January 2016

January 2016

Volume 5Issue 1

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S a n M a t e o C o u n t yIN

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E Next-generation orthopedics: biologics

The best place on Earth

Online review sites

Physicianinnovation & technology

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Physician

© 2015 NORCAL Mutual Insurance Company. * Based on 2014 data.

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M E D I C A L P R O F E S S I O N A L L I A B I L I T Y I N S U R A N C E

Editorial CommitteeRuss Granich, MD, ChairJudy Chang, MDUli Chettipally, MDSharon Clark, MD Edward Morhauser, MDGurpreet Padam, MD Sue U. Malone, Executive Director Shannon Goecke, Managing Editor

SMCMA Leadership

Michael Norris, MD, President; Russ Granich, MD, President-Elect; Alexander Ding, MD, Secretary- Treasurer; Vincent Mason, MD, Immediate Past President

Alex Lakowsky, MD; Richard Moore, MD; Michael O’Holleran, MD; Joshua Parker, MD; Suzanne Pertsch, MD; Xiushui (Mike) Ren, MD; Sara Whitehead, MD; Douglas Zuckermann, MD; Dirk Baumann, MD, AMA Alternate Delegate; Scott A. Morrow, MD, Health Officer, County of San Mateo;

Editorial/Advertising Inquiries

San Mateo County Physician is published ten times per year by the San Mateo County Medical Association. Opinions expressed by authors are their own and not necessarily those of the SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted.

Acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised.

For more information, contact the managing editor at (650) 312-1663 or [email protected].

Visit our website at smcma.org, like us at facebook.com/smcma, and follow us at twitter.com/SMCMedAssoc.

© 2016 San Mateo County Medical Association

January 2016 - Volume 5, Issue 1

Columns

S a n M a t e o C o u n t y

Physician

Feature Articles

Next-generation orthopedics: biologics ................................................. 8Carri Allen Jones, MD

The best place on Earth ......................................................................... 10Uli Chettipally, MD, MPH

Online review sites: How to survive, thrive and manage your reputation ...................................................................................... 13Ashley Porciuncula

SMCMA welcomes new members .........................................................12

Membership updates, index of advertisers .........................................14

Of Interest

President’s Message: Innovation and technology .................................... 5Michael Norris, MD

Executive Report: Help keep SMCMA leadership strong .......................... 7Sue U. Malone

On the cover: “Light Lines” by Nathan Harper, 2008. https://www.flickr.com/photos/bottleleaf/2684002442.Used with permission under Flickr.com Creative Commons License.

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The passing of the torch...

President’s Message

Michael Norris, MDPresident

Innovation and technologyAsking me to address innovation and technology in modern medicine is beyond my pay grade. As many who know me well will attest, I am probably the only member of SMCMA who still owns a flip-phone. To say I’m a Luddite is an understatement. Nevertheless, I have been impressed with recent innovative approaches to difficult problems, where traditional therapies were “good enough,” but now can be made better.

Pharmacological advances in the treatment of many cancers can now be guided by genetic analysis of the specific tumor. Melanoma is one lethal malignancy that is responding in many patients with advanced disease. Chemotherapy for breast and lung cancer has changed dramatically over the past several years.

Following the lead of favorable outcomes seen in rapid diagnosis and intervention in STEMI cardiac patients, the same approach is being applied to stroke patients. The Telestroke program has allowed evaluation of patients in an ER by a stroke specialist, with guidance regarding management. Early diagnosis, imaging studies, and intervention, either via fibri-nolysis or catheter thrombectomy, have shown improved outcomes in patients treated in the early hours post onset of symptoms. Recent studies in Europe have demonstrated that catheter thrombectomy may be superior to fibrinolytic therapy alone in selected patients. These modalities simply did not exist a few short years ago.

Patients with significant Aortic Stenosis may be too frail to undergo open aortic valve re-placement. Now, we have the TAVR technique, transcather aortic valve replacement. The early results have been quite dramatic, in patients in their late 70s and 80s. I recently saw a woman of 90 who had the procedure done with an overnight stay and minimal down-time. Cooperation between clinicians and the biomedical engineers have advanced the develop-ment of this technology.

We are now entering the era of tissue engineering and regenerative medicine. Stem cells are being investigated in the the fabrication of new tissues lost or damaged through disease or injury. New bone, cartilage, even organs are on our horizon.

Advanced 3-D imaging is used in the manufacture of custom replacement “parts” in or-thopedics and other fields. Facial transplantation, a science fiction theme until recently, has been advanced via the use of templates of the missing tissues, including maxillary and cranial bone, so the donor tissues may be matched to the recipient defects.

Living and practicing in the cradle of nanotechnology and biotech gives us an excellent perspective on the constant evolution of new modalities. Give me time, and I may yet get a smart phone and join you all in the 21st century. ■

We are now entering the era of tissue engineering and regenerative medicine. Stem cells are being investigated in the fabrication of new tissues lost or damaged through disease or injury. New bone, cartilage, even organs are on our horizon.


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Executive Report

Sue U. MaloneExecutive Director

Getting involved in SMCMA governance is a great way to develop leadership skils and have a voice on the issues that affect the practice of medicine in San Mateo County.

Help keep SMCMA leadership strongThe San Mateo County Medical Association offers its members several opportunities to get involved in association governance. This is a great opportunity to develop leadership skills and have a voice in the issues that affect the practice of medicine in San Mateo County.

The SMCMA Nominating Committee will soon be meeting to develop recommendations to the Executive Commitee and Board of Directors to fill positions on the Board and the SMCMA Delegation to the CMA House of Delegates.

The SMCMA Board meets monthly, with the exception of June and August, on the second Tuesday of each month. Meetings commence at 6:30 p.m., last approximately two hours, and include dinner. Board terms are for two years, renewable for a maximum of two terms.

There are also opportunities to serve on the SMCMA Delegation to the CMA House of Del-egates, CMA’s legislative body that establishes the policies that govern the association and elects CMA’s president. The House meets during the CMA annual meeting each October, al-ternating year-to-year between Sacramento and Anaheim; the 2016 meeting will take place October 14-16 in Sacramento. Throughout the year, virtual meetings are held to discuss resolutions proposed for House consideration, and to consider opinions on each resolution offered by CMA Reference Committees. San Mateo County is part of District VII, which also includes Santa Clara, Monterey, Santa Cruz, and San Benito Counties.

Current SMCMA members are invited to apply for either or both of these opportunities. Members can self-nominate or suggest other members who are interested in serving. Please apply by Friday, February 19, 2016, by emailing SMCMA Executive Director Sue U. Malone at [email protected]. ■


by Carri Allen Jones, MDIn a parallel fashion, could orthopedic procedures such as arthro-plasty become obsolete, or the arthroscope, a historic instrument found in the Smithsonian?

Many in sports medicine agree the advancement in arthroscopy over the last few decades has been one of the greatest innovations in orthopedics. More recently stem cell applications, tissue engi-neering, and 3-D bioprinting have emerged as the next generation of orthopedics.

The potential benefit of orthobiologics and stem cells in sports medicine gained public interest in 2009 with the news sto-ry on Pittsburgh Steeler player Hines Ward’s ability to return and play in the Super Bowl after sustaining a MCL tear two weeks prior. His treatment with PRP (platelet rich plasma) heralded an expedited recovery. Subsequently, a parallel rise in public and practitioner interest and usage occurred.

Stem cell therapy is gaining momentum as a clinical option in orthopedics. However, high level research on the technology’s efficacy has not been completed and long-term safety unknown. The general scarcity of information from large random-ized controlled trials emphasizes the need for rigor when consid-ering stem cells for treatment in orthopedic conditions. Bioeth-ics and regulatory concerns remain, as clinical usage of stem cell therapy is outpacing the evidence. The Center for Biologic Evalu-ation and Research, a division of the FDA, released preliminary guidelines for regulation in 2014. Most likely a heightened wave

of regulation will occur within the next few years, yielding a ca-pitulation of clinic closures due to non-compliance, poor quality assurance, and unsubstantiated claims. The corollary, improved concentrated rigor in orthopedic regenerative medicine should emerge to further advance tissue engineering, 3-D bioprinting, and gene therapy.

Basic science of treatmentStem cells may be derived from allogeneic and autologous sourc-es. Allogeneic mesenchymal cells (MSCs), for example, can be de-rived from the placenta, umbilical cord, or umbilical cord blood.

Autologous stem cells include endothelial progenitor cells sourced from bone marrow or peripheral blood, hematopoi-etic stem cells, adipose-derived stem cells, and the most com-monly used type, MSCs, de-rived from bone marrow. Both the ideal type and number of stem cells needed to treat spe-cific clinical conditions is un-known.

Bone marrow-derived MSCs are the most reported stem cell type used in the literature. It is estimated more than 100,000 U.S. adults receive cellular therapy each year in which clinicians use a point of care same-day procedure to harvest

bone marrow aspirate, concentrate the aspirate by centrifugation, followed by injection of the cells into the treatment area.

The number of stem cells harvested varies depending on the prac-titioner isolation technique, donor age, donor health status, and medical device used for processing. Also, the cell count number is limited to the retrieval harvesting passages and cannot be ex-panded in cell culture in the United States.

Digital health innovations have made it possible for us to use portable devices to access medical informa-tion, monitor vital signs, take tests at home and carry out a wide range of tasks. A recent article in the New England Journal of Medicine cited physician concern that these innovations can come at the expense of the human connection at the core of the patient physician relationship of trust, given the vanishing need of a stethoscope. The diagnostic utility of the stethoscope is obvious, but some will ask, will the loss of the symbolic and ritual connection change the perception of trust?

NEXT-GENERATION ORTHOPEDICS: BIOLOGICS Unlocking living architecture potential and engineering fitness


Continued on page 11

The ability of stem cells to replicate over long periods, and their extended life span, are the features that generate the most enthusi-asm. Once delivered, these multipotent cells can differentiate into bone, cartilage, tendon, ligament, and endothelium. They also re-lease a number of bioactive factors stimulating tissue repair and wound healing, along with other paracrine signaling behavior for daughter cells and possible homing. Cellular analysis and char-acterization of the graft material confirm the pluripotent nature, allow cell sorting and surface marker identification, genomic se-quencing, along with the number of nucleated cells prior to im-plantation.

Platelet-rich plasma (PRP) is plasma enriched with a 3-5 fold higher concentration of platelets than baseline whole blood. PRP is considered an orthobiologic and has gained support in ortho-pedics for its utility in restoring function more quickly, hastening recovery. Platelets and white blood cells are a rich source of bioac-tive growth factors that can modulate the healing process. When activated they release growth factors that act locally to recruit undifferentiated progenitor cells to the site of activation, trigger mitosis, and initiate tissue regeneration and remodeling. Further classification of PRP has been recommended to influence greater inter- and intra-operative clinic reliability for uniformity of re-porting and tracking data. This includes PRP with or without leu-kocytes, and PRP with or without activation. Also, one step fur-ther that may be considered is the number and type of white blood cells given different characteristics of granulocytes, lymphocytes, and monocytes.

Growth factor concentration in any PRP preparation is directly proportional to the amount of platelets captured. The greater the growth factor amount, the greater the response and recovery of the target tissue. Many do not realize all PRP is not equal. The amount of platelets collected may vary with speed of venipunc-ture, processing equipment, centrifugation time, radius distance from center of the centrifuge, soft versus hard spin, anticoagulant, and use or no use of an agonist activator.

The mechanism of some of the key growth factors involved in the healing process include upregulating other growth factors as a chemo attractive for stem cells (Platelet Derived Growth Factor, PDGF), stimulating angiogenesis and neovascularization (Vascu-lar Endothelial Growth Factor, VEGF), stimulating migration and adhesion of progenitor cells (Stromal Derived Growth Factor), and promoting cell mitosis and differentiation for connective tis-sue and bone (Transforming Growth Factor Beta, TGF-B). One of the most important functions of platelets is their role in promot-ing angiogenesis, as the re-establishment of blood flow through angiogenesis is critical for healing.

Recent studies indicate the optimal platelet concentration to stim-ulate angiogenesis ranged from 1.5 million to 3.0 million platelets per microliter (Giusiti et al, Transfusion, 2009).

Stem cellular biologics injected precisely under live dynamic ul-trasonography or fluoroscopy into the area of an incomplete ten-don or ligament tear, meniscal tear, subchondral bone marrow le-sion, osteoarthritic joint, or lumbar disc annular tear has revealed promising results with diminished pain, improved function, and in some cases, improved living architecture radiologically. The limitations of the studies are the lack of robustness, methodology, study power, and often confounding variables and potential bias.

Augmented reality: Osteoarthritis as a health riftPain is an enormous global public health problem. One of the leading causes of pain is the escalating prevalence of osteoarthritis that is associated with an extremely high economic burden. This burden is largely attributable to the effects of disability, comorbid disease, and the expense of treatment. The occurrence of OA is increasing due to an aging population and obesity. approximately one-third of direct osteoarthritis (OA) expenditures are for pain medications. Another half of the cost is for hospitalizations for arthroplasty.

Emerging technologies can be immersive to solve the burden of this disease. Can augmented reality illustrate the role of new technologies, touring the individual amongst treatment regimens while empowering their decision for engineered fitness and avoid-ance of pain and disability? Can the reality of the pathogenesis of osteoarthritis be altered through genetic engineering? Can behav-ioral modeling through gamification challenge extreme detrimen-tal joint activity? Can we incorporate protective wearable alarms? Can we be a molecular anthropologist and unlock the heritable multi generational forces that shaped the individuals epigenomic information?

Function follows formBiodesign and tissue engineering have lead to the potential of 3-D bioprinting in orthopedics. This innovative technology allows the creation of organized 3-D tissue constructs via a “layer by layer” deposition process. This process also allows the combination of cells and biomaterials in an ordered and predetermined way. Cur-rent research applications are focused on cartilage bioprinting and regeneration. The capability to re-grow living tissue at the core of the complexity remains a major challenge due to the differences in cell types, matrix components, and organization for hyaline carti-lage regeneration.

A more recent promising approach is using mesenchymal stem cells or chondroblasts as the cellular matrix in the scaffold struc-ture. Designing the formed scaffolding with the chondrocytes embedded would change their function and morphology based on the extracellular matrix. Influenced by design, with function following the form.


by Uli Chettipally, MD, MPHTwenty-five years later, after going through a few boom-and-bust cycles, the Bay Area is now bustling with activity. When we moved here, we did not realize how much this area was going to change, with this unexpected growth of the local economy. It be-came a shining example of a place where dreams can come true. With the internet boom, people from all over the country and the world, started coming in for a piece of the action and start-ups started popping up everywhere. We all know of neighbors who suddenly became millionaires. Unicorns were being born and bred here!

In the late 1990s, I was curious enough to get in on the action and worked for a start-up for a year. It was an exhilarating ride. The fact that someone would give you a half million dollars to build on your idea was thrilling. My excitement was short-lived. The market crashed and my one-year sabbatical came to an end and took with it my dream of becoming an entrepreneur. I was lucky enough to be able to do what I did, at a time in history when doing a start-up was relatively easy. I went to the other side and came back alive. My friends get a kick out of listening to the stories of the dot-com roller coaster ride.

Little did I realize how this place and the experiences would change me. When I was growing up, I always wanted to be a sci-entist. I wanted to invent things and discover cures for bad dis-eases. These days, I think and talk about feasibility, market fit, valuation and scalability. I have learned a lot just by living in the Bay Area. Having friends, neighbors and co-workers working, growing, and crashing in this economy has taught me a lot about the business of start-ups and the life of an entrepreneur in gen-

eral. I can understand what drives people to take such huge risks and how they feel when they do not succeed.

I can also understand the disdain some feel when they are not enjoying the benefits of this start-up economy. I have seen first-hand the pain of physicians who, after completing their training, come to the Bay Area for jobs and are not able to afford to buy a house. With the huge student loan debt on one’s back, even rent-ing a place becomes challenging. These are some of the smart-est, most hardworking individuals, who have postponed their gratification for years, in order to have a good life. Becoming a physician is one of the toughest careers one can chose. The years and years of study, the high intensity of focus and the grueling training—only to realize that there is no pot of gold at the end of the rainbow. I have known many who had to leave the Bay Area as it became unaffordable. No wonder more than 50 percent of recent medical graduates in the Bay Area do not go into resi-dency training.

The turmoil continues as healthcare is also going through enor-mous changes. Traditional medical practices cannot survive the onslaught of new technology, new regulation and new business models. We hear more and more about physician burnout, how senior physicians are quitting practice and retiring. How can one cope with this high velocity of change, both outside and inside?

There is hope. We as physicians are ingenious at solving prob-lems. We take care of patients with really complex pathology. We navigate a system that will make any normal person shudder with fear. We have found cures, eradicated diseases and brought hope to the suffering patient. There is a lot of innovation hap-pening in healthcare, particularly in the Bay Area. According to Rock Health, $4.5 billion went into digital health investments

After I completed my residency in Los Angeles, my wife and I were looking for a place to relocate. LA was great but, after living there for five years, we wanted a change of scene. A place with less traffic, better air quality, and cooler weather. That is how we ended up in the San Francisco Bay Area. I took a stable job, we bought a house and started a family, settling in a quiet neighborhood on the Peninsula.

the best place on earth


The best place on EarthContinued from page 10

in 2015 alone. This is on top of $4.3 Billion that was invested in 2014. Nearly half of the startups are in the Bay Area!

We have access to world-class universities and the cream of the talent pool. Biotechnology was born here. Silicon Valley breeds here. Sand Hill Road passes through here. Menlo Park is in our neighborhood. The greatest innovators the world has seen worked in their garages here. America is looking up to us to solve its problems. Can we become the change agents? Can we advocate, advise and administer the change? Can we become the innovators who will drive this change? We are the smartest and the brightest, and we understand the systems—both healthcare and human. We have the opportunity of a lifetime in front of us, right in our own backyard. We truly are living in the best place on Earth. ■

About the author

Uli Chettipally, MD, MPH, is an emergency phy-sician, researcher and innovator at Kaiser Per-manente Medical Center, South San Francisco. He is also co-founder of the Bay Area Chapter of the Society of Physician Entrepreneurs (SoPE), a nonprofit, global biomedical and healthcare innovation and entrepreneurship network.

Next generation orthopedics: BiologicsContinued from page 9

Current challenges

Although research in stem cell applications in orthopedics and cartilage bioprinting is growing exponentially, there is lack of ro-bust and rigorous in vivo studies that can validate the long term capability of cells and material to regenerate.

Osteoarthritis is becoming more recognized as a disease of the subarticular region and as a whole, an organ undergoing fail-ure. Bench to bedside translation of cellular therapies is in its infancy. It represents great hope and a possible paradigm shift in the medical model of arthroplasty to the possibility of upstream measures where painful orthopedic conditions become rare and the socio-ecological forces of burden diminished. ■

About the author

Carri Allen Jones, MD, is currently in practice at Remedy Medical Group in Redwood City, and Peninsula Orthopedic Associates in Daly City. She is also Chief Science Officer at X Tech Ventures. Dr. Jones is board certified in physi-cal medicine & rehabilitation, pain medicine, and sports medicine, and fellowship trained in

tem Cell Regenerative Medicine & Orthobiologics. She has special inter-est in design thinking for the intersection of technology, medicine, and the social sciences.

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SMCMA welcomes new members

James Chen, DO*Allergy

San Mateo

Joshiah Ambrose, MD*Neurology

Redwood City

Melissa Chin, MD*Internal Medicine, Hospital Medicine

Redwood City

Sheila Chan, MD*Neurology

Redwood City

Mindy Kwan*Obstetrics-Gynecology

Redwood City

Yana Kriseman, MD*Neurology

Redwood City

Christine Kwan, MD*Internal Medicine, Hospital Medicine

Redwood City

Alex Keedy, MD*Diagnostic Radiology

SSF

Michael Ho, MD*Cardiovascular Disease

Redwood City

Meredith Kelly, MD*Psychiatry San Mateo

Daniel Hsu, MDNeurological Surgery

Redwood City

Sandeep Gupta, MD*Sports Medicine

Redwood City

Christine Gorey, MD*Obstetrics-Gynecology

Daly City

Olga Hewett, MD*Psychiatry

Redwood City

Yiyi Gu, MD*Internal Medicine, *Rhumatology/SSF

Orin Eddy, MD*Emergency Medicine

Redwood City

Clarissa Doi, MD*Internal Medicine

Redwood City

Roberto Felix, MD*Cardiovascular Disease,

*Internal Medicine Redwood City

Brian Dummett, MD*Internal Medicine,

Hospital Medicine/SSF

Kenny Lai, MD*Diagnostic Radiology

Redwood City


by Ashley Porciuncula

In the digital age we live in, doctor-patient communi-cations don’t end when the patients steps out the door. People are constantly connected, socially and profes-sionally, and the medical field is no exception. Now more than ever, patients are reviewing their doctors online, rating their experiences, and writing personal-ized testimonials about their visits on sites like Yelp, HealthGrades.com, Vitals.com, ZocDoc, and others. The results from a survey conducted by Dimensional Re-search emphasize the value of a good review. 90% of par-ticipants were swayed by positive reviews while 86% were swayed by negative reviews. Just as consumers rely on testimonials when making a purchase, potential clients consider prior patients’ feedback when choosing a doctor.

Because online reviews are playing a bigger role in guiding decisions, doctors need to make that moni-toring and evaluating their online presence a priority in order to man-age and improve their practice’s reputation.

Assess and take control First things first: take stock of your exist-ing Internet presence. Search for the name of your practice as well as the names of your staff and doctors to get a full picture of what people are saying about you. Some of the more popu-lar websites for pre-existing client-made pro-files, comments, and ratings are HealthGrades.com, Vitals.com, RateMDS.com, ZocDoc.com, Yelp, Google Reviews, and Facebook. Remember, it’s not possible to simply opt out of being reviewed. When creating your pro-files, use it as an opportunity to shape the perception of your practice. By uploading brand elements, a description, a wel-come message, and other information about your practice, you are taking the first step to controlling how your practice is viewed.

Once setting up your profiles, examine all client-written re-views and see whether you can make any immediate changes to your practice to improve how it’s managed.

Encourage positive reviews

There are a number of ways to encourage patients to leave positive feedback: add links to your profiles on your prac-

tice’s website and in emails, follow up on appointments with an email asking patients to rate their experiences, post flyers advertising where patients can find your practice’s profiles online, and, of course, provide your best services. Some prac-tices even set up Wi-Fi in the office to make leaving a review easy before or after an appointment.

Day to day, don’t be a stranger to your patients. Engage with them online through social media to show that you pay at-tention to their needs in and out of the office. They will be more likely to write a review if they think you will read and respond to it. Setting up social media profiles may sound un-necessary and time-consuming for some practices, but once they are up and running you will soon see their benefits.

When you do get a positive review, reach out to the patient and thank them privately. A personal touch goes

a long way in the office and online. Do not post your own or make patients write

them for you. Reviews should always be optional. In fact, you can be liable for false reviews.

When bad reviews happenEven if you have an A+ relationship

with your patients, few physicians are exempt from ever receiving a bad review.

If you receive negative feedback, read it and then walk away to reflect for a while—a few hours or even a day. Then you can craft a polite and professional response instead of

an impulsive one. Once you have taken time to write your response, reply to the user direct-

ly through the website, publically when possible, but do not acknowledge the patient is your patient.

When writing a public response, remember that any and all personal patient information must be emitted to comply with HIPAA laws. The CMA legal department recommends the following: “Our practice takes patient concerns seriously. Federal laws preclude us from responding to [a] patient[’s] concerns publicly. If you are our patient, please contact our office directly at [your contact] so we can address your con-cerns confidentially.”

Remember that negative reviews will happen, but your over-all reputation will shine through. As long as you have posi-tive reviews to balance it out, your reputation will not suffer.

ONINE REVIEW SITES How to survive, thrive, and manage your reputation


INDEX OF ADVERTISERS Cooperative of American Physicians ........................................... Inside Back CoverInstitute for Medical Quality .................................................................................6The Magnolia of Millbrae ........................................................Outside Back CoverMedical Insurance Exchange of California (MIEC) .................................................4NORCAL ......................................................................................Inside Front CoverTracy Zweig Associates .......................................................................................14

Charles Eid, MDNovember 28, 2015

Jack Kahoun MDAugust 4, 2015

In Memoriam

RETIREMENTSThe following SMCMA members have recently retired from practice:

Waichi Chan, MD

William Chung, MD

Vincent Dilella, MD

Lisa Dyer, MD

Kim Feigon, MD

Charles Goldberg

Sharyl Hardiman, MD

Joseph Kahn, MD

Manuel Luna, MD

Bohdan Makarewycz, MD

James O’Donnell, MD

George Shorago, MD

Richard Tanner, MD

Burton White, MD

Larry Yeager, MD

Online review sites

Continued from page 13

Remember that negative reviews will happen, but your overall reputation will shine through. As long as you have positive reviews to balance it out, your reputation will not suffer.

Monitor and maintain future reviews Be patient. A good profile requires time. As reviews ac-cumulate, trends will emerge and the average rating will become consistent and more accurate. Dedicate a specific person to regularly monitor all of your profiles. The of-fice manager is usually the best person for this position. When setting up your profiles, you can opt to receive noti-fications when new reviews are added. You can also set up

Google Alerts to send you an email whenever Google Search finds something new about you or your practice.

If your practice is small or there is not someone on your team who can handle the added work, there are profession-al consultants that can set up and monitor your profiles and social media campaigns. These service providers will be able to personalize a system that works for your practice and takes the stress off you and your team.

About the authorAshley Porcincula is a branding, logo, and website designer, blogger, and social media consultant to physician practices. See her work at www.plcpracticewebsites.com. This article previously appeared in the November/December 2015 issue of San Francisco Medicine.

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January 2016

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