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How patients are using online ratings

Article-How patients are using online ratings

The overall theme in healthcare is that patients are online more than ever, according to Steve Xu, M.D., M.Sc., resident physician, postgraduate year two (PGY2) in dermatology at Northwestern University School of Medicine, Chicago.

“We believe cosmetic surgery and aesthetics represent a beachhead in this theme,” Dr. Xu says.

Dr. Xu offered insights to colleagues around patient online reviews during the 36th Annual Conference of the American Society for Laser Medicine & Surgery (ASLMS 2016), Boston, Mass.

“Recruiting cosmetic patients often includes an adept online marketing strategy. Managing online reputations is very important,” he says.

More than 60% of patients consult reviews before selecting a provider, according to a study published Feb. 19, 2014 in the Journal of the American Medical Association.1 Dr. Xu is among the authors on another study he presented at ASLMS 2016 that approaches the theme in a different way.

“Rather than investigating specific providers, our study looked at how laser and light procedures (there are many of them) are rated. In the context of aesthetics, this is important because patients are picking their surgeons and have a specific procedure in mind. Understanding how real-world patients are rating procedures is useful for cosmetic surgeons in setting expectations and price setting,” Dr. Xu says.

“A patient may come in and be interested in laser resurfacing with even a specific laser brand in mind based on online reviews,” he adds. “They will have done their research on their surgeon, and have a price point in mind based on what they have read. A cosmetic surgeon should be ready to anticipate these notions, explain the imperfections in online reviews and how costs can be highly variable.”

Based on his findings, Dr. Xu says cosmetic surgeons should keep these important points about patients’ online reviews in mind:

  • Cosmetic surgeons should understand reviews, before/after pictures and patient-driven discussions of specific surgeons are available online with surprising geographic specificity, he says.
  • Although online review sites such as RealSelf can provide valuable information on patient mindset and geography-based pricing, patients’ interpretations of these results must be done with caution, according to Dr. Xu. 
  • Finally, cosmetic surgeons should have talking points ready to explain to patients why online reviews are imperfect.

“Our analysis of the information on laser/light procedures on RealSelf found that the reviews do not reach enough specificity in regards to the procedure being discussed. Reviews were posted in general terms, laser types, specific laser brands and intended outcomes,” he says.

Cosmetic surgeons know that each patient is different in regards to skin type, treatment goals, etc., so, even if the categorization were accurate, the results couldn’t be generalized, Dr. Xu says. As a result, surgeons should emphasize this point in counseling patients, who might have already formed their notions of procedures and laser types.

“Ultimately, surgeon experience in assessing a patient's skin type and treatment goals, as well as real-time adjustment of laser parameters to tissue response, is the most important factor in a successful outcome,” he says.

What can surgeons do to overcome online review pitfalls? Dr. Xu says awareness is the first step. Websites, like RealSelf, will only grow in influence and popularity.

“Be ready to share your perspective on online reviews. Online reviews are useful, but they don't tell the full story. A cosmetic surgeon's experience and ability to assess tissue response, patient type and patient goals is still the most important factor in a successful outcome. At the end, this will likely be the most cost-effective solution, even if the upfront cost is higher,” Dr. Xu says. “We want to delight our clients and avoid disappointment. Online reviews don't always tell the real story. The final satisfaction scores (specific to RealSelf) may not factor in neutral or 'not sure' reviews. For many cosmetic procedures, it takes time before the final results are seen. Tattoo removal is a good example of a laser procedure with a lot of 'not sure' reviews, which explains the discrepancy between our satisfaction scores and what's reported on RealSelf. Clinicians should recognize that online reviews of procedures and devices with a high number of total reviews and a low number of neutral reviews are less prone to bias.”


Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA. 2014 Feb 19;311(7):734-5.

Disclosure: Dr. Xu reports no relevant disclosures.

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