What makes for a good plastic surgery experience? Is it a good surgeon? A pristine office? A welcoming staff? If online reviews are any indication, it’s a combination of the three, and maybe more. But if a practice fails to perform in any one of these areas, it can mean an automatic one-star review, regardless of how the practice performs in the other two areas.

“Patients are looking for a five-star experience from start to finish,” says Dr. Bruce Chau, a plastic surgeon from Berkeley, Michigan. “Drop the ball with a bad initial phone call, and you can get a bad review before the patient ever books a consultation.”

At least that’s what the findings of a new study by the Northwestern University Feinberg School of Medicine say. In the study, researchers analyzed more than 1,000 patient reviews on Yelp, RealSelf and Google and found that while patients scored surgeons and practices highest for a positive overall surgical outcome, things like the kindness and personality of the doctor, the condition of the facility, and, yes, even the behavior of the office staff – from the very first phone call – also make a difference.

“It makes sense,” says Chau. “Would you want to spend thousands of dollars at a practice where you were treated rudely? Would you feel safe trusting them with your health care when you can’t even book an appointment without getting an attitude? Probably not.”

In fact, even patients who had not-so-perfect recoveries were still likely to leave a good review if all other factors were positive.

“If a patient had complications they usually still left a good review if it was handled well and if the rest of their experience was a good one. People understand that there are some things that are out of their surgeon’s control,” says Chau.

Authors of the study highlight that ultimately it is the same foundation of any good relationship – whether it be between spouses, business partners or even surgeons – that makes a positive patient experience.

“Communication is key,” says Chau. “From the very first phone call to the final post-op visit, the patient needs to feel safe and informed every step of the way, and the only way to do that is with effective communication.”