How Safe is Your Reputation?
Risk & Reward in the Digital Age
The last thing Walter Palmer was probably thinking as he jetted off to Africa was that his upcoming vacation would change his social network profile. The general dentist from Bloomington, Minnesota had developed a passion for big-game hunting, and in the summer of 2015 he was returning to Zimbabwe. There he engaged the services of a guide he believed to be trustworthy. Out on the savanna, he killed a mature adult lion that he thought was a legal, permitted target. But that particular animal, it turned out, was part of an Oxford University conservation project. It had a name (Cecil) and a legion of adoring fans.
A British tabloid broke the news of Cecil’s death. Once upon a time, the story might never have reached anyone living within 1,000 miles of Palmer’s practice, but amplified on the Internet, the news triggered a shocking eruption of fury. At least one Facebook page exclusively devoted to shaming Palmer appeared. On his practice website, hundreds of self-styled animal-rights defenders posted reviews reviling everything from his dental skills to his penchant for the safari life. Protesters marched outside his practice and taped vicious comments to the front door. Faced with death threats, Palmer eventually closed the office for more than a month.
Digital Presence
It’s hard to imagine more vivid proof of how swiftly and mercilessly globally diffuse events can shatter a dental reputation. It also can be hard to remember just how recently that fearsome power has developed. In 1985, when he started his Levin Group dental consulting firm, practice-management consultant Roger Levin, DDS, says, “Reputation-management for dentists was patient word of mouth. That was pretty much it. And if you’d been around a long time, people just assumed you had a good reputation.” Keeping patients happy was important. “There was an old saying that a happy patient told five people and an unhappy patient told 20.” But Levin says now “a happy patient tells five people, and an unhappy one can tell 20,000—by going online.”
Lee Ann Brady, DMD, who owns a restorative practice in Glendale, Arizona, says when she graduated from dental school in 1988, “Dentists who did anything beyond having their names in the Yellow Pages were considered unprofessional and not reputable. Today it’s like a total reversal. Not only is advertising mainstream, but probably one of the most prolific conversations in all of dentistry is ‘how are you marketing your practice? How are you letting potential patients know about your philosophy? Are you using social media?’ We probably talk about that more than we talk about any other non-clinical topic.”
Levin argues that part of what has driven this change is decreased demand for dental services. In decades past, “dentists had just about as many patients as they wanted, but today you don’t have as many new patients coming in. They’re not expecting to have quite as much treatment as they once did.” In response, reputation management has developed as a way to attract and retain patients. At the same time, the evolution of computers, the Internet, and the myriad uses to which both can be put have transformed the ways in which reputations can be influenced. Slowly but inexorably, the dental profession has embraced those tools.
Marketing consultant Naomi Cooper says when she left her position as vice president of marketing for 1-800-DENTIST to form her Minoa Marketing firm, she would ask her lecture audiences how many participants had a practice website. That was in 2009, and “it would be like 60%. There were still a lot of people saying they really needed one—but they didn’t have one yet.”
Today Cooper says at least 90% of American dentists have websites. Many also have plunged into the world of social media, according to Diana Friedman. Before becoming vice president of market intelligence for Henry Schein Dental, Friedman was president and CEO of Sesame Communications. There she conducted a study to determine how many dentists were using social media at that time (about 2 years ago). Social media was defined as including anything beyond the basics of a website (and tools to optimize the likelihood of it appearing high in Internet searches). More than 600 dentists responded, Friedman says, with more than 70% of them professing to use channels such as Facebook, Twitter, and Instagram to promote their practices.
“My dad was a dentist,” says Las Vegas cosmetic and restorative dentist Joe Willardsen. “He practiced for more than 30 years. But even the patients who had been with him for 25 years didn’t know that much about him.” Willardsen contrasts that with his own patients today. “They can go online and learn about how many kids I have and what activities I do. In 15 minutes, they learn more about me as a person and what I do in the dental field than they did about my dad in 25 years. So when they’re making a decision on where they’re going to go, the more positive things you put out there, the better to help them make their decision.”
Like many practice-marketing authorities, Willardsen stresses that non-digital factors still constitute the foundation of a good reputation. “One of the most important is your staff. That’s the first thing patients interact with, and it’s something that speaks volumes about you and what kind of company you’ve created.” Brady echoes that conviction. “You could be the most phenomenal practitioner. You could have the newest technology, the most gorgeous office, and if you have an employee who’s not nice on the telephone or whatever, it becomes part of your reputation.”
Team and Practice Reputation Effects
Practice-management consultant Jay Geier, founder of The Scheduling Institute, elaborates that not only must all the practice team members contribute to providing excellent customer service for existing patients, but they also must be properly trained to convert calls from potential new patients into actual appointments. “The phone call sets the bar for the patient experience in the office,” Geier says. “Your staff determines the new patient experience; that new patient experience drives your reputation; that reputation feeds online reviews; and online reviews, in turn, result in calls. It’s a cycle of things that continue to happen, but if you don’t have this one piece right, not only are you not closing those calls that come in, you’re not setting that level of excellence for the experience. Meanwhile, you’re pouring a lot of money down the drain with no concept whatsoever of how those calls convert and what happens to them.”
For the last 20 years, a variety of products such as Patterson’s EagleSoft have developed to help improve the entire customer-service experience, from basic accounting to scheduling to charting to insurance management. “Thirty years ago, the staff would pull up the rotary phone and the typewriter and those postcards,” says Dan Easty, a regional technology advisor for EagleSoft. Today, however, patients want a more sophisticated experience. “They expect it.”
“Attention to detail is part of your reputation,” says Brady. But she adds that today the details include “everything about your professional persona. It’s the performance of your team members. It’s the physical appearance of your practice. Very often in dentistry, there’s a disconnect. The dentist wants to practice really high-end, exquisite, quality-based care, and yet the carpets are frayed. I think sometimes we get so caught up in all the new stuff, we tend to forget the basics. All those little tiny details are the pieces and parts of how people come up with an opinion about you. And your reputation is really just the fancy marketing way of saying what people’s opinion of you is.”
If happy patients are still at the core of good word of mouth, what has changed, according to the marketing experts is that word of mouth alone is no longer sufficient. “When someone used to give your name out, they’d write it on a Post-it note and hand it to their neighbor or the girl in the cubicle next to them,” says Cooper. “And that person would say, ‘Okay I’m going to call.’ That’s the only thing they could do—call. Back in my 1-800-DENTIST days, people used to call us because they thought we were like the Better Business Bureau of dentists. They’d say, ‘Oh, I just want to check up on this dentist to see if he’s any good.’ They thought we were the arbiter of who the good dentists were.”
Today, Cooper continues, “When someone recommends a dentist, what’s the first thing you do? Type that name into a search engine such as Google, and your online reputation has to validate that referral because the girl sitting in the cubicle next to you maybe has teeth that don’t look that great. Or you suspect your neighbor is not that smart.” Checking out a practice’s website is akin to driving by the physical location, Cooper asserts. “Is this a good place? Does it look clean? Nice? Modern? Professional? Or is it dated? It gives people an impression of you.”
The cost of acquiring a website can vary widely, according to Brady. “There are websites that cost $500 and websites that cost $25,000. I’m not necessarily saying you need the slickest, fanciest website you can get. But you don’t want people saying, ‘Who did this? A fifth grader?’”
Data from the Levin Group confirms that 85% of patients check a practice’s website before they visit the physical presence. That includes those who don’t have a word-of-mouth recommendation but rather turn to an Internet search engine to find dental care. Advice about how to ensure that one’s business shows up on the first page or two of search results (so-called search-engine optimization or SEO) has generated an entire industry and a large body of literature, some of it specific to dentists.1 “A lot of things matter,” says Levin. “Video raises your SEO. Links raise your SEO; having more searches raises your SEO; certain key words. You have to know what the rules are and play accordingly to get the best results.” He adds that Levin Group research indicates that around 45% of practices currently are paying for assistance with these SEO tasks “because they don’t know how to do it themselves.”
“It’s cyclical,” Geier agrees. “The web, Yelp, SEO—all those things impact the number of calls that you get. The number of calls is what drives the number of new patient opportunities handled by your team. Your team drives your experience; your experience drives your reputation. The better you are at the experience, the more your online presence gets fed with positive reviews.”
Soliciting and Managing Reviews
Regardless of how a prospective patient finds his or her way to a practice’s website or social media profiles, he or she is likely to pay attention to reviews from other patients. The 2015 BrightLocal Consumer Review Survey, which included responses from 2,354 individual consumers in the United States and Canada, found that 92% of the respondents reported reading online reviews, compared to 88% in 2014.2 Moreover, dentists and doctors came in second only to restaurants when the survey participants were asked about which type of businesses they read online reviews for. When asked to select up to three types of businesses for which reputation mattered the most, an equal of consumers (47% of all those surveyed) picked doctors/dentists and restaurants.
Cooper is among those who urge dentists to solicit reviews constantly. “If something is a habit, it’s much more likely you’re going to do it,” she asserts. “If you say you’re going to do something once a month, it ends up being every two months and it’s a numbers game. Just because you ask them, everyone won’t do it. They might think about it or even want to do it, but that doesn’t mean they’re actually going to get around to it.” A practice might have to ask 10 or 20 people to net one actual review. “So what I usually tell doctors is in your morning huddle, everyone should pick one patient a day that they’re going to ask for a referral. My upgrade to that is to add one target for an online review.”
To select those targets, “Think about whether the person has their smartphone glued to the palm of their hand. They’re the ones who literally are sitting there playing Candy Crush or reading email or texting all the way through every single appointment,” Cooper says. Assuming that the appointment goes well, “fish for a compliment,” Cooper instructs. “There are so many ways to do that. You ask, ‘How was your visit?’ ‘How did things go today?’” Cooper has created a free video tutorial spelling out what to do with the response.3 She insists that this routine gets easier with practice. “When you say something once, it feels awkward, but by the time you’ve said it 80 or 100 times, it feels completely natural. The hard part is just getting over the embarrassment of not being perfect at first. That drives dentists crazy because they like to be perfect at everything.”
Plenty of good online reviews is the best prophylactic measure against the occasional negative one, practice-management experts say. “I personally get skeptical when something is 100% 5-star,” states Ed Zuckerberg. “It’s either too good to be true, or it’s amazing. While occasionally something pleases everybody all the time, as dentists I think it’s pretty much impossible, and I think people understand that. If you see one negative review out of 10 or 15, but 90% are extremely positive, I think most people will discount the negative reviews.”
At least one dentist has rejected that view and reacted by suing patients who’ve written negative Google and Yelp reviews,4 but that approach may have backfired. When New York endodontist Nima Dayani recently filed a lawsuit claiming he was defamed by a patient’s negative Yelp review, Yelp retaliated in late July of 2016 by slapping a “Consumer Alert” on Dayani’s Yelp page. “This business may be trying to abuse the legal system in an effort to stifle free speech, including issuing questionable legal threats against reviewers,” the warning reads. Yelp also grayed out all of Dayani’s reviews, which quickly had acquired more negative commentary about his lawsuit.
Suing writers of negative reviews also may soon become more difficult; two bills intended to protect consumers from such lawsuits are currently making their way through Congress. The states of Maryland and California already prohibit the inclusion of so-called “gag clauses” in contracts between consumers and businesses.
Rather than turning litigious, Zuckerberg advises an almost polar opposite response to any negative review. Don’t fly off the handle, he suggests, but “think about whether the criticism or negative comment has any validity and might actually reflect a problem in your office.” Talk to staff members or family or colleagues, “and when you finally do address a complaint in social media, address it with sincerity, with tones of apology, with maybe a reasonable argument, a promise for improvement in the future. Address it like a mensch.”
“Negative reviews are not always the end of the world,” adds Lindsay Albanese, a senior digital marketing manager for Officite. Indeed, even the unfortunate lion-hunting Minnesota dentist reopened his practice after 6 weeks and is working today. He may never placate all his angry lion-loving review writers, but Albanese says dentists who address more mundane complaints in a positive light can wind up with a result that’s just as powerful as a positive review. “It seems that when potential patients see a response to a negative review, they know the business is attentive to what people are saying, that they’re willing to make the practice better and move forward,” she says.
Although reviews both negative and positive continue to be highly influential, some observers speculate that their power may be waning. “People know every business on the planet is doing campaigns to get people to review them,” says Brady. “As soon as reviewing became powerful, people came up with strategies to get people to review us. It went from something organic to marketing. Whenever that happens, people begin to discount it. They don’t discount it completely, but the wave is shifting.” Brady notes the success of nextdoor.com, the private social network that over the past 6 years has organized neighbors in more than 100,000 communities to share everything from local crime news to recommendations for a good veterinarian—or dentist. A passionate recommendation on such a site hearkens back to the time of real-time word of mouth. “If someone [on nextdoor.com] says, ‘Oh my God! I love my dentist!’ that has vastly more positive impact on the growth of my practice and continues to build my reputation.”
The need for constant change seems certain to continue. Although more than 90% of dentists in the United States may now have websites, Cooper says many of those websites haven’t been upgraded in years. “They look completely out of date. Immediately, it tells you, ‘Oh, this person is not tech-savvy,’ which is the last thing a dentist wants patients to think.” At the very least, any website design should be responsive to the size of the screen on which it’s being viewed (phone, tablet, or computer.)
Stay Current with New Social Media
Social media content also is continuing to evolve. Zuckerberg mentions the new Facebook Live feature, which enables users to broadcast live events. He advises dentists to consider using it when “you’ve got a patient in the chair that you’ve just wowed, and they can’t do enough for you. Too many of us just say, ‘Well, thank you for your compliment, Mrs. Jones, but that’s what I’m here for.’ Why not instead pull out a phone and ask, ‘Would you mind if I video you and broadcast it out to my Facebook fans?’”
Along similar lines, Tim Vassilakos, senior manager in charge of social media and integrated marketing at Henry Schein, mentions the tide of young patients who are taking pictures of themselves mid-procedure “because they want to show how great their dentist is doing something specific. It tells you that the next generation of patients wants to review their dentists but they’re not going to sit down and write a 400-500 Google review. They’re going to do what comes naturally to them. And it feels so much more genuine than a review.”
Although some patients may spontaneously be taking #dentistchair selfies, it takes a lot of thought and calculated effort to create an integrated online presence. For that reason, Friedman makes the case that dentists need professional help. “Social media is all about content,” she points out. “How do you create really great content that the market cares about? Content that patients will engage with?” Even if a practice has a modern website and a Facebook page and a LinkedIn account and Instagram and Twitter, “All of these different channels should look the same,” Friedman argues. “They should all have a similar view and voice and content strategy. Because if Peggy Sue does the Twitter and Ann does the website and somebody else does your Facebook, the community listening in will be confused about who you are.”
Final Thoughts
It really is pretty complicated to put a comprehensive program together,” Levin agrees. “It’s not one thing. It’s multiple parts, synergizing together.”
At the same time, Willardsen makes the case that “you can’t just hire it out without being hands-on with it as well. No one wants to read statistics on how fluoride helps cavities. They want to see the real practice, the real patients, and employees. So if you want a good reputation on social media, you have to be engaged in it.”
Geier seconds that idea. “When it comes to managing your reputation, you have to think about the fact that the reputation of your practice improves with the right team and the best patient experience. The more patient centric your office, the more you over deliver to your patients, the better your reputation will be. And this translates to the online community as well.”
References
1. McLeod NS. Enhancing the online presence of a dental practice. J Prosthet Dent. 2012;107(4):271-275.
2. https://www.brightlocal.com/learn/local-consumer- review-survey/
3. http://minoamarketing.com/how-to-ask-patients- for-online-reviews/
4. BuzzFeed News. Yelp’s warning: This dentist might sue you for posting a negative review. Posted July 25, 2016. https://www.buzzfeed.com/leticiamiranda/yelp-warns-dentist-may-sue?utm_term=.eeNWozE7R#.lj8YO9x5B
