Consumers consider online reviews important for choosing physicians, but they should be wary of using those ratings to choose plastic surgeons.

The reviews tend to be polarized, and some are written by people whom consulted with the doctor but never had surgery, reports a new Northwestern Medicine study.

The study examined online ratings of doctors who performed cosmetic breast augmentation in six major U.S. cities.

In reviews by patients who had cosmetic breast augmentation, patients’ treatment by the surgeon’s staff was nearly as important to them as the outcome of the surgery.

The online platforms for patient reviews in the study analysis included RealSelf, Yelp and Google and 935 positive and 142 negative reviews.

“We found the people who write these review are either very happy or unhappy, so it’s difficult for the consumer to get balanced information,” says Dr. John Kim, a professor of plastic surgery at Northwestern University Feinberg School of Medicine and a plastic surgeon.

The finding most surprising is the importance of interactions with the doctor’s support staff,” Kim says.

“The important thing used to be how the surgery turned out,” Kim says. “Our study shows what’s almost equally important are things we wouldn’t have thought of like how quickly we answer the phone, how nice the staff is in their interactions, the wait time and bedside manner.”

The cost of the elective cosmetic surgery procedures, which are generally not covered by insurance, is at the bottom of patient concerns, Kim says.

Other study findings include:

• There were significantly more 1 star and 5 star reviews than 2, 3 or 4 star reviews. Patients with more extreme views (1 star: worst surgeon ever, or 5 star: best surgeon ever) are more likely to write a review online than those with more moderate views.
• Google reviews were more favorable than reviews on Yelp in each major city studied. The difference was most evident in Houston, where the average Google rating was 4.7 and the average Yelp rating was 3.8 despite 60 percent overlap in surgeons reviewed.
• There are many more reviews of plastic surgeons for consumers to evaluate. The number of online reviews on plastic surgeons on Yelp and Google have shot up at an average rate of 42.6 percent per year since 2011, driven predominantly by a 51.4 percent annual growth rate among Yelp reviews.

“Unhappy patients take up more screen ‘real estate’ than happy patients, posting longer reviews, which creates a bias of dissatisfaction in online ratings,” said study author and medical student Rob Dorfman

Doctors are not allowed to respond to negative reviews online due to HIPPA (the Health Insurance Portability and Accountability Act).

“You could have been practicing quietly and humbly for 20 years, but patients think someone with 1,000 reviews, even though they have much less experience, must be better,” Kim says. “So the ubiquity and quality of online reviews may increasingly substitute for experience and ability.”

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