Based on a PracticeCare® podcast conversation, Barbara Khozam on Asking Patients For Reviews, with Barbara Khozam, patient experience consultant and founder of Barbara Khozam Incorporated.
Why don’t happy patients leave reviews on their own?
They don’t think to. When a patient has a good experience, the expectation going in was that you’d do a good job — and you did. Nothing unusual happened. There’s no trigger to go write about it.
The unhappy patients are a different story. They find the time. And the platforms — Google, Yelp, Facebook — make it very hard for you to get those reviews removed, especially in healthcare where HIPAA limits what you can even say in response.
The math works against you by default. The only way to change it is to ask.
What do most practices’ reviews actually look like before they start working on this?
Mostly ones and fives, and not many of either. Nobody leaves a three-star review — that takes more thought than people are willing to put in. You get the extremes: the angry patient who made time, and the occasional raving fan.
Over 80% of patient comments are positive. The problem isn’t what patients think of you. It’s that you’re not asking them to say it anywhere it counts.
How do you show a practice owner that their reviews are a problem?
Show them the data the way a new patient would see it. Barbara does what she calls a social media analysis — she searches the specialty and city, looks at the results, and shows the client exactly where they land and what people are saying.
Seeing your own profile at 11 o’clock at night — fewer reviews than the practice down the street, and older ones — lands differently than being told about it.
What’s the most common mistake practices make when asking for reviews?
Making it too hard. If you’re asking a patient to check their email, log into Google, find your listing, and figure out the review form — they’re not going to do it. Patients can barely manage the patient portal.
The ask has to be frictionless. A text with a direct link right after the visit, when the experience is fresh, is far more likely to work than any multi-step process.
Timing matters too. One client was sending review requests right after consultations — before any real work had been done. A patient actually told them: can I wait until the work is finished? They changed the timing and results improved.
Should the doctor be the one asking, or can staff handle it?
Both, ideally. When the provider asks, it carries more weight. The doctor said it, so the patient registers it. The front desk can follow up as a reminder — and it lands differently than a cold text from the office.
Most doctors resist this. It feels pushy. But the framing matters. “Please give us five stars” is weird. “We’d really appreciate your feedback — it helps us make sure we’re taking care of you the way you want” is not.
How many times do you need to ask before patients follow through?
More than once. Looking at client data, 80 to 90% of reviews come in on the second or third ask. People are busy and well-intentioned — they miss the first request, or they mean to get to it and don’t.
This isn’t unique to reviews. Nobody does much of anything the first time you ask them. Build the follow-up into your process and expect it to take a couple of nudges.
Do gift cards or incentives help get more reviews?
Neither Barbara nor Carl recommends them. When you attach a reward to a review, it feels transactional — like you’re buying the rating. Barbara’s tire shop offered her a discount for a 10-star review and she found it off-putting.
More to the point: if you’re earning the five stars, you don’t need to pay for them.
Does it matter how many one-star reviews you have, or just your overall rating?
The volume of negatives matters more than the rating alone. Barbara worked with a client who had a five, a four, and a one — and Google showed a two-star overall. The one carried more weight than the math suggested.
The fix is volume. You can’t delete the bad reviews, but you can bury them. When a handful of negatives is surrounded by 40 or 50 positives, readers stop wondering what’s wrong with your practice and start wondering what’s wrong with that one person.
Recency matters too. A string of glowing reviews from four years ago with nothing recent raises its own red flag. People notice.
Can positive reviews be used for anything beyond marketing?
Yes — and most practices miss this. When a review calls out a specific staff member by name, share it with the team. Positive patient comments are a real morale driver. When the front desk person finds out a patient wrote about how compassionate she was, that means something to her and to everyone around her.
Reviews are usually treated as a marketing asset. They’re also feedback you can act on, and a way to keep good people engaged.
Can you reply to negative reviews given HIPAA?
This is genuinely unsettled. Healthcare attorneys don’t agree on it. The most conservative position: don’t reply at all, because any response acknowledges a doctor-patient relationship — protected information. Even “we’re sorry your appointment didn’t go well” confirms there was an appointment, and only patients have appointments.
The less conservative position: you can reply, but stay completely generic. Something like “We’d like to understand your comments better — please contact us at [number].” No acknowledgment of any specific experience, no apology for something that implies treatment.
Get advice from a healthcare attorney in your state before replying to anything. And be careful about pulling reviews onto your website — promoting a patient’s words can raise its own compliance questions depending on where you practice.
Where does a practice start if they want to get serious about reviews right now?
Two things, in order. First, make sure the experience deserves the review. The Net Promoter Score question — how likely are you to recommend us, on a scale of 1 to 10, and why — tells you more about actual patient loyalty than any satisfaction survey. If the score is low, start there.
Then build the ask into your exit process. Add it to the patient discharge checklist as the last step. Text a direct link right after the visit. Put a QR code in the exam room. Ask more than once. Use a review service that makes it easy — just confirm it’s HIPAA compliant, because a patient’s name combined with their contact information can qualify as protected health information.
It doesn’t have to be complicated or expensive. It has to be consistent.
A final note
I’ve had clients with one review — a one-star — and they’d been in practice for 15 years. That’s not an accurate picture of who they are. But it’s the only picture a new patient sees. The lesson here isn’t really about reviews. It’s that the experience patients have inside your walls is invisible to the outside world unless you create a habit of bringing it out. Whatever you own and wherever you practice, that habit is worth building.