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Dr. Naderi answers your questions about all facial plastic surgery procedures, from facelift, rhinoplasty (nose job), to eyelid surgery (blepharoplasty), and dermal fillers.


Postby Dr_Naderi » Sun Jul 17, 2011 12:22 pm

“I would not send my worst enemy to this doctor. He is uncaring and all he cares about is money….!”

This was an online “anonymous” patient review from a young Asian female that I recently met, cared for and treated in my office. This is a perfect example of the potential downfalls of anonymous online doctor rating sites. It also demonstrates one of the new issues of practicing medicine in the twenty first century: Lack of respect and appreciation for doctors.

Perhaps as a profession we have brought this lack of respect and appreciation upon ourselves by allowing a few minor bad apples to practice bad medicine and compromise patient care. Or perhaps our society has become so self- centered and entitled that this outcome was inevitable. Sadly, reading or writing angry and nasty comments online is a normal thing now-a-days that is not limited to defaming doctors. The internet has opened a culture of anger and retribution.

As such, http://www.Opentable.com allows restaurant owners to rate their clients for a change! A restaurant owner can evaluate and comment on a bad patron and warn other restaurants about his or her poor manners. In medicine the ratings have so far only been one sided. HIPAA protects patient privacy but it has become an abused right and many doctors are fighting back with online YouTube videos discussing certain patient cases in order to provide “the other side of the story.” There have been several cases of hefty lawsuits claiming Libel and Slander and Defamation against some patients who recklessly voice their biased opinions online.

So back to this quote I just read about me a few minutes ago.

**There will be no mention of any names nor will we compromise patient confidentiality, which is of utmost importance to me and my practice. The doctor-patient relationship is a sacred and confidential one. But when a patient voices a harsh unwarranted opinion online, for the whole world to see, there must be a responsible response presented.

So one of her many many negative reviews stated this:

“I would not send my worst enemy to this doctor. He is uncaring and all he cares about is money….!”

The whole story is as follows:

So a young Asian female made an appointment for a "cosmetic revision Rhinoplasty." Our policy is clearly posted on our website as well as the initial patient paperwork that each patient reads and fills out and signs. There is nothing ambiguous about it. The link below takes patients to the mandatory health history and demographics data that each patient must read, complete and sign. If they don't pre-fill these forms online, they get to read and complete the forms in the office before their very first consult as any patient would visiting any doctor's office.

http://www.virginiafacialplasticsurgery ... forms.html

At the end of the form, the statement below is clearly visible:

…Functional consultation fees will be billed to me &/or my insurance company. I understand that office visit charges are payable in full on the same day service is rendered. …. If insurance can pay for part of my desired surgery then my insurance may be charged for the office visit(s). I authorize The Naderi Center to bill my insurance company when appropriate. Regardless of insurance coverage, I am responsible for all bills being paid in full in a timely manner. I understand that my contract is between The Naderi Center and myself and it is my responsibility to follow through with my insurance.

This statement above or something very similar is a part of every doctor’s office’s initial patient packet of forms. This is nothing unique.

What is unique is that some cosmetic surgeons offer free “cosmetic consults” so that patients paying large sums out of pocket for purely aesthetic surgery can get a special incentive to visit that plastic surgeon. In Northern Virginia many plastic surgeons offer free cosmetic consults and so did I for the last 6 years. (**As of July 1st 2011, we will no longer be offering any free consults in order to avoid unpleasant situations like this case).

So when I saw the patient I realized her issue is not cosmetic nor is she looking for a revision Rhinoplasty. Her issue was an infected, red, inflamed, painful implant inside her nose and she was seeking a diagnosis not revision surgery. Apparently she had been to many doctors but most had taken the time or initiative to treat her since her surgery was done abroad. Her own surgeon abroad prescribed an antibiotic course for her, which she decided not to complete!

I was alarmed and concerned and I spent nearly an hour discussing my findings and concerns with her. I told her that if this is not treated aggressively and properly, then it may spiral out of control into a full blown infection of the nose with an abscess causing irreversible scarring and potential extrusion of the implant or even a life threatening sepsis requiring hospitalization and I.V. antibiotics. I took pictures of her and I showed her pictures of other patients who have had horrible infections of their implants so that she could see this is not a joking matter. I told her she should have completed the antibiotic course her original plastic surgeon prescribed for her and that it was not a good decision to stop the antibiotics half way through its course.

So as a concerned doctor, I took the time to contact my colleague at a tertiary care academic hospital in Washington DC for him to see her and connect her with his infectious disease specialists so that she could be under the proper care. I told her she would need to start with oral antibiotics but most likely the infectious disease doctors would place a PICC line for intravenous antibiotics at home. Ultimately the implant may need to get removed and replaced with natural cartilage but for now with proper aggressive treatment the implant may be able to be saved.

Although she had been to several states and seen multiple doctors no one had actually taken the time to treat her and many of the doctors simply did not know the diagnosis. A dermatologist had given her some form of a skin cream for treatment!?!

Ironically her main concern was whether she could drink alcohol with the antibiotics since she was going on vacation and did not want anything to interfere with her enjoyment of alcoholic beverages. She went as far as to ask me if she could wait a week before starting the antibiotics which I prescribed to her and I told her that I would recommend starting the empirical treatment as soon as possible.

So obviously this was a normal doctor’s visit and not a "cosmetic consult" and as such my staff told her and charged her insurance for the visit as would be expected of any patient visit to a doctor. How little insurances reimburse for such visits is a whole other topic but any “normal” person would have been grateful for the time and treatment and would not think twice about expecting all of this to be totally FREE. But this person apparently thinks that doctors should work for free. At the very least she does not understand the difference between a "cosmetic consult" and a "doctor's visit." As if this was not bad enough, she took the time and effort to go to MULTIPLE websites and write MULTIPLE NEGATIVE REVIEWS of me, my practice and my staff!

She called my office twice the next day (yesterday) complaining about her insurance being billed even though she was fully aware of this at the time of co-pay collection at the end of her visit. The reasonable explanation was given to her that her visit was not cosmetic and that the issue was medical and an hour of time was spent with her diagnosing her potentially dangerous condition and treating her. Rather than simply being appreciative or grateful, and saying “thank you” she instead paid us back by writing multiple vindictive review of me and my staff online.

As I have said before, the beauty of having a medical practice where 99% of my patients are happy and grateful and sincerely appreciative of the care that they receive by me and my staff, is that we always know exactly who it is when and if an “unreasonable patient” occasionally or rarely comes along and writes a negative review online.

When I emailed her politely and asked her “why” she did such things, it was clearly obvious that she just simply thought her actions were valid and reasonable and that she is entitled to her opinion! The fact is in the past an unreasonable patient could voice his or her concern to anyone he or she wanted to and her opinion and statement would be protected under the freedom of speech. However, when you tell another person your opinion face to face, you allow them to know who you are and see you and converse with you and ask questions so that they can judge for themselves whether your opinion is valid or simply due to anger or maliciousness. But when today, anyone (a patient, a competitor, etc) can go online and write a review for the whole world to see, you end up affecting their judgment in a biased way. THOUSANDS of potential patients can read an online review and become affected. While reading other’s opinions is important, being able to know the whole story is even more important. Frankly I visited a doctor’s office myself as a patient a few years ago and I was appalled by the poor treatment I received from their staff and their physicians. When I went online, I saw that there were 60 detailed negative reviews out of about 70 reviews. I could believe these reviews. And it didn’t seem like these doctors really cared to respond or change or improve. On the other hand, I look at myself as a physician who cares for all of his patients and not a provider of cosmetic surgery or a business. I take pride in the fact that the VAST MAJORITY of my patients truly adore my practice and form strong bonds with me and my staff.

I have even been awarded the 2010 Most Compassionate Doctor Award
“In 2010, fewer than 3% of the nation's 720,000 active physicians were honored with a Compassionate Doctor Award. Congratulations on your inclusion in this distinct group.”

So to get an unreasonable patient take the time to go all over the internet and bad mouth me truly hurts! The fact is that these reviews do affect others. We had a prospective patient call my office and cancel her appointment before she ever came in to see me and before she had the chance to judge for herself and her explanation to my patient coordinator was “did you know Dr. Naderi has a negative review online?” My staff tried to inform her that no one can please everyone all the time and that the vast majority of happy patients do not take the time to go to 10 different websites and write 10 positive reviews of a doctor while an angry disgruntled patient will make it a mission to “take down a doctor.” To no avail she never came in to see us.

I had another patient bad mouth me on http://www.makemeheal.com saying that my staff offered bottled water to the lady sitting next to him in my waiting room but not to him and he concluded that the reason for this must be the fact that he is a poor carpenter and that the other lady drove a Mercedes!? Not sure how my staff would know his job or her car? It is almost ludicrous but these “negative reviews” are what we occasionally have to deal with.

Other layperson patients such as the one with screen name "jccustomz" truly live on some chat rooms and BLOGS such as http://www.makemeheal.com spending hours each day acting as experts and giving their advice to potential patients telling them who is good and who is not good while in fact they know very little about such matters and they are recklessly dispensing opinion as “experts.”

I had another lady come see me with a perfectly fine nose, one that was not absolutely perfect but one that was very nice and did not require yet another revision surgery. I spent 40 minutes trying to inform her about human anatomy and healing bio-physiology and scar contracture so that I could persuade her not to go through another revision rhinoplasty. All this was free of charge because I did offer free cosmetic consults but I made it a routine to take plenty of time to care for and educate and talk misinformed patients out of unnecessary elective cosmetic surgery. But she went online and wrote that same afternoon that “Naderi does not know what he is talking about and he could not see my problem!”

So this latest patient (reviewer200) and her actions are not shocking. But a simple “thank you Doctor” would have been nice instead of all the time and effort she put into bad mouthing us. Sadly, respect and appreciation is sometimes hard to come by in today’s entitled society…..

...and here are just a handful of her time and efforts: http://maps.google.com/maps/user?uid=211428158166711201747&hl=en&gl=US&ved=0CGgQhQo&ei=RkcjTuTKFaHkyQWIn6XyDA&ptab=1

Makes me scratch my head some times and question if it is all worth it? But the hundreds of happy, smiling, grateful patients each year make it all worthwhile.



[Online replies to questions are NOT a substitute for actual consultation & exam & should not be considered "medical advice."]
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Location: Herndon Virginia & Chevy Chase Maryland

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