recently from two Yelp reviewers. One person gave me a one-star review because she got a bruise after a non-surgical injectible treatment to the face. Another left a one-star review because she was unhappy with her cosmetic surgical procedure.
Obviously if I’m using these examples, then I believe they were unfair complaints. In the first example, a bruise is a very normal potential outcome after an injection to the face (or anywhere). Luckily, they’re temporary. And in the second example, the patient’s results were so amazing that we wanted to post her before and after photos online if she would have allowed. Clearly there were other issues at play in the second example. Some issues can’t be fixed with cosmetic surgery, and I should have identified those issues preop. So that’s on me. But to be clear, we make patients happy every day and within the Yelp realm, we still have 4.5 stars out of 5 from over 50 patient reviews.
What’s my point in all this? It’s not simply that the customer is not always right. These two reviewers actually revealed an interesting thought process in statistical and psychological terms known as a confirmation bias.
The customer is not always right!
Let’s talk about confirmation bias. According to Wikipedia, confirmation bias is “the tendency to search for, interpret, favor, and recall information in a way that confirms one’s preexisting beliefs or hypotheses.” Often, when we’re on Facebook and reading controversial articles, we end up in an echo chamber, hearing the same arguments that reaffirm our own pre-existing beliefs. This confirms our own feelings, blocking out all other dissenting opinions.
In the case of the Yelp reviewers, they both said the same — but opposite — thing. Let me explain. The patient receiving non-surgical injections (that resulted in a bruise) stated that I should stick to surgical treatments since she only noticed 5-star reviews from surgical patients. In contrast, the surgical patient said I should focus on non-surgical treatments since she only noticed 5-star reviews from patients receiving non-surgical services!
In their mind, they only saw 5-star reviews from patients receiving the opposite treatment they received (surgical reviews in the case of the non-surgical patient, non-surgical reviews in the case of the surgical patient). But, if anyone takes a critical look at all of my reviews, they would very quickly see they’re evenly distributed between surgical and non-surgical reviews. In fact, the surgical patient that said I only had 5-star reviews from non-surgical patients obviously didn’t recognize that the very FIRST review on the page (which was 5 stars) was from a surgical patient! Again, adding up to a cumulative 4.5 stars out of 5.
So, based on their confirmation bias, they only saw reviews that reaffirmed what they already believed — that I’m good at the procedures they didn’t receive! If the non-surgical patient believes I’m good at cosmetic surgery and the surgical patient thinks I’m good at non-surgical services, what are we to believe? Taking their two reviews together, I’m either good at both cosmetic surgery and cosmetic medicine…or bad at both! Needless to say, the customer is not always right.
How to handle online reviews, IMHO
This sort of digital bashing is why I never respond to online reviews — good or bad. In the case of a negative review, the complaints are by their nature one-sided and inaccurate. If you respond to a negative review, it’s hard not to come off as defensive or angry, which reduces your credibility as a physician. You can’t win a shouting match with a patient, so I simply don’t respond online at all.
If the review is positive and you respond to thank the patient, then your lack of response to the other negative reviews suggests the author(s) of the 1-star review(s) was speaking the truth. So, again, I don’t respond to either.
Despite our lack of response online, we do contact everyone ‘offline’ to either thank them or attempt to resolve the issue. But, I think the real path to success with online reviews is not to sweat the few bad reviews or how you respond to them. The answer is to flood review sites with 5-star reviews by your favorite patients, without bribes!
Simply request that every happy patient “check in” on Yelp (for example) when they’re in your office and then write a review. By checking in, it’s more likely to “stick” and not be filtered by the Yelp algorithm.
I recognize this may be easier said than done. But, if asking every happy patient for a review is part of your normal checkout process, just like obtaining payment or scheduling their next appointment, you’ll gradually grow the number of reviews you have. That in turn will drown out the customers that aren’t always right by the ones that are!
Dr. Jonathan Kaplan is a board-certified plastic surgeon based in San Francisco, CA and founder/CEO of BuildMyBod Health, an online marketplace for healthcare services that allows consumers to determine cost on out-of-pocket procedures, purchase non-surgical services, and in exchange, the healthcare providers receive consumer contact info — a lead, for follow up.