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 were RealSelf, Yelp and Google. The study assessed 1,077 reviews across the platforms, comprising 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,” said senior study author Dr. John Kim, a professor of plastic surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine plastic surgeon.

The study was published April 26 in Plastic and Reconstructive Surgery Journal.

The finding most surprising to Dr. Kim is the importance of interactions with the doctor’s support staff.

Service is becoming paramount and almost as important as tangible results and outcomes.” John Kim

Professor of plastic surgery "The important thing used to be how the surgery turned out,” Kim said. “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. Service is becoming paramount and almost as important as tangible results and outcomes.”

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

The data was obtained in December of 2016 and January of 2017 from New York, Los Angeles, Chicago, Houston, Philadelphia and Miami. The first five of these cities were included because they represent the five most populous metropolitan areas in the U.S., based on 2015 U.S. Census data. Miami was included because it has the most plastic surgeons per capita of any metropolitan area in the U.S.

Other study findings:

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.

“Unhappy patients take up more screen ‘real estate’ than happy patients, posting longer reviews, which creates a bias of dissatisfaction in online ratings,” said first study author Rob Dorfman, a fourth-year student at Feinberg.

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

“That is an important point for people to understand,” Kim said.

As a result of the findings, Kim has begun implementing changes, including office training for personnel to enhance the service aspect of patient care.

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.

Kim cautions that online exposure can become a surrogate for experience.

“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 said. “So the ubiquity and quality of online reviews may increasingly substitute for experience and ability.”

Kim suggests consumers do the following when vetting a plastic surgeon: 1) determine if they are board certified, 2) ask your primary care doctor, trusted friends and family for a referral, 3) meet with the surgeon and determine your comfort and confidence in them.