DVM, DACVS, ACVS Fellow, Surgical Oncology
Dr. Vinayak received her bachelor’s degree in biology from the University of Georgia at the age of 19 before starting veterinary school. She then completed a 3-year surgical residency at Texas A&M University and stayed on for a year as a clinical instructor, during which time she became a diplomate of the American College of Veterinary Surgeons (ACVS). Dr. Vinayak then spent the following 7 years as a private practice specialty general surgeon in the Chicago area. The next phase in her career came as she saw consultation patients with cancer. During a 3-year residency, Dr. Vinayak elected to pursue an ACVS-credentialed fellowship in surgical oncology and was thrilled to be accepted to Colorado State University’s Cancer Center. Dr. Vinayak is involved in research on numerous topics, as well as currently coauthoring a surgery textbook. She is blessed to have a wonderful husband, 2 boys, and her amazing cats.Read Articles Written by Arathi Vinayak
We all know the feelings—nervousness, excitement, anticipation, hopefulness, and a touch of dread—as we click into the app to check our veterinary clinic reviews. As humans, we seek this validation, defined as the desire to have someone else’s approval or agreement with what we do. As veterinarians, we have thrown so much of our lives into the profession—often placing what we do for work over our physical and mental health and our children, families, and friends—that it is only natural to seek acknowledgment for the sacrifices we make daily. So, when we see 5-star online client reviews, the elation we feel is second to none. For a short time following, we float and feel all those late nights and weekends of placing our jobs ahead of everything was worth it. That validation, however, soon vanishes as we read a critical or negative review.
There is a dichotomy in these reviews: The extremely happy clients leave 5-star reviews and the unhappy clients leave 1-star reviews, with very few in between.1 Let’s face it, we rely on the same review services to help us choose a handyman, doctor, restaurant, party venue, pediatrician, or urgent care. We make these choices for our personal lives using those extreme reviews, and the reality is that our clients are likely familiarizing themselves with online reviews before choosing a veterinarian, too. A survey of 1000 human patients revealed that 71% used online reviews as the very first step in finding a new doctor.2 In another study evaluating human patients choosing physicians, 28.1% strongly agreed that a positive physician review alone would lead them to seek care from that practitioner.3 We can assume that similar human decision making would be used in the veterinary setting. Thus, positive reviews can be that practice-building boost we need to grow our client base.
On the other side of the spectrum, the “1-star haters” can deter clients from choosing a veterinarian or hospital. In the previously described study of human patients choosing physicians, 27% indicated that a negative review would lead them to pass on seeking care from a physician.3 We know that these critical reviewers may be unhappy in general with all services they encounter in life, often leaving a trail of similarly rated reviews when we click on their user profiles. We also know deep down that we, as veterinarians, are not perfect, that there may be truth to the negative reviews, and that we should endeavor to make changes, if needed. It may be about inefficiencies in the check-in or check-out process, long wait times, high costs, parking difficulties, or other factors that may have soured client experiences rather than the treatment and care pets received during the visit. Unhappy clients also result from having unrealistic expectations, such as demanding a cure when there is none. We know all of this; however, it can be soul crushing nonetheless. We forget about the 40 other patients/clients we have made happy that week, the 100-plus patients we have helped that month, and the several hundred to 1000-plus patients we have saved that year. We obsess over that bad review and promptly forget the 5-star reviews from other clients. We take the review as a personal affront.
Why do we do this? Research shows that humans suffer from what is termed a negativity bias.4 Evolutionarily, paying attention to threats was a matter of survival. While this may have helped in early human history, this passed-down trait now impedes our ability to deal with negativity. Studies show that it often takes 5 positive interactions to undo the impact of 1 negative interaction. To compound this, an “amygdala hijack” occurs during a negativity bias situation leading to an overreaction and a reduced ability to have a rational emotional response.5-7 The amygdala, located at the base of the brain, is crucial in processing emotions. It sends signals to release cortisol and adrenaline at times of stress, and the sudden release of these hormones renders us incapable of responding rationally for a period of time.
It is important to recognize that dwelling on negative reviews can have significant mental health implications. Psychological distress in the veterinary profession is already high based on a 2015 report in JAVMA, showing that 1 in 11 veterinarians experienced serious distress and 1 in 6 veterinarians contemplated suicide after leaving veterinary school.8 Veterinarians are 3.5 times more likely to die by suicide compared to the general population due to mental health implications.9 A recent Time magazine article discussed clients villainizing veterinarians as one of many reasons for suicide in our profession.10
But it’s not all bad news. While it is true that an abundance of negative reviews can destroy a business, having some negative reviews may not be all that bad. A special online analysis by Womply Research titled “How Online Reviews Impact Revenue” provides an understanding of online reviews’ true financial impact. Surprisingly, businesses that have 15% to 20% negative reviews actually earn more revenue than those with 5% to 10% negative reviews.8 Negative reviews, up to a certain extent, show a sense of authenticity with the optimal negative reviews being between 10% to 25%.8 Clients expect to see negative reviews and having only 5-star reviews can make clients wonder if the reviews are fake or paid. A detrimental impact to revenue was observed in businesses with negative reviews accounting for 25% or more of the total reviews.8 Fortunately, the average business has less than 19% in negative reviews. Knowing that negative reviews increase revenue may help temper the adverse feelings we have toward them.
There are also actions veterinarians can take to provide a sense of agency. In the same Womply analysis, businesses that responded to reviews were found to earn 35% more revenue than average.11 Responding to reviews shows that the business cares, and this sentiment is demonstrated better when the business consistently responds.11 This does not mean that we should respond only to the negative reviews with a defensive post. We ought to address both the positive and negative reviews with genuine responses. A study evaluating negative online reviews for physicians suggests addressing particularly negative reviews outside of the online platform (e.g., contacting the client for constructive feedback to address what could be done better).12 Third-party management firms have also recently become a popular way to respond to reviews in a timely manner, but the value and efficacy of using these firms have not been evaluated to the author’s knowledge. Another strategy is to increase the total number of reviews posted (both positive and negative), which research shows results in a more positive attitude toward the rated physician.13 Asking clients to provide feedback by including links to review sites on emails sent to clients, appointment reminder cards, and business cards can increase the total number of reviews, with most of them being positive statistically.
While we cannot prevent negative reviews online, we can work to better understand our reactions to those reviews, realize that negative reviews may be an opportunity for betterment and may not adversely impact our business, and work to address the underlying issues behind the reviews. We should have reasonable, sustainable goals for ourselves in regard to online reviews and, above all, be kind to ourselves. While we would all love a perfect rating, we should more realistically aim to maintain an overall rating between 3.5 and 4.5, not 5, out of 5 stars.11
- Devgan LL, Klein EJ, Fox S, Ozturk T. Bifurcation of patient reviews: an analysis of trends in online ratings. Plast Reconstr Surg Glob Open. 2020;8(4):e2781. doi:10.1097/GOX.0000000000002781
- Hedges L, Couey C. How patients use online reviews. Software Advice. April 3, 2020. Accessed December 22, 2022. https://www.softwareadvice.com/resources/how-patients-use-online-reviews
- Burkle CM, Keegan MT. Popularity of internet physician rating sites and their apparent influence on patients’ choices of physicians. BMC Health Serv Res. 2015;15:416. doi:10.1186/s12913-015-1099-2
- Norris CJ. The negativity bias, revisited: evidence from neuroscience measures and an individual differences approach. Soc Neurosci. 2021;16(1):68-82. doi:10.1080/17470919.2019.1696225
- Duan K, Gu Q, Petralia RS, et al. Mitophagy in the basolateral amygdala mediates increased anxiety induced by aversive social experience. Neuron. 2021;109(23):3793-3809.e8. doi:10.1016/j.neuron.2021.09.008
- Roozendaal B, McEwen BS, Chattarji S. Stress, memory and the amygdala. Nat Rev Neurosci. 2009;10(6):423-433. doi:10.1038/nrn2651
- Daviu N, Bruchas MR, Moghaddam B, Sandi C, Beyeler A. Neurobiological links between stress and anxiety. Neurobiol Stress. 2019;11:100191. doi:10.1016/j.ynstr.2019.100191
- Nett RJ, Witte TK, Holzbauer SM, et al. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. JAVMA. 2015;247(8):945-955. doi:10.2460/javma.247.8.945
- Tomasi SE, Fechter-Leggett ED, Edwards NT, Reddish AD, Crosby AE, Nett RJ. Suicide among veterinarians in the United States from 1979 through 2015. JAVMA. 2019;254(1):104-112. doi:10.2460/javma.254.1.104
- Chan M. Veterinarians face unique issues that make suicide one of the
profession’s big worries. Time. September 12, 2019. Accessed December 22, 2022. https://time.com/5670965/veterinarian-suicide-help
- Womply. Impact of online reviews on small business revenue. Accessed December 22, 2022. https://www.womply.com/wp-content/uploads/2018/01/How_Online_Reviews_Impact_Revenue.pdf
- Cooper HJ. Pearls: how to address negative online patient reviews. Clin Orthop Relat Res. 2018;476(6):1162-1163. doi:10.1097/01.blo.0000533614.05050.10
- Grabner-Kräuter S, Waiguny MKJ. Insights into the impact of online physician reviews on patients’ decision making: randomized experiment. J Med Internet Res. 2015;17(4):e93. doi:10.2196/jmir.3991