Medical-centric online discussion forums have become common, popular meeting places for patients to share information—or misinformation—about physicians.

In my online travels, aesthetic surgery-related discussion forums (or bulletin boards) are numerous, frequently factual, sometimes entertaining, and can be misleading.

On a positive note, these virtual gathering places allow patients to discuss and compare data and experiences on various procedures and products, and critique individual surgeons.

I have seen a lot of very good comments, ideas, and advice on these bulletin boards, but I have also seen downright false, mean-spirited, confusing, and doubtful information as well.

Sooner or later, however, you will encounter comments written by an unhappy patient with an ax to grind. No one likes to hear negative comments about themselves.

One surgeon friend had an unhappy patient who indulged in the online character assassination of this world-class surgeon in virtually every forum that would accept a post.

The result? The surgeon was discredited for something that was not really his fault.

At times, a mediocre physician may warrant such bad publicity, but one should always stop and take a deep breath before discrediting someone.

We have all gone to a great restaurant and had a bad meal, or gone to a famous vacation destination and had poor service, etc. The same can happen with aesthetic surgery.

Although complications following surgery may be your fault, a percentage of patients will be troublesome—they might refuse to follow preoperative or postoperative instructions, use medications they are warned not to use, or smoke cigarettes and lie about it.

The problem with some bulletin board postings is that they tell only one side of the story.

If I post a message that says a specific hospital has a high mortality rate, it may cause readers to parrot what I wrote and to speak badly about the hospital.

If, however, I say in the next sentence that it was a hospital that treats only terminal cancer patients, you then get the other side of the story.


Usually, it is a simple matter for you to avoid the kind of trouble that my surgeon friend had with his disgruntled patient. offers online forums covering all things aesthetic.

A simple policy of staying in close touch with patients and catching their complaints early on, before they hit the online discussion forums, is critical. And it is so easy to do.

For example, always try to personally answer e-mails on a timely basis, give patients your cell phone number, and surround yourself with a compassionate and caring staff.

In a successful and busy practice, you will occasionally have patient-related problems.

Over the years, you and your staff can sniff out patients who may be problematic—for instance, know-it-alls who don’t listen or talk trash about previous surgeons, or those who are not dependable.

On the other hand, a patient’s sixth sense about surgeons can tell a genuine, proficient, and caring surgeon from someone who is faking it.

See also “The Future Is Here” by Robert C. Silkey in the June 2007 issue of PSP.

In resolving conflicts, responsible communication from both sides can make things better.

Some patients, though, will never be happy because they are not happy with themselves.

Aesthetic surgery requires a stable, rational, and psychologically secure patient for the best outcome. Patients with psychological and/or image problems have no business being in your office. The surgeon who operates on them has made a mistake before he makes his first scalpel cut.

As for those pesky negative online posts, online forums are very helpful when they are factual. When they are not, be prepared to step in and correct misinformation and offer your side of the story.

Joseph P. Niamtu III, DMD, is a board-certified oral and maxillofacial surgeon in private practice in Richmond, Va. He can be reached at .