Flawed: Consumer Review Sites for Dentists and Physicians

Did you know that my NYC Cosmetic Dentist practice has a five star rating?[1]

Truthfully, I didn't know that either until I started thinking about and researching today's blog topic, which is online reviews of dentists. And you'll probably be surprised that even though I have a really good rating, I think the system is flawed, and somewhat meaningless. (So does that mean I'm telling you to ignore my five-star rating? I guess it does!)

Now, don't get me wrong -- I do think online rankings/reviews for certain things are VERY useful -- things like hotels, movies, food, theme parks, video games... even products at Amazon.com and the like. But as a dentist, I do have to say that I think online ratings for the medical fields are not very helpful.

The reason I think online ratings are okay for some things is volume. Sheer volume. If you get 5,000 reviews (like a restaurant/hotel/etc. would), you can generally assume that most of them are written by real people. In this age of smartphones, I've seen people writing a restaurant review while eating their meal. Or, people writing a bad review of a product when they really have an issue with the post office who lost their delivery. (How many times have you seen that on Amazon -- somebody gives a book a one-star review because they never got their order... Are they really reviewing the book?)

That said, once you get past a certain number (let's say, several hundred reviews), people with an axe to grind have less influence on an overall score, and you begin to see the true picture of the business or product.

But for a dentist or doctor? It'll be years and years before you get 500 reviews. Thus, people with an axe to grind (or a competitor looking to hurt you) will have a huge influence. Or, on the other side of that coin, "fake" good reviews can have a big influence also. For example, look at my reviews -- more than half of them are anonymous. How do you know I didn't write them myself? The truth is, you don't know that for sure. (I didn't write them, mind you, but I am trying to point out how absurd the review process can be.) I do understand that hotels and restaurants can have "fake" reviews also, but once you get into big numbers, they tend to wash out. If a place has 4,000 reviews and most of them are not so good, it's probably a safe bet you won't get the greatest meal there.

Here's another thing I found out in my research -- there is an industry out there based on fake reviews.[2] People will do anything for money, and if it means sitting at home in your PJs and writing fake reviews for five dollars... Well, there's someone out there willing to do it. Or, companies themselves try and manipulate reviews.[3] It seems in this online world, business gets more and more cutthroat.

You know, as I write this post and think about it, what's to stop a company from ordering 1,000 testimonials from, say, an outsourcing company for one dollar each or something like that? This would satisfy some of the criteria I mentioned above as being "good" (a sheer number of reviews). I like to think people (and companies) are honest, but increasingly, we find that money rules all. After all, I still get e-mails from Nigerian princes looking for ME to help them transfer money. They must not know the truth -- my wife handles that stuff because I am inept. I'm a good dentist, but I leave the checkbook to others.

There's another aspect to reviews that I want to discuss, but it's more related to my industry, although I'm sure other industries have similar issues. And that's the fact that sometimes good dental work is more painful in the short term than bad dental work. Let me give you an example: Dentist A skips a key step in making a crown. This causes most crowns to fail in a few years, but patients experience little pain during or after the procedure. Dentist B (me) does not skip this key step. However, doing a crown this way can (and often does) result in perhaps two weeks of mild discomfort. But, after the two weeks, things are fine, and the crown lasts 30 years.

Which patient is more apt to write a bad review two days after the process? But, which patient actually got the better treatment?

There are a lot of examples like that in dentistry. The fact is, good, competent dentistry is not cheap, nor is it the most fun way to spend a day. I can admit this. But, those two things can make some patients angry, angry enough to say something bad online. So in the end, take dental (and any medical profession) "reviews" with a grain of salt. Ask advice from family and friends, and go with your gut.

Oh, one last thing -- while researching, I came upon a list I ranked #2 on, and I am kind of proud of this one.[4] And I have you readers to thank for it.

Until next time, keep smiling!

[1] http://www.yellowpages.com/new-york-ny/mip/thomas-connelly-cosmetic-dentistry-450988165

[2] http://www.nytimes.com/2011/08/20/technology/finding-fake-reviews-online.html

[3] http://www.msnbc.msn.com/id/31928795/ns/travel-news/t/tripadvisor-warns-fake-reviews/

[4] http://www.1dental.com/blog/2011/05/20/top-10-dentists-in-social-media/

 

Follow Thomas P. Connelly, D.D.S. on Twitter: www.twitter.com/dr_connelly

Comments

[StephenJK]

04:01 AM on 01/04/2012

Here's an idea for the future: When our teeth reach full maturity, extract all the molars and pre molars and put implants in. That way you wouldn't have to perform useless, painful, money making scams like root canals and crowns and bridges. Then you really wouldn't have to worry about bad reviews. We have the technology, now use it. Drilling teeth out and filling them with mercury laden substances, too? I'd rather live in a world without dentists if they're not going to evolve with the rest of civilization. Oh, and when you charge the amounts of money you do, well, a lot of people I know can't afford it.

[AnnainLA]

02:36 PM on 01/03/2012

If you can afford to do so , you should get a second opinion before doing dental work to make sure the dentist is not recomending unneccessary procedures

[pfezziwig]

09:33 AM on 01/03/2012

There's no such thing as an incorrect opinion. Does the author believe patients are too stupid to comment on their own services received and such information should only be published by 'experts'?

These online ratings would have greater value if doctors and dentists actually stopped fighting them and started using them. At HealthcareReviews.com they can respond to or censor patients comments, it's a free promotional tool, they have control over their online reputation, patient feedback..time to join the rest of us in the 21st century and stop fighting the internet.

[Nelson Camen]

01:35 AM on 12/25/2011

What are your thoughts on refunds for bad dental work and how can we ask our dentist for one? Do dentist usually have a refund policy for cosmetic work?

[noahmarder]

02:52 PM on 12/31/2011

Morally, if the work was not as advertised, you deserve a refund. If you just had a bad outcome, but the dentist was not at fault, you don't. Legally, if you already paid, you are SOL. You would have to go to court, and the legal fees would probably exceed the cost of the dental work. If you were seriously injured though, it may be worth it because you can sue for damages which would be much higher than the cost of the procedure. If you haven't paid yet, you could refuse and give your dentist a written explanation. This will carry significant risk to your credit score, and some risk of a lawsuit, but it may be worth it.

[TeethWhiteCure]

09:29 AM on 12/24/2011

Shouldn't we let dentists write reviews about their patients? -- chronic late arrivals for appointment, failure to show up without notice, delays in payment, refusal of recommended treatment for prevention, never flossers and poor brushers, unhealthy eating and living habits, plus many POSITIVE reviews for the exceptional outstanding healthy oriented, respectful motivated patients that would score 5 stars.

[noahmarder]

02:45 PM on 12/31/2011

A dentist (or doctor) is a professional who is publicly advertising his services. As such, he is considered a "public figure" with respect to libel laws, and opens himself up to criticism. A patient is a customer or client, and does not have the same vulnerabilities. Any untruthful statement on such a review would be an invitation for a libel suit. A doctor or dentist would be well within his rights to charge fees to no shows and those who are chronically tardy and initiate collection procedures against those who don't pay. The other criticisms listed are personal health choices made by the patient and don't deprive the doctor/dentist of any income. Release of that information to the public would also be a violation of HIPAA laws.

In fact, some doctors/dentists DO gossip to one and other about "difficult" patients, who then may have a difficult time getting treatment from anyone. Sometimes, the fault was mostly with the doctor/dentist, who then blamed the patient if he got upset when things didn't go well. The patient typically has no recourse.

If doctors/dentists would agree to open themselves up to some OBJECTIVE accountability measures, they wouldn't have to worry as much about the impact of unfair negative reviews.

[Alchemist65535]

07:30 PM on 12/19/2011

I spent more than 20 years in the HMO and insurance software business, designing software and reviewing and auditing plans and providers, including office, chart and patient reviews. Developing ratings of providers, dental and medical, including labs, was difficult to do even with complete information. We took into account short and long term outcomes including redos. We also included patient ratings and complaints. Because we were doing this inside a plan there was no problem with spamming ratings. I considered a rating site on the internet for treatments and providers. The big problem was how to weed out the outright fraudulent reports. One of the things that can be done is to make it a question based survey method that requires a 10 minute commitment to prepare with spambot prevention techniques. I changed dentists a few years ago because of a third professionally questionable judgement call in two years including a bad and extra expensive outcome with a refusal of a promised no-cost redo. I didn't trash him on the internet only because I don't like to do that. Something like what he did would have had him kicked off any of the panels I helped supervise or had him on the watch list. Some of it was so borderline as to suggest fraud if not outright malpractice. A different DDS years ago did deliberate malpractice over a disputed bill. I was too sick to deal with filing and following up on a complaint for prosecution.

[dpkjj]

07:05 PM on 12/19/2011

I disagree. Everyone knows, or should know, that any online reviews are not statistically reliable, but they can be a guide, especially on the extremes - very good or very bad. For example, I had a dentist that so badly botched the work that most of it had to be redone less than a year later. And, to rub salt in the wound, the insurance company doesn't want to pay because they say the work was already done and they won't pay for it twice. You better believe I put that information on our local Patch - other patiens should be forewarned.

[SoCalDoc]

07:12 PM on 12/26/2011

For some reason this doesn't surprise me.

[dpkjj]

02:34 PM on 12/27/2011

Which part?

[SocialDentalNet]

02:37 PM on 12/19/2011

+1 noahmarder & reachpatients

Dentists need to educate themselves and update their mindset - digital word of mouth will be the #1 new patient acquisition method. The days of direct mail aren't over (with a QR code), but the landscape has changed.

For the dentist, especially the younger ones, digital marketing is becoming SOP rather than a PITA waste of money.

Dental patients aren't quite there yet when it comes to online reviews....because the dentist has not done an adequate job of communicating with patients. Not everyone is a prospect for the online review but every practice should have a systematic way to elicit, publish, and amplify their digital word of mouth.

[noahmarder]

04:00 AM on 12/19/2011

Consumers (patients) trust their providers (medical professionals) with their health and lives, yet we have no way of judging the quality of those providers. These ratings sites are a flawed way to do that.

In a fair system, if I went to a dentist for a crown, I should be able to get a report on how long his crowns tend to last, and the rates of various complications. The stakes are much higher in other specialties, yet there is still very little transparency. The only objective data I can get is malpractice/settlement/sanction history. Even there, many victims of malpractice don't sue, and insurance companies will often settle cases in which no malpractice occurred. There is also a big difference between "just good enough to avoid malpractice" and true high quality medicine.

If healthcare providers were actually accountable for their performance, we wouldn't have these flawed rating systems, the good doctors would shine, and the bad ones would either have to improve or make way for more competent performers. As a whole, patients would have better outcomes and costs (due to fewer complications and less waste) would be lower.

[NanoViking]

08:35 AM on 12/19/2011

..in a fair system, if you went to a dentist for a crown both you and your dentist would be adequately informed of the chemically toxic and radioactive content of the dental ceramic crown intended for your mouth. Sadly, there is very little accountability in the US dental industry - beyond that stipulated by the money minders. And when money rather than consumer safety is the bottom line THAT is not reflective of an industry being held accountable.

[noahmarder]

02:41 PM on 12/19/2011

If your dentist doesn't know what he is putting in your mouth, find another dentist. That information is available.

[reachpatients]

05:13 PM on 12/16/2011

Tom: I think you're right that it may be a long time until patients search for doctors like they shop for their next restaurant; restaurant patrons are trained to leave ratings, often as they eat, while patients aren't quite there yet.

I think the most time-efficient approach for most physicians and dentists is to solicit reviews from patients who

1) will leave their real name and town
2) be honest
3) are generally satisfied

Obviously not everyone will leave their full name, but it's more powerful than "Anonymous". And this will work better for patients of more elective practices and not so well for, say, addiction recovery services.

On the whole, however, I've had great success with this more pre-emptive method of controlling the doctor rating sites. At the very least, doctors should be claiming and filling out their profiles on these sites, as Google (for whatever reason) ranks them highly in their results, often above a doctor's own website.

Another good approach is to seek out mediocre reviews from patients who have done well but not great, or who had a complication and it was handled well. These "not-so-stellar" reviews also give another layer of credence to the reviews on the site.

Noel Henley, MD
http://www.reachpatients.com

[1Dental]

10:20 AM on 12/16/2011

Dr. Connelly,
You were an obvious choice for our Top 10 list. Thanks for mentioning us! I agree that online reviews in the dental/medical field get a little out of hand sometimes. We've found Dr. Oogle to be a little more reliable, but even then, sometimes the disgruntled people are the only ones to leave a review, whereas it may not even occur to a happy patient to leave a review. If the dentist is wonderful and just had 5 frustrated patients, yet those 5 patients are the only ones to go online about it, it skews the reviews negatively. Even so, congratulations on 5 stars!

[darrelldk]

05:51 PM on 12/15/2011

Dr. Connelly, as you probably know, this month we learned that an aggressive Manhattan dentist named Stacy Makhnevich DDS actually attracted permanent damage to her reputation, as well as a class action lawsuit, by attempting to prevent her patient from posting bad reviews about her practice on the internet. Here’s something interesting the adventure taught me about the reliability of Yelp: When word got out on the internet that Dr. Makhnevich was charging the former patient $1000 a day until he took down his complaints, the number of her reviews on Yelp went from 5 to 300 within 24 hours. While on ratings website DR.Oogle (doctoroogle.com) - which only accepts reviews from the dentists’ patients – the number of Dr. Makhnevich’s reviews remained at 10 during the same period.

Spread the word. DR.Oogle is reliable.

D. Kellus Pruitt DDS