Why ratings websites suck

Who judges the judges, watches the watchers, curates the curators? This is not just a question for today's content entrepreneurs and their publishers, who are always looking for the cheapest way to aggregate and profit off of usable content. There are so many different sources that sort the stuff we read now that you can't really participate in your community unless you use an app or website that functions as a streamliners of streamliners. Since we as internet users don't trust people who don't sound like we do, with the decades-long collapse of faith in political and mediating cultural institutions, the ease with which we simply fall into our reading habits by default almost ensures that there will never again be a single arbiter of what matters, what's important, what's true, or what you should read. For politics, I find sound the arguments that say the disembodied sources of authority are ultimately empowering, as well as arguments that say it has created a legion of super-narcissists incapable of forming political or even social attachments with people who are different.

Outside of politics, there's potential for actual harm.

Take the sudden explosion of medical rating websites. Combine that with an elective surgical procedure that, while generally safe, can be catastrophic in the hands of an inexperienced surgeon. Add to that legitimate personal vanity and ego, and — well, welcome to Beverly Hills, where, if plastic surgery were ever banned, the tax base would shrivel like an old man's scrotum. (Although, apparently, there is a shot for that.) A tummy tuck, or an abdominoplasty, is one of the more common aesthetic surgeries performed in a two mile radius of my home. It helps women after pregnancies, when rapid expansion and contraction of skin, along with the bloating and shrinking of fat cells, produces especially difficult-to-lose flab or simply doesn't look good. (Anyone, male or female, who has lost a lot of weight might have the same problem). High demand changes the course of surgical procedures in several ways; for one thing, innovators find ways to make the procedure easier and safer. And you'd better bet that plenty of non-plastic-surgeons figure out they can make money by learning the operation on the side. It becomes cheaper and generally safer, but inequalities in the quality of the procedures, in outcomes, creeps into the system.

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Cosmetic surgery remains somewhat taboo, so a lot of people might begin their search for a doctor on the Internet and not rely on word of mouth. If you type in "Tummy Tuck" and "Beverly Hills," you'll find surgeons tripping over themselves to cut into you. Many offer Christmas specials. (Half off and we'll throw in smart lipo of your chin!). Most offer free consultations. The marketing is ingenious. But hey, we all know that some doctors are good and some aren't. So, assuming a prospective patient is mindful, he or she will do some research. Google tries to help, sort of. Like every content aggregator, it has introduced its own rating system for services. Not only can you give those truffles four stars, but if you like the way your body looks after major surgery, you can appropriately reward the able bones-saw. But Yelp also has its own ratings. And then the medical review websites, several of them, have their own ratings. So do specialist sites, like realself.com. I noticed that one doctor who has practiced for years in Beverly Hills received 4.5 out of 5 stars on Google, but 3.6 out of 5 on Yelp. The difference: The Yelp review included several incredibly scary narratives from a woman who claims that the doctor scarred her for life, literally laughed at her as she screamed out in pain on the operating table, and taunted her about her claim of medical malpractice. One star! But right above and below, other reviews could not be more different. This same butcher is apparently also the "nicest surgeon" one reviewer has ever met, with a gentle and patient bedside manner who was very attentive to her (minor) pain during the same procedure, and who went out of his way to discourage her from getting post-tummy tuck liposuction because the results would be too minor to notice. Another woman noted how this doctor gave her his cell phone number in case of an emergency, and when she thought she had a post-surgical infection, he recommended that she go to an emergency room and then met her there.

Yelp and Google vet reviews, using computers and humans, but it's not possible for every review to get the attention of a curator (this is the fourth meta-layer of curation, in case you're wondering), and I can think of several ways that enterprising doctors can game the system if they know how the Internet works and can intuit what Yelp's programmers might find suspicious. There are also reputation management companies that are worth the cost if they can erase a bad experience off of the web. I don't know if the bad review better reflects the doctor than the good ones. For all I know, the surgeon might be a heroin addict who is prone to fits of narcissistic fury. This is Los Angeles, after-all. I do know that, after two hours spent trying to make any sense of the ratings systems and trying to correlate between them, I gave up. There are too many curators and too much conflicting information. Google also makes things more confusing by allowing surgeons to write "articles" that Google presents in the same style as genuine news articles. But, of course, they aren't "articles" — they are brochures for the surgeon's practice.

So if I you want a tummy tuck in Los Angeles, you might as well use a phone book. The ratings, the curators, the supposedly neutral procedures that help us sort information, are as reliable as anti-corruption police in Russia.