If you type the terms "San Francisco" and "plastic surgery" into the Google search engine — as countless people have —the first business that comes up is the San Francisco Plastic Surgery & Laser Center. Beneath the name of the business sits a short review: "Dr. Rajagopal is an excellent plastic surgeon. She is caring and experienced." There's no source name attached.
A broader search for Rajagopal reveals countless positive reviews all over the Internet. She's apparently a "knowledgeable," "truely gifted surgeon" with an "artistic eye" and access to "cutting edge" technology. On Citysearch, 30 out of her 32 reviewers have given her five stars, and numerous patients say there aren't enough stars in the rating system for a doctor of this caliber. She comes in on Sundays. She gives flowers to her patients at the end of their surgeries.
"Once you meet Dr. Usha Rajagopal, you'd wish she was your mother!" Rosie W. of San Francisco wrote in a Yelp review of the doctor. According to a review on one surgery forum: "if any of you are thinking of going to Dr. Rajagopal, go right ahead. She is top notch, and really knows what she is doing."
There's just one big problem with all of these fantastic reviews directing readers to Rajagopal for medical procedures. It's impossible to know which of them — if any — were written by actual patients. In fact, some of the reviews appear to be classic cases of what's commonly referred to as astroturfing — ringing endorsements that look like a groundswell of support when in fact they are being paid for. The practice is named after Astroturf — synthetic carpeting designed to look like real grass.
While fake reviews intended to lure business certainly aren't exclusive to the medical industry, they seem considerably more insidious when the stakes can be life and death. No matter what the industry, publicly misrepresenting yourself in an attempt to bring in business is illegal under the Business and Professions Code in California.
But ever since doctor review websites sprang up in 2004, moderators have been dealing with fraudulent postings. The so-called reviewers sometimes make suspicious claims or over-the-top recommendations that seem unlikely to have come from real patients. Some reviews can be traced back to IP addresses in doctors' offices.
John Swapceinski, cofounder of RateMDs, says he's seen hundreds of incidences of what appear to be medical astroturfing. Because of the anonymity of the Internet, it is nearly impossible to tell who sat at the computer to post the misleading review. Maybe it was the doctor. Maybe it was the doctor's mother, son, friend, or all of them. Or maybe it was someone paid by the doctor.
In the case of Rajagopal, suspicions have been raised about a marketing professional hired to augment the surgery center's business by increasing its online presence. The marketing woman did a fantastic job of getting Rajagopal to the top of the Google rankings, but in doing so, she left behind a trail of evidence suggesting falsified patient reviews. According to a video Rajagopal made praising the marketing work, the woman's efforts may have steered numerous hopeful patients to Rajagopal's website and then into her office.
Some of Rajagopal's patients disagree about her purported capabilities, as does the Medical Board of California. Documents obtained from the board and San Francisco Superior Court show that some patients — who have not posted their stories in the comments sections — have been hurt by Rajagopal. In one instance, a 35-year-old woman who was undergoing a fairly routine plastic surgery didn't get the chance to tell anyone about the quality of the doctor's care. Due to what the medical board has called Rajagopal's "gross negligence," the woman sustained a serious brain injury. She slipped into a coma, and never woke up.
It used to be that people found the goods and services they required through the Yellow Pages and recommendations from friends. Nowadays, they increasingly turn to the Internet for suggestions, even when it comes to something as serious as medical care. To find a local doctor, many people do Google searches, then look over the reviews that come up on top. Websites like RateMDs, Book of Doctors, Vitals, and HealthGrades have become popular. Yelp has also become a destination for those looking to gauge the popular opinion of local doctors.
"When shopping for a product or service, 73 percent of consumers use search engines to find local businesses from which to buy," states the website of SF Web Consulting, the business Rajagopal hired. Pictured on that site, the red-headed owner and self-proclaimed SEO (search engine optimization) expert Tracy Rosecrans wears a bright smile.
"The Google algorithm? No mystery to us," her website brags. "At SF Web Consulting, we know what it takes to be #1 ... we'll get you to the top for the keyword search of your choice. Watch your brand new site take its place at the top of search results, and let the leads pour in."
Understanding Rajagopal's online ascent first requires a visit to Rosecrans' YouTube page. That account, which Rosecrans admitted to creating under the screen name "trosecra," establishes that Rajagopal is her client. A video posted on the trosecra account features Rajagopal describing how Rosecrans helped her business. "I'm Dr. Usha Rajagopal from SF Plastic Surgery and Laser Center," she says in the video. "It's my pleasure to recommend Tracy from SF Web consulting. She has helped us tremendously."
In the video, Rajagopal goes on to explain that over the last two years, her web presence has "skyrocketed,"which has brought in more business. "Most patients come from searching on the Internet or through word of mouth," she says.
To get some idea of what Rosecrans was doing to elevate Rajagopal's web presence, search Google for "trosecra" and "Rajagopal." Of the 15 or so hits that come up, many contain wildly positive reviews of the doctor posted by someone with the screen name "trosecra" on various websites. In some cases, trosecra claims to be a woman who had breast implants. In others, trosecra posts as a man who had surgery to reduce the size of his breasts.