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Reputation Management — with Jeffrey J. Segal, MD, JD (Ep.198)

Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and reputation management.

I’m your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today’s episode is called “Reputation Management — with Jeffrey J. Segal, MD, JD”.

At the medical conferences I speak at, there’s usually a talk about reputation management and how to keep %*@^ from hitting the fan and ruining your name. 

So, I invited one of the country’s leading authorities on medical malpractice and reputation management to update you on how to stay out of trouble and keep your reputation as stellar as possible. 

Jeffrey Segal, MD, JD is a board-certified neurosurgeon, but he’s also an attorney and partner at ByrdAdatto law firm. He’s also a reputation management expert. Dr. Segal focuses on keeping doctors from being sued for frivolous reasons and to minimize the need for difficult reputation management.

⬇️ Click below to hear “Reputation Management — with Jeffrey J. Segal, MD, JD”

On this week’s Beauty and the Biz Podcast on reputation management, Dr. Segal and I talked about:

  • How to protect, preserve and manage your reputation online
  • How to spot trouble early so your reputation management take far less effort
  • How to handle patients with mental health issues who can cause havoc with your reputation management and a lot more…

Every surgeon who has done enough surgery has or will experience patients who become problems, so this episode gives you strategies to help with your reputation management.c

Prevent Bad Reviews — with Jeffrey J. Segal, MD, JD & Beauty and the Biz Ep.198 • Reputation Management — with Jeffrey J. Segal, MD, JD •

P.S. If you enjoy Beauty and the Biz, I would appreciate a 5-Star Review to grow the audience to help more surgeons.


Reputation Management — with Jeffrey J. Segal, MD, JD (Ep.198)

Catherine Maley, MBA: Hello and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and reputation management. I’m your host, Catherine Maley, author of “Your aesthetic practice, which your patients are saying”, as well as consultant of plastic surgeons. To get them more patients, more profits and better reputation management. But today’s talk is a little different.

We’ve got a very special guest who’s an expert at reputation management. His name is Dr. Jeffrey Segal. Now he’s not only a board-certified neurosurgeon who trained at Baylor College of Medicine. He also just happens to have graduated from Concord Law School. So, he’s also an attorney and he’s also a partner at ByrdAdatto law firm, and a reputation management guru.

So, Dr. Segal launched a company called Medical Justice in 2002, and Medical Justice is the physician-based organization focused on keeping doctors from being sued for frivolous reasons and to help with their reputation management. That’s why he’s on here. This is becoming more and more of an issue. So, Dr. Segal also founded eMerit to help doctors protect and preserve their reputations and teaches reputation management, particularly online.

Now, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice, online reputation, and reputation management, and I hear him talk at the meetings all the time. He’s a really popular, he’s got such a popular topic because it’s a hot topic, and it probably always will be. So, Dr. Segal, welcome to Beauty and the Biz.

Jeffrey J. Segal, MD, JD: Hey, Catherine, thanks for allowing me to participate.

Catherine Maley, MBA: Absolutely. Just out of sheer curiosity, how does, how does one go from a neurosurgeon to an attorney and reputation management expert? Because that didn’t take a couple minutes. That took years and years to become one, to then become a lawyer, and that took a whole lot of time to then become more entrepreneurial.

What was that path like? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Well, it’s interesting because I did not intend that to be the case, and it’s like having that conversation with your parents and your wife, how that happened. In between, I was in biotechnology, so, I practiced as a neurosurgeon for a decade. Perfectly happy doing that. And then I had a son who became ill.

He’s better now, but I took a year off. We moved to North Carolina to seek services for him, and I became persuaded that a certain set of pharmaceutical compounds might help him. And in that process went to where they were on a shelf, university of North Carolina licenses, compounds, raised money, and started a biotechnology company.

So, if. Knowing what I now know, I probably would not have done it, but we’re able to move these compounds pretty far along from preclinical to phase two, get the company sold to a medical device company. By then, a number of years had gone by. Question was whether I can go back to practicing neurosurgery.

I thought since so, many years had gone by, it’d be a challenge to per, you know, to reasonably persuade a passion to go under the knife, even though I’m arrogant enough to believe I could do it. I’m not sure I had these, the persuasive skills to do that. So, I formed medical justice and got a law degree along the way.

So, in some sense you could just say, I’m confused. Another sense you can say I’m a lifelong student.

Catherine Maley, MBA: You’re probably both, right? So, the thing about frivolous lawsuits and subpar reputation management: How did that come about? Because you wouldn’t have had that issue as a neurosurgeon, but you certainly would as a solo practitioner, plastic surgeon.

So, how did you segue into that world? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah, it’s a great question. I actually did have it happen to me as a neurosurgeon. Oh. And I was sued one time for what I perceived to be a frivolous reason. The single expert who testified against me had actually been expelled previously from our professional society, the American Association of Neurological Surgeons.

Why? Because he was delivering frivolous testimony. Yet, even though he’d been booted out of our professional society, there he was on the circuit making a very handsome living testifying, saying one thing on one coast, saying the exact opposite on another coast, but his core competence, He had good communication skills.

He could speak well to a jury, so, he was in demand. In any event, I, he had never seen or done the case at issue, but it didn’t stop him from running his mouth. The case was dismissed about two weeks before trial. I never felt as if I lost won anything. I just felt as if I lost less and I thought there has to be a better way.

So, we started medical justice as a way of holding proponents of these frivolous lawsuits accountable. In one sense, what do we do? We sue lawyers that inappropriately sue doctors. And more broadly, over time, we’ve expanded our mission to deal with all types of conflicts. Goal is to deescalate a conflict.

I mean, by the time people get to lawyers. There’s a lot of conflict in the background. And there are, and in fact, this is probably a good segue to talk about, well, what kind of conflicts are there, what types of, what types of Sabre rattling takes place and well, all types. The, it typically gets started with yelling, screaming, or nasty emails.

Somebody doesn’t, somebody says they don’t like how they were treated, for example, that’s the lowest level. Or they could put a nasty note on the internet. They can file a complaint to the Board of Medicine. All of that requires no effort whatsoever. They could sue you in small claims court. They could hire a lawyer to send a threatening demand letter or they can sue you.

So, a gazillion ways for a conflict to take place. That’s the bad news. The good news is there are ways, if you are attentive, To the process to head this off at the past before there’s litigation, before there’s a nasty note on the internet before they even start yelling at you. There are plenty of ways to identify trouble before it shows up at your door and avoid this before it creates a headache.

Catherine Maley, MBA: I’ll tell you being a cosmetic patient myself and just, and just being in this industry for decades, I have noticed that a lot could have happened at the beginning to prevent the drama happening at the end. And let’s just talk about patient selection, in terms of reputation management. I know so, many surgeons, and I don’t know if it’s arrogance or just.

Whatever, but they don’t want to say no to, to the surgical procedure or the money or whatever, and they always think they’re going to be able to handle it. Even if staff is saying, I don’t know about this one, I’m not feeling good about that. Can we just start there? Like, what? What can they do to just cut it off at the beginning? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah, so, the first thing is to select your patients carefully. It’s a cash pay business. There’s this tendency to want to get everybody through the door. Nobody will ever have on their epitaph. I wish I had done one more patient that that epitaph does not exist on a gravestone. So, be. There are a handful of patients you not only should say no to, you must say no to.

They’re not great candidates for surgery. You may believe they have a cosmetic problem or an aesthetic problem that you can solve, but that’s not their underlying problem. If a patient comes in there and says, Hey, look, I just want to take three or four years off. I just want to feel better. That’s probably a good candidate for a procedure.

If a patient comes in and says they’re struggling to put food on the table and a roof over their head and they’re struggling financially, or if they believe that the procedure will shave off 30 years, or if the procedure will save their marriage. Not a great candidate. Those are people who have expectations that cannot be managed.

You cannot manage those expectations. The best thing to do is to say no. And the other thing is that there are. Cash pay businesses where patient will have a particular budget and you say, I can’t do that for you, but I can do something at 10% of that cost. But you know, in your heart of hearts, it’s not really going to do what the patient wants.

They’ll be back, they’ll believe, they will have believed that somehow, they’re getting a permanent solution when they’re only getting a four-week solution. Expectations aren’t managed, just don’t do it. I’m telling you that the amount of extra revenue that you get for that one patient will pale, pale in comparison to the headache that you will experience.

And I’ve often said that in with the benefit of hindsight, if you had known that this particular patient would cause this much agony in your life, would you have paid them? Would you have given them a check in advance of seeing you to stay out of your practice? Hundred percent of practices say yes, I would’ve paid them.

I’m still waiting for the one to say no. I probably would not have paid them to stay away. No, they, they will, they will tear your soul out and they’ll rip out. You know, your, you know your desire to practice medicine right at your bone marrow.

Catherine Maley, MBA: Do you have a professional way to tell a patient No, because I have found these patients are still going to slam you online when you say no, you know, is there a w the right way to do it without them giving you a bad review about it? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Maybe, I think I, I’m going to say upfront that even if, first of all, you should be capturing feedback from patients so, that if you get the inevitable bad review, it’s not a showstopper, it’s not going to destroy your practice. In fact, I will argue having an occasional negative review amongst a C of positive reviews is actually a good thing.

I think it’s actually better than having a hundred percent positive reviews. Why? Because it demonstrates authenticity, credibility, et cetera. If you have a hundred percent five-star reviews, let’s say you have 500 five-star reviews and just says, great doctor, love you, you know, there’s no meat to the review it.

It looks like marketing material, but having an occasional negative reflects reality. The public knows you cannot make everybody happy. The Ritz Carlton doesn’t make everyone happy. The public wants to see how you can solve a problem. So, if you have an unhappy patient and you’ve at least work to try to solve their problem, you can tele telegraph that in a HIPAA compliant way.

Good for you. I think you’re better off now when you get that negative review. You don’t feel like sending flowers and chocolate to that patient. Of course, but you should. You probably should. Only because I think holistically it’s, it’s helping you. But anyway, back to your very good question. How do you gently.

Give somebody the boot, if you will, you know, without being offensive. And I think the way to do it is to validate them. Say, look I’m not disagreeing with your, you know, with your treatment plan, what you’re requesting. I just do not believe I will be able to meet your expectations. I’m not suggesting no one will be able to meet your expectations.

I just don’t believe that I can meet them. And I. I just want you to be happy. I want you to be happy, and in doing so, I don’t think it would be a good idea for me to take your money, ultimately go through a procedure and you not be satisfied or happy. Now, that will work with most people. There are, there’s a small subset of patients who do not have a core aesthetic problem.

They have a mental health problem. Mental health problem may be something like body dysmorphic disorder, just to give this a, a name and there it’s a body image problem. It doesn’t matter what they see in a mirror. They don’t. They experience a different image. And when you operate on somebody with body Dysmorphic disorder or B D D, you’re actually doing them a disservice.

I mean, arguably it’s malpractice, but I would just say, you know, more, more charitably, you’re doing them a disservice. And the proper thing to do is to refer them to a healthcare professional, mental health professional who deals with body image problems. As an aesthetic practitioner, you do what you know how to do.

But let’s say for example, a patient came in there and they had, they had a kidney stone, or say they had chest pain. You’d send them to a urologist for the kidney stone. You’d send them to a cardiologist for chest pain. You would properly refer. Then if you can identify, if you can make a presumptive diagnosis of something like B D.

D. Having a preexisting relationship with a mental health professional that you can gently pass the baton over to for additional screening. You’re doing them a favor. And in some sense, you could say, I’m not saying no forever. I’m just saying no for now. I just want you to be screened and be evaluated by somebody that I know, somebody that I trust, and they can give you a clearance.

But if you’ve got a good screening tool for b d d, being able to gently. Get them referred to the proper individual in many senseen. I mean, you were really doing them a favor. Will they write you a bad review? Typically, they will not. Can I promise? They will never write a bad review. No, I can’t. But I, I can tell you that if you, you do the right thing most of the time on balance, you will be better off than operating on that passion or just kicking them out the door and saying, I can’t help you.

Catherine Maley, MBA: Just good luck with that. But now that we have social media, I see every day I, I don’t know if it’s B, d, d or whatever you want to call it, but the outrageous big boobs, big butt, little waist, huge lips. Is that b d, d or is that just, what is that? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: You tell me. Yeah, so, I, I’d have to plead ignorance there. I’m in North Carolina.

I don’t see it as frequently as perhaps you do on the West Coast, but, but you know, I’ve been to Miami and I’ve definitely seen it there and I can, I can tell a trend and every three or four years the trend changes so, that it’s something else. I think you just got to do what you do. Okay. If, if the patient wants something that is outrageous, they’ll eventually get it done.

There’s always somebody who will do it. Even remember Michael Jackson was able to find a doctor to put him to sleep at night and ultimately put him to sleep permanently. But you don’t have to be that. You don’t have to be Michael Jackson’s doctor. You, you, you just do good work., you’ll have a good practice.

Don’t feel compelled to have to do outrageous things just to, just to keep the lights on. Most people are reasonable. I, I know sometimes it’s hard to believe that, but most people are reasonable and want reasonable things. And if somebody’s pushing the envelope to get you to do things that you’re not comfortable, things that you think are not within the standard of care, just say no.

Because if you, if you do say yes, sooner or later, you’re going to get burned. I, I, is it b d, d? I don’t know, but I know it’s not something that I know that most practitioners should stay away from. Let’s just talk about, you know you know, putting in breast implants that are ginormous. Okay. It’s possible that there will never be a complication associated with that, but it’s just physics.

You’re putting in a, a mass under the skin or under the muscle. And if the skin or muscle has to stretch, Beyond what it’s capable of doing, and it outstrips its blood supply. I can tell you with a hundred percent certainty what’s going to happen, that the skin is going to slough off, the implant will be exposed and it’s going to get infected, and then the implants are going to need to be removed.

Now, they may not have liked their breasts beforehand, but I can assure you they’re not going to like having a giant gaping hole in their breast without any mass in it. I think to, to me, that’s a worse outcome. But all you can do is what you can do. You can try and persuade them based on the best evidence and your judgment.

And if you say no, maybe they’ll go somewhere to say yes. But I, I, I know that you can’t beat physics a hundred percent of the time. That much I’m confident of.

Catherine Maley, MBA: So, what about the patients who schedule surgery, put down the deposit, then change their minds, cancel the surgery. Now they want their deposit back.

The date can’t be filled, or they’re scrambling to try to fill that date. Who I realize that’s the patient’s problem, you know, they caused that. However, what’s the best way to handle that? Because of this online situation. You know, they’ll, they’ll be online saying, I can’t get my money back. The guy stole my money.

How do you handle that when a patient reneges on what they’ve… How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: This is a challenge, and I have changed my opinion on this over time. If you had asked me 15 years ago, I would say a deal is a deal. You basically stuck your deposit down. That’s. I scheduled you for surgery. I wasn’t guaranteeing you an operation.

I was guaranteeing you a slot on the schedule, and I honored my end of the bargain. I’m keeping the money. So, that was Jeff Segal me speaking 15 years ago. I’ve changed my mind. I’ve changed my mind over time because here’s what I think happens. I think if you’re dealing with a significant sum of money here, you’re putting the patient in a bind.

The bind being that. Are being forced to choose between Forfeit Inc. A large amount of money. Let’s say it’s $10,000 just to make this a round number or have a procedure. They don’t want to have, have a procedure. They don’t, an elective procedure they don’t want to have. And what I’ve seen over time is that if you push them into that situation, They’ll ultimately have the procedure.

They’re not going to forfeit the money, but that’s when the fireworks begin. They’ll have the procedure. You will have done what you, what you, you know what you said you would do. You honored your end of the bargain. Then they’re going to. Tell you how horrible you did the job. They don’t believe it, but they’re going to tell you how horrible a job was and they’re going to demand their money back.

They’re going to demand their money back or slam you on the internet. So, as unsavory as it is to just swallow hard and let them go, I would probably most of the time give them their money back. Now, I think it depends on the situation. If it’s, if the patient has a good reason for. For canceling the procedure and if they gave you adequate advanced notice and you could potentially fill the slot.

I’m saying just do the, be good, be a nice person and give it back, particularly if you can fill the slot. Okay. Because really you haven’t been injured, you haven’t been harmed, and you’re just trying to be nice and do the right thing. If they have a medical event or a life event that took. And it looks like they really do want the surgery down the road.

Just ask them gently, you know, would you like to postpone this at no charge? And we’ll do this when the dust is settled. You know, it sounds like you’re going through a lot of life stressors right now. This is an entirely elective procedure. You don’t have to have it done. But if you think you want to have it done, we’ll just go ahead and, you know, keep your funds you know, stored away and we’ll, you know, we won’t raise our rate for you because typically we will.

Raise rates, you know, twice a year, once a year, and we’ll honor our end of the bargain and flesh that out. But if they basically just say, look, it’s the day before the surgery I’m canceling. Do I have a reason? No, I have no reason. I just don’t want it. What don’t you understand about that? And that’s a nasty individual.

Okay. And do you really want that as your patient? I mean, I, I think you’re probably better off not operating on that individual and just flipping it around and. Giving them the cash back. I mean, to me, deposits are mostly there to get people to commit to a date and it serves its purpose. It gets people, it puts something on a calendar.

So, when I say I’m going to, I plan on going to Europe, to me that’s a wish. It, it has no substance whatsoever. Once I stick that on the calendar, that baby’s real, I’m going, I know, I’m going ticket. Yeah. Once you buy an airline ticket, it’s real. Now, you know, if I, I can change my mind and I can cancel the flight as, as I just did for my wife the other day.

So, now she’s got x number of months to go ahead and use those dollars for something else. But I mean, over time we’ve hotels and airlines have kind of figured out how to find that nice balance between the two, at least holistically. You may get screwed on a particular patient, but. In aggregate, I think you’ll be better off by adopting that philosophy.

Catherine Maley, MBA: Well, here’s another thing that can go sideways. You’ve had your surgery and now you as a patient, you get this bill and it’s for another thousand dollars for or, and anesthesia because the doctor took longer than expected. I personally, Thought, why is that my problem? Like, I’m the patient, he’s the expert.

Why am I paying for him to take longer than he said he was going to? Do you have a comment on that? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah. I don’t disagree with that. With your interpretation of that, I mean, look, in the elective space people are looking for. One shop pricing, they’re not looking for surprises. If it’s an insurance world, it’s not really your money.

I mean, let Blue Cross manage that, not my problem. And once you’ve hit your deductible, it’s just break out the champagne, all of everything done, you know? But I mean, if, if indeed there’s going to be extra fees related to taking more time, Then the rational argument is, well, do I get money back if the surgeon was fast, if the surgeon was faster and only took half as much time, because I was simple, do I get a refund?

And we know the answer to that. The answer is that a big no. So, if I, I think the proper way to do it is to try and work with facilities and other professionals who are willing to accept fixed. With the understanding is that you are already arbitraging this, you have more knowledge than the patient and you’re in aggregate.

You’re going to come out ahead. Mm-hmm., if you basically say, I’m going to accept the risk of the case going longer, I’m just going to eat it. But you know in your heart of hearts that you’re benefiting by the case going. If you could stuff in more cases good for you, you, you’ve actually benefit. So, I, I think barring extremely unusual circumstances, you’re probably better off eliminating surprises to patients.

Nobody likes a surprise. I know. I don’t like a surprise, you know, when I get a letter from the I r s, if it doesn’t have a check in there for me, I’m, I’m not happy. That’s an un, that’s an ugly surprise. And even if I do get a check and I’m not expecting it, that’s also an ugly surprise because if you cash that check, You’re going to get hosed a year from now.

So, my, my larger point is try to eliminate surprises for those in the cash pay business and you’ll eliminate future headaches for yourself. Oh, and let me tell you another thing. Avoid billing patients for $24 and, and 32 cents. You know, it just pisses people off Now. Particularly if they’re not expecting it.

I’ve seen people sent to collections for under $25. I don’t get that. I don’t get it because if the patient is unhappy or suffered a complication and they, they just ate it and they learn to live with it, that’s the, that’s the one thing that rubs salt in their wound. It’s, it’s a, it’s an unforced error.

You don’t need to do it. If you’ve got a $24 bill with a hangover, write it. Just write it off.

Catherine Maley, MBA: Here’s the next surprise that comes up. The patient has their procedure. They’re not happy with their result. The doctor agrees and says I’ll; I’ll do a tweak in the office if possible. Mm-hmm., if he can’t, he says, I’ll, we’ll go back to surgery, but you’re paying the OR and anesthesia and I, I will forfeit my feet again.

The patient says, why am I paying? It’s, you know, you are the expert, you did it. You can see there’s a problem. And I know that’s murky because sometimes the doctor can’t see there’s a problem. But oftentimes there really is. I mean, he did he, he does need some kind of revision to be made. How, how tricky is that?

Or is it more black and white than it seems? Because I, as me, as a patient, if I see something’s wrong, I mean, but I’m reasonable too. What if it’s a reason? Revision? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah. So, the answer, I’m going to give you a lawyerly answer. Okay? It depends. Every, every doctor is different. Every patient is different.

Right? Here, I would say if you’re going to do a revision procedure where you waive your professional fee, then. You do want to spell out in advance who is responsible for anesthesia and the facility. Okay. And try that. That’s a trial balloon. See how it goes. If the patient thinks that’s reasonable, they’ll sign off on it.

Get them to sign off on it. Get them to say, here’s the deal. The deal is this. And most of the time they’ll say yes, but not always. Then you got to recognize who is that individual that is going to need something more just to solve their problem. Do. Would I roll over? I probably, I might, I might. I’m actually thinking about myself at that point.

I’m thinking about do I want to go to World War III over a modest amount? And. Or do I, will I eat some of that fee even partly because I already received a large amount of money from them in the first place. Now is it as much? No. But is this really going to change my financial statement at the end of the year?

No, it’s really not. And if I’m already psychically invested in this particular case, and it’s starting to raise my blood pressure at this stage of my life, I’m going to opt to decrease my blood pressure. It’s not going to bother me One. But that’s me. I, again, if you had asked me 20 years ago, I would’ve given you a completely different answer.

I would’ve gone to war.

Catherine Maley, MBA: The, the reason patients will go online, typically, I’ll just say in general because I talk to them all the time, is because nobody fixed their problem. They had a problem, nobody heard them or listened to them or did anything about it. How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Repeat what you just said. That’s the most important point of this conversation.

They did not feel listened to. They didn’t feel listened to. Listen to them. If you listen to them, they’ll give you the answer still. Sir William Osler said, the patient will deliver the diagnosis to you, and here it’s the same thing. It’s a communication issue. If you stop talking for a moment and you start listening, they’ll tell you their perception of what they believe the problem is, then you’ve got a question, can you solve their problems?

In my estimation, Once you’ve listened to them, you’ve already, you’ve, you’re 90% of the way there to solving their problem. You may have to go a little bit more and some problems cannot be solved. I, I don’t, I agree. Not every problem can be solved, but where else do you get 90% success rate? I think that’s pretty good that those are pretty good odds.

Catherine Maley, MBA: When you do know it’s not your best work and the patient knows that too, like everyone knows that but you don’t want to do it again. You’re, you’re kind of done with it. What is the easiest way to detangle? I personally, I like the refund idea, the one with, and you agree not to disparage me? Yeah. In any way, shape, or form.

Is that still the best way to handle that? Or what is your approach? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Couple ways to do that. That to me is tried and true, meaning that patients unhappy. It may not be your best work. It could have been the patient, you know, biology. Biology, and it is what it is. But being open to the idea in the cash pay field of giving the patient their money back.

You give, you, get, you give, you get. So, what do you want from the patient? I want a release. I want two things. No legal mischief, no online, mechi. 99% of the time, they think that’s a pretty good deal. And they’ll say yes, and you become a beneficiary of that too. And the reason I say you become a beneficiary if you’re seeing a patient 12 times post-op and you see the name on the schedule and your sphincter tightens up because of your nose coming in during the day.

That eats into your longevity, you’re going to live a few minutes less the more, more of those experiences that you have. So, in, in a sense, you’re paying for longevity and we, I mean, to me, that’s the cheapest way to live longer and live well longer. So, yes, you give, you get, it’s got to be a nice crisp release.

And a good release is typically five pages long and, and we, we have those available. Something you can also. If you could potentially have the patient seen by a colleague of yours that you trust. If you think the patient is not malignant and they’re a reasonable human being, but you believe, or both of you believe that the trust that is necessary in a good doctor-patient relationship is gone, you can offer to say, look, I know that our relationship.

As good as it could or should be. But I’m open to sending you to somebody that I trust and I’m hoping you’ll trust him or her too. And I, I can get you on their schedule, you know, to be seen as s a P. That often also helped. Now, they may say, any friend of yours is an enemy of mine, and they don’t want to see that person.

But by and large, you. You’re coming up with potential solutions, you’re solving a problem here. Can always fall back and giving the money back. But sometimes if you can kind of keep it in the fold with people that you know and trust every, you become a beneficiary of that, and hopefully it solves their problem and they’re happy to.

Catherine Maley, MBA: So, what about arbitration? Because I think egos get involved and it gets overblown and a third party that could smooth things out makes sense to me. When do you, how does all that work? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: The arbitration? Okay. So, there are a couple ways to think about this. One is, I’ll call it informal mediation and then arbitration.

Let me explain the difference. So, sometimes the love is lost that the doctor and patient really do not want to talk to each other any longer. They don’t like each other. It’s a bad marriage and they need to divorce, but they need to separate amicably. So, sometimes hiring an attorney like me, because I will do this, I will reach out to the patient.

I’m not formally mediating. I do represent the doctor, and I do tell them that, but I’m a person who will actually listened and validate what is obvious. I mean, if a patient had an infection and they had an unexpected complication, I’ll just acknowledge the obvious they’re unhappy with how this turned out.

Why would, why wouldn’t, why would they be happy with that? I mean, it makes no sense to, to perceive otherwise, and hopefully we can negotiate a detant a way out. Perhaps how to give the patient summer all of their money back. Or we even had it where the doctor will donate to a charity so, that something good comes out of this instead.

So, there are a thousand ways to come to an amicable resolution. So, that’s that one bucket. The other bucket, arbitration is more formal. Arbitration is an alternative to court. Arbitration is alternative to court. So, why do I like arbitration? A court is, so, what is arbitration? Arbitration is. The sides agree to resolve their dispute informally in a private setting, typically with a retired judge, and it’ll be private and binding.

It’ll be private and binding. So, why do I like that? Well, to resolve a case in the normal system in a court, it’s public. Everybody can see it. They can read everything. And when you’re dealing with an aesthetic case, I mean everybody benefits by this being private, at least I think they do. It’s faster, typically because it’s less formal, typically costs less, not always, but typically it’s less expensive to go through.

And it’s binding, meaning that you can’t appeal it. So, when the decisions in the decision’s in with court, you never know when it ends because you can certainly appeal it and there could be no end to this stuff, at least, you know, no conceivable and to the process. So, I’m a big fan of arbitration and while I, it clearly benefits the physician, the doctor, the provider.

I also think it benefits the patient. I think everybody benefits from this.

Catherine Maley, MBA: So, let’s say the patient wants to, let’s just talk about reviews, because reviews are going to be the being of every plastic surgeon’s existence. And I, I feel for them because nowhere else on the planet can you complain about somebody with no recourse at all.

And the doctor. You haven’t? I don’t know. It’s just, it’s so, unfair. Because most of the time the surgeon is not, their intent is fine. They have no ill intent. And you’re getting bashed online for things you can’t fix. You can’t get it down. You can’t. Although just recently on the West coast there’s a federal lawsuit against a surgeon who was filling around with the reviews.

And I hear this a. Either they’re having their staff write good reviews or bad reviews for the competitors, or they’re paying right the reviews for all unnecessary… How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Here’s the deal. Here’s how I would do it. Look, if you’re a high performing practice doing great work, there are ways to get honest reviews and they’re mostly going to be positive from your patients.

But don’t filter reviews. It’s called review getting. Have as many patients as you’re possible, participate in the process, have it so, that it’s done at the point of service. I’m making a plug. Our organization does this stuff with the merit. We’re not the only one that does it. But aggregating reviews from your patients, not filtering them, not getting them, you will be perceived for the most part, for what you are as long as you get them up there.

You will get an occasional negative review. It’s inevitable everybody gets it. As I told you earlier, having an occasional negative review is actually better than no negative reviews as much as you.

Catherine Maley, MBA: I tell doctors this all the time. I say your three hundred and thirty-six five-star reviews. Is so, inauthentic.

I wouldn’t trust that at all. How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: So, plus, who’s going to read 336 reviews? People read 10, 15 reviews. They may ask to read the lowest one. Great, get to the lowest one, and then see if there’s a HIPAA compliant response. Did the doctor or the provider take the high ground? Did they try to solve a problem? Do they look to be reasonable?

Why the patient is trying to identify if they become the complainer, will their problem be solved? And that’s all they’re looking for. They’re looking for insurance or reassurance and typically it’s, you can provide it, you can solve that problem.

Catherine Maley, MBA: Yeah, well a lot of times too because we patients, we love to look at the one-star review and see what happened.

And a lot of times that one star is so, chaotic you can tell it’s not a balanced. Person who’s writing that review. So, that’s handy. But otherwise, if the reviews are just, he made me wait forever like, I hope that’s your worst review. Like, he was so, busy. He, you know, I got two minutes with him.

Like, that’s a, that’s still a really good review. How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: It is because how does it get positioned? So, if he made me wait, it means, look, I spent as much time as needed with a particular patient and after the patient before. Had a crisis or had additional questions. I gave them the benefit of the doubt. I gave them extra time, just like I’ll give to you.

If you become that patient, you turn a negative into a positive. If You know, if they say you only spent 10 minutes or not enough time, you go the, the, the, the subtext is that you’re so, many people want you, you’re in demand. The public must know how great you are. So, not all of these are really bad. I think the things that are manageable, if there are money issues, you just.

Put down a statement, which is our patients sign off on the expected amount they will pay in advance. And if there’s if there’s a disagreement, they’d they need to do little more than come to our office and we’ll fix it. I mean, it’s, it’s the type of thing. If it’s in writing, you’re just honoring what’s in writing.

It is what it is. I think if they’re just unhappy, and I said, Segal’s a butcher. Yeah. There’s only so, much you can do with that, but. You know, if the patient, for example, had an infection you turn a negative into a positive, you say something to the effect of the infection rate for this particular procedure is, 2%.

In our practice it’s 1%, so, it’s less than the national average. However, patients are not statistics. A patient either experiences an infection or doesn’t, a hundred percent or 0%, but regardless, we’ll stand by our patients and try and fix them until they’re satisfied, something like that. And so, what have you done with that?

You’re basically. Acknowledging the obvious that infections do happen, that in your practice it’s lower than the national average. And number three, you’ll do your best to try and make it right. That’s per that’s a great answer, by the way. And by the way, There’s no violation of HIPAA in the way I just described it.

Catherine Maley, MBA: Mm-hmm. You know the big ones that end up usually on TV or something, it’s when the doctor didn’t respond they told them they’ll be fine. We’ll they’ll be fine. Just get some rest and days go by and then it becomes a very big issue. So, a lot of this can be prevented, but what’s the, what’s the most frivolous and the least frivolous?

Do you have any like, like extreme example? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Oh my God, for the most frivolous, there’s so, much attention to that. My, here’s my favorite case with the frivolous lawsuit, and it’s not an aesthetic case. Okay. But hopefully you’ll bear with me. So, a. I believe in this case it was a urologist and a small town performed a vasectomy on a particular patient.

And a year later, the patient’s wife became pregnant. Okay? A year later, the patient’s wife became pregnant. The male comes back and is livid, is saying that the vasectomy didn’t work. Now, by the way, the postoperative sperm count was zero, and in rare cases it does happen where the, the vast deference, which is tied off and cut.

Come back together. It, it does happen. But that’s not what happened here. What happened here is that they lived in a small town and everybody knew that the patient’s wife who got pregnant had a lover on the side. So, this was a lawsuit, and until they were able to get a paternity test to demonstrate it wasn’t his child.

This was a, this was a lawsuit and I would argue a frivolous lawsuit. So, that’s one of my favorite cases. I, I typically ask the audience if they have a hypothesis as to how this might have happened. You know, when the. Patient’s wife became pregnant after he had a vasectomy. Is there a hypothesis as to how this could potentially have happened?

I can’t believe she let it go that far. Oh, I know. and it was a small town and basically the doctor said to everybody in the town who knew she was seeing, you know, there was no mystery here. And we, but they, I guess the patient, the husband was the last to know here in terms of. Least frivolous cases. Look, if a patient has a complication, that’s an unexpected outcome for them.

And to them, that’s a big deal. I think one thing to pay attention to is this, that much of the aesthetic world is cash pay. And if you’ve got a Blue Cross policy, they exclude cosmetic procedures. So, what happens if the patient ends up getting a local infection? What if the patient gets a local hematoma?

It depends. Blue Cross may not pick up the tab for that. So, if the patient has an urgent problem goes to the er, they may or may not pick up a tab. I will tell you we had one client. I would say this wasn’t pretty decent outcome. The patient was operated on, I think in Southern California and then went up to Washington State and developed post-op day number three, four, developed a hematoma, breast hematoma.

And so, the doctor says, look, just go to the er, just get it taken care of. She goes to the ER, phone call, doctor comes in, finds a hematoma, removes it done under general anesthesia. Blue Cross would not pay for it. They basically said, this is a complication of a procedure that we don’t. We’re not covering it.

But interestingly enough, this the anesthesiologist or the surgeon did a pregnancy test on the patient just to dot all their eyes and cross the T’s and to everybody’s shock, it was positive. So, the patient was pregnant I guess newly pregnant at the time she was going to be put to sleep. So, the argument that we made was.

Because they wouldn’t pay the anesthesia bill. So, the argument was that, well, look, they weren’t just taking care of mom, they were taking care of the baby. Anesthesiologists were taking care of the embryo or the fetus, and they accepted that appeal. So, they, they bought it, meaning that there are ways to do it.

And in addition, if the patient has a systemic illness like sepsis or a pneumothorax, Something that’s potentially life-threatening. Typically, on appeal, they will pay for it. But be careful. If somebody has just a local infection and they are sent to the ER and now the I C U and they’ve got tens of thousands of dollars, this could be a potential challenge.

So, I, I tell people, look, if people are spending their last. On a particular procedure and they truly don’t have the resources to weather a potential storm, just be careful because they’re going to be looking you to make that payment. You know, if they can’t, otherwise they’ll have to file for bankruptcy.

Catherine Maley, MBA: For sure. Well, we’re going to wrap it up. I don’t know how you’re a lawyer. I was going to be a lawyer for about a minute and I realized how negative it all is. Like you have to live in that mindset of what could go wrong. And I didn’t. So, I went into marketing instead. I thought that was a lot more positive and fun.

But good, you know, you’re probably doing God’s work there. So, good for you.

Jeffrey J. Segal, MD, JD: I try to maintain a sunny disposition. So, my, my feeling broadly is that I’m here to solve a problem. Not to say no. Good for you. I typically say my feeling is ye, so, I, I have two ways of saying something. I could say no because, or yes.

If no, because, or yes. If I try to say yes, if more often than not.

Catherine Maley, MBA: Good for you though. Good mindset. So, how can others get ahold of you if they do have a little issue and they’d like your 2 cents out?

Jeffrey J. Segal, MD, JD: I’ll give you my email address, so, it’s [email protected] and my office phone number is (336) 691-1286, and you can just look us up. at It’s one-word We’ve been at this now for over two decades. Every time I think we’ve seen it all, I’m proven wrong, but we have worked with over 11,000 practices across the country over two decades, and lots of problems to solve.

Lots of conflicts, but the good news is most of the time things go smooth.

Catherine Maley, MBA: Oh, that’s all. That’s a lot of problems to solve there. 11,000. Holy cow. But thank you so, much. I appreciate your time, and I will see you at a conference coming up soon, I’m sure. And everybody, thanks for joining us. And if you haven’t already, please subscribe to Beauty and the Biz and share this with your staff and colleagues and anyone else who’s interested in the frivolous lawsuits because they’re going to happen.

They’re just going to happen, period.

Everybody that’s going to wrap it up for us today, a Beauty and the Biz and this episode on reputation management.

If you’ve got any questions or feedback for Jeffrey J. Segal, MD, JD, you can reach out to his website at,

A big thanks to Jeffrey J. Segal, MD, JD for sharing his tips on reputation management.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you’ve enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don’t miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It’s guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I’ve gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to and let’s grow your cosmetic revenue.

-End transcript for “Reputation Management — with Jeffrey J. Segal, MD, JD”.

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Catherine Maley

Catherine is a business/marketing consultant to plastic surgeons. She speaks at medical conferences all over the world on practice building, marketing and the business side of plastic surgery. Get a Free Copy of her popular book, Your Aesthetic Practice: What Your Patients Are Saying View Author Profile.


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