The importance of responding to "ALL" Online Reviews

In this day and age of Internet “authors” almost all of us that own aesthetic practices have a new challenge to meet.  

How to deal with online reviews? We all know the impact of online reviews that are negative. In looking through over a 50 websites with reviews I found a troubling statistic. 97% of these websites only responded to negative reviews and missed out on a golden opportunity to improve their search engine ratings by responding to every review.

Let’s look at the first impact of only responding to negative reviews and that’s being put in a reactive mode that is going to almost always be defensive and will stand out like a sore thumb. I urge you to think like a patient when reading reviews and especially replies to reviews. If you were a patient and had taken time to write a positive review wouldn’t you liked to be thanked for it? Wouldn’t you like to read that the owner/physician of this practice also took their time to reply back to you?

By only replying to negative reviews we usually create a negative stream of content to and from.  In most cases that I read through, the negative review would generate 2 replies from both the poster and the owner/physician and the more post, the higher the positioning will be. Now contrast that with replying to all reviews. If you have 30 online reviews on Google and reply to all of them, you effectively have 60 reviews. 

It does not need to be lengthy. Something as simple as “Thanks so much for taking the time to let us know of your outstanding results. My team and I love what we do and look forward to seeing you again soon”. If you were a perspective patient looking for a place to visit and read how engaged the practice is with their patients, wouldn’t you be more inclined to visit a place that looks like they really, really care? Of course you would…

The other positive aspect of replying to reviews as the owner is that you can quickly bury a negative review off of page one. All it takes is the creation of and responding to 3-5 positive reviews and the 5th down negative review is now on page two. When replying to negative reviews also try and think like a perspective patient.  Try not to engage the patient unless they misrepresented their visit. Something like, “I was sorry to learn of this negative experience.  We greatly value both your treatment and our reputation.  Please email me at () with the details of what happened so I can get involved and work at trying to find a solution to this issue and thanks so much for letting us know”.  Now if you were again a perspective patient and read the owners reply, wouldn’t your image of the practice still be very high despite a negative review.

Now get to work on finding a mutually agreeable win/win solution. In most cases, you will be able to find some way to satisfy the patient. If not at least the reader will see that you tried by your initial response. If however you try and “air” the defense of the negative review online, it will usually result in an ugly exchange that will benefit no one.

So, embrace all the online pontificators. The old adage, “if you can’t beat them, join them” applies as does “silence is acceptance”. Let everyone read how much you care by replying to all reviews.

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Healthcare Communities On The Rise

Buyer's Remorse In Plastic Surgery

"OMG!! what did I do?! ...

I must be crazy to do this!" said my patient only hours after her tummy tuck. She was in some pain and distress, as the anesthesia was wearing off, and began a tirade of self-disparaging statements reflecting all her worst fears and anxieties about the surgery.

I stopped what I was doing, and sat down with her on the recovery room bed to calm her down. It's amazing how comfortable those recovery room beds are...and the patients seem to really like it when I take my time to explain and review things with them. She did fine after some pain meds and a little small talk, and on her 1 week postop visit, was happy as a clam with her new flat tummy. And that's when I realized just how common "buyer's remorse" is in plastic surgery.

Plastic surgery, especially cosmetic surgery, is elective. That means that it isn't surgery that you need, but surgery that you want. Oftentimes, people overlook the pain and discomfort that is inherent to any surgery. Although, most people who have had plastic surgery, and, gladly, the vast majority of my patients, will say that they are happy with the decisions that they made, a certain segment of the patient population will always have difficulties in adjusting to the postoperative demands, no matter how carefully they were selected by the surgeon or how well surgery was performed.

Every plastic surgeon hones his/her patient selection skills over years of education, training, and practice. The goal of every plastic surgery practice is to only have happy patients. As this is an ideal that will probably never be reached, we surgeons must realize that some of our patients will be unhappy, at various stages of the postoperative period. Those patients need special attention, understanding, and a compassionate review of clinical details. They must be empowered, and be actively involved in the procedures of postoperative recovery. It's also important to give your patients options as to colleagues who may serve as second opinions.

As a patient, if you find yourself unhappy with the results of a cosmetic procedure, take a deep breath and fret not, as it depends on the timing. Most early remorse cases are due to the unexpected, and probably poorly managed, pain and discomfort. Moreover, remorse is clearly correlated with incidence of complications of surgery. In the case of the former, simple and more precise pain control and behavior modification is all that is needed. In the latter, both preoperative and postoperative miscommunication between patient and surgeon is the usual contributing factor. As difficult as it is to do, as a patient you must communicate with your surgeon, even if you believe that he/she is responsible for a poor outcome.

We must realize that we can all end up being the patient who regrets having plastic surgery. It can happen if you're the best patient, or if you have the best doctor. What's important for both of you is to keep the lines of communication open so that proper, just, and adequate resolution is reached. No patient should abandon his/her doctor, and the opposite is just as true.

Surgery for Free???

"I want my surgery for free" my friend tells me... Just how many times have we (plastic surgeons) heard that before?

Obvious to me, that meant that my surgical fee will be waived. Oddly enough, for my friend, an intelligent person in her own right, this meant something completely different. She thought the entire surgery was actually for free. After a slightly awkward moment, I asked her if she knew anything about surgical fees and healthcare costs. To my astonishment, she had absolutely no idea. Being the consummate educator that I am, I decided to use this conversation as a teachable moment to instruct my friend about the economics of plastic surgery. Delving further into the topic, I found that one of the most popular Google searches regarding plastic surgery is plastic surgery costs. Frankly speaking, plastic surgery cost is so paramount, that if you listen to some of my friends and colleagues at our trade meetings, it seems that cost is so often the only determinant factor indicating performance of the surgery or not. In light of these glaring facts, here's a brief primer on the topic.

In performing cosmetic and plastic surgery there are three basic fees that must be considered:

1) the surgical fee,

2) anesthesia fee, and

3) facility fee and materials costs.

The surgical fee is the simplest to understand, and frankly the easiest to negotiate. Basically, it is what the surgeon takes home. From this fee the surgeon pays for all the costs incurred in becoming and being a surgeon. This may included school loans, malpractice insurance fees, office rent or mortgage, staff salaries, and other costs, to name just a few. The surgical fee is determined by the judgement of one person alone, the surgeon. Depending on his/her practice expenses, he/she determines the fee, and is ultimately the one able to negotiate it. More often than not, when plastic surgery fees are negotiated and consequently lowered, the change in price comes from this portion of the overall cost of the surgery.

The anesthesia fee, one often overlooked by many, is the hardest one to negotiate. Basically, it is what the anesthesiologist takes home. This fee may depend on several factors, including the nature of the surgery, the nature of the anesthesia administered (local, regional, or general), the time of surgery, and other technical issues as well. The anesthesia fee is usually determined ahead of time between the surgeon, anesthesiologist, and/or the surgical facility, and thus, it is usually not subject to much negotiation.

The facility fee, also one that is difficult to understand, generate, and consequently, negotiate, is composed of many elements that may not be readily seen. These include the costs of nursing care, medical materials and drugs used during surgery, and other costs of running an ambulatory surgery facility. Again, this is usually a fixed price that most commonly is not subject to negotiation, especially with the operating surgeon. Additional material costs may be added, for example, when using breast or facial implants or other materials related to specific cosmetic surgery.

During your plastic surgery consultation, when the time comes to talking about the costs of surgery, it is always worthwhile to ask about each one of these fees, as some may be negotiable. The fact that cosmetic surgery is not covered by medical insurance, and is thus a luxury item paid for by discretionary income, has actually contributed to it becoming so affordable and within reach to larger segments of the population. Plastic surgery is one of the last vestiges of the healthcare industry where free market forces act to shape the economic transactions between producer (doctor) and consumer (patient). The more knowledgeable and informed you are, the better the chances you'll get a better product and bigger bang for your buck. A cautionary note, however, is that in plastic surgery, as in most industries, you get what you pay for. Your quality assurance is the doctor's credentials and bedside manner, their specialty-specific board certification, and surgical center accreditation. If all of those factors are satisfactory, then feel free to shop around. And remember, an educated consumer gets the best deal.

Medical Spa Branding: Getting Started

The big shots are only the little shots who keep shooting. - Christopher Morley

Your actions, over time, equal your brand.

It's determined through your output: the work you do, the products sell, the services you provide, and the content you create.  It determines how much money you make, and how much control you can exert over your career and your lifestyle.

If you're not exercising, you'll lose muscle tone and gain fat. If you're not working on your own brand, it'll backslide too. Rest too long on your laurels and you run the risk of undoing all of your hard work and fading in to the background. If your behavior, attitude and output contradict your existing position, your real positioning will change.

You're not going to need much to get started, just and understanding of how all of this fits together (this guide), some thought about your goals, and the effort to take action. Once you've determined your capabilities and decided where you want to be, you should be able to manage everything in your head, and a few bookmarks in your browser.

Your goals and were you want to be are up to you. We're going to focus on what actions you need to take to get you there.

Success is measured in years, not months.

To get started, read through this guide, give it a little thought, then act.

Plastic Surgery & Malpractice Lawsuits In The US & Canada

If you're a plastic surgeon in the US and you've been practicing for a while, the odds are good that you've been sued by a patient.

In the US there are about 95 medical liability claims filed for every 100 physicians—or almost one per doctor—and nearly 61% of physicians age 55 and older have been sued, according to a report released by the American Medical Association and based on a survey of 5,825 “non-federal patient care physicians” conducted in 2007 and 2008.  The survey, which included doctors practicing across 42 specialties, found that 42.2% of the respondents had a claim filed against them at some point, with more than 20% of physicians sued at least twice.

The most-sued specialties were obstetricians/gynecologists and general surgeons, with 69.2% of them being sued. (Psychiatrists were the least sued at 22.2%...  probably because they can use the Jedi mind tricks to mitigate their risk by keeping their patients happy.)

The study also found that 47.5% of male physicians had been sued, with 26.3% having been sued twice; and that 23.9% of female doctors had been sued and only 9.4% had been sued twice... andticdotal evidence that female physicians may be able to manage patient interactions better post treatment.

This brings up some of the interesting differences between practicing in the US and other countries. Certainly the US is letigious, perhaps the most country in the world. (If that's not the case, please comment.) I've posted before about how our Members outside the US can end up handling unhappy patients.

Read Learning From Physicians World Wide: Unhappy Patient? If You're In Mexico Just Call The Cops

In Canada under the single payer system, the numbers are dramatically different for a number of reasons, all of them economic. Between 2002 and 2006 the C.M.P.A. reports only 5246 lawsuits were filed against doctors in Canada: only about a 1000 claims per year.

Why?

First, In Canada, court awards are much lower than awards for similar injuries from courts in the United States. Cases that might be successful in the U.S. are simply not economically feasible to pursue in Canada.

Second, In Canada, most doctors are defended by a single organization, the Canadian Medical Protection Association (the C.M.P.A.) with a couple of billion of dollars in the bank that can be used to defend physicians. The C.M.P.A. reports it's success rate in defending claims brought against doctors. More than 3800 of the 5000 claims were dismissed or abandoned because the victim or their family quit or ran out of money, or died before trial.

The result? A couple of online articles on this subject express these stats: more than 5000 lawsuits filed against Canadian doctors, only two percent (2%) resulted in trial verdicts for the plantiff and for the few plantiffs who won at trial, the median damage award was only $95,500. Just try and get a US lawyer to go for that. (If you're a physician in Canada and you can clarify this, please leave a comment.)

There are advantages to being a physician in the US for sure, but there are also risks. The numbers are bigger on both ends.

Medical Devices & Estheticians

It's true, medical devices are used by Estheticians.

In most clinics in the US, esteticians are often used to perform treatments... but outside the US not so much. Here's an email I received from Susanne Warfield, Executive Director of NCEA, taking us to task for 'misinformation'.

Susanne Warfield - Executive Director NCEA

I received a call from one of our members regarding your website and the statement about estheticians using medical devices.

Estheticians are using medical devices every day...- even an electric tooth brush is a medical device as defined by the FDA. It is very important that we understand that any device sold and marketed in the United States must be registered with the FDA and laser and light therapy devices are just another medical device that have "Indications for Use" and "Intended Use".

Please update your misinformation on your website as it it incorrect. Thank you

Anyone have thoughts on what an esthetician in the US (or each state) can or can not perform? Where's the line?

Bad Reviews Of Your Medical Spa? Yelp Accused Of Extortion

Are you being extorted to keep your medical reputation clean?

Wired.com posted a story about a complaint filed in California that the online review site Yelp.com manipulates the reviews, and therefore the business ratings, through business practices that amount to extortion.

From the story:

 “Yelp’s sales tactics amount to high-tech extortion,” said plaintiff attorney Jared Beck in a press release. “The victims tend to be small businesses, such as our client, who often have no choice but to pay Yelp exorbitant sums in order to prevent further harm to their livelihoods.”

Yelp released a written statement in response to the lawsuit.

“The allegations are demonstrably false, since many businesses that advertise on Yelp have both negative and positive reviews,” the statement read. “These businesses realize that both kinds of feedback provide authenticity and value. Running a good business is hard; filing a lawsuit is easy. While we haven’t seen the suit in question, we will dispute it aggressively.”

Read the entire article here

Your reputation is one of your most valuable assets. If you're looking to protect and control your reputation in a real way, check out this review marketing product from Frontdesk.

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Medical Spa MD Members get a Podium patient review marketing account and save $1,257

Protect your reputation. Get new patients. Medical Spa MD Members receive a special, full service Podium account that includes: no setup fee (save $300), a 10% discount forever (save $330/year) and on-demand patient review marketing training for your entire staff ($597 value).  This offer is not available anywhere else.

Breast Fat Grafting Comes Of Age

The search for the ideal breast implant material has spanned everything from soy oil to paraffin. 

The current generation of silicone implants are one of the most studied medical implants in the world.  Despite the favorable safety profile, a sizeable percentage of women interested in augmentation surgery have sat on the sidelines.  There most cited concern is having something they consider unnatural in their body. 

At the recent American of Society Plastic Surgeons meeting in New Orleans,  fat grafting to the breast seems to have come of age.  Plastic surgeons have been using fat grafting to the breast for patients undergoing reconstructive breast surgery for several years now.  The original hesitations of using fat grafts for breast augmentation purposes have to do with the number of procedures necessary and the ability to read subsequent mammograms.  Both these issues are slowly being resolved.

Who is a candidate?

Most patients would prefer to have this procedure in one surgical procedure with one recovery.  Ideally, a perfect patient would want to increase their breast size from 1 to 1 1/2 cup sizes larger.  They would need to have a sufficient fat volume to be liposuctioned to provide enough material to graft.  People that are very athletic often would not have enough donor fat to be used. 

Who is not an ideal candidate?

Traditional augmentation is still best utilized for the very slim patient who wants to increase her breast size 1 1/2 to 2 cup sizes or more.  A breast implant would allow more shaping options to the breast particularly giving a patient more fullness in the superior portions of the breast.

There are still are remaining issues of the effectiveness of mammograms in patients that have had fat grafting to the breast.  Newer imaging technologies, or CT/MRI, may help resolve these issues.

Men & Their Path To Plastic Surgery

Men may not be as open to their bodies as women, but they have their own insecurities about appearance, especially when entering middle age.

At the last couple of years, plastic surgeons noticed an increase in the number of guys seeking their skills to improve their bodies.

What are the most common complaints among men when it comes to body image and the available surgeries to treat them?

Man boobs – Gynecomastia

Men as they age can develop fat around their chest, which results in the appearance of male breasts-known in the medical language as gynecomastia.

According to the American Society of Aesthetic Plastic Surgery (ASAPS), 40 to 60 percent of men suffer about this issue. Liposuction or cutting the excess glandular tissue is the key.

The Beer Belly

This condition can be caused by an intake of too many calories from alcohol or simply of genetics. When diet and / or exercise aren’t working to shrink the belly may liposuction will be the way to remove the excess fat.

ASAPS reports, liposuction was the most common procedure for men last year. It can be combined with a tummy tuck to remove any excess skin left over, following liposuction.

The Male Face

This area is another place of concern for men, as wrinkles and lines are impossible to hide. The most popular options to get rid of them are Botox® injections and facelifts.

Source: ASAPS