Trashed on the Web? Now what?

In the good old days, patients who didn't like their doctors might complain to a small circle of friends, neighbors, or colleagues. Although potentially damaging, such comments had a limited effect. Today, however, thanks to a growing crop of medical Web sites, news groups, forums, and blogs, patient complaints can quickly circulate all over town or around the entire country, available to anyone with Internet access. Whether that's a good thing is a controversial issue, particularly if you're one of the physicians being publicly criticized.

A number of these Web sites, most only a few years old, solicit and publish patient comments or ratings on doctors. They include RateMDs.com, NDDB (short for National Doctor Database), DrScore.com, DoctorScorecard, Book of Doctors, and ConsumerConnection.com. RateMDs boasts ratings for nearly 42,000 doctors, and DrScore claims 20,000.

By publishing patient ratings of physicians' clinical skills, personality, and office staff, the sites claim they're providing a valuable public service for patients who need help in choosing or evaluating a doctor. Consumer advocates agree, pointing out that such information isn't readily available to the public.

While physicians may protest that such comments are unfair, some sites insist that their ratings offer them a reality check on the quality of their care. But not all doctors appreciate that opportunity. As Joanne Wong, co-founder of RateMDs, says, "Judging by the e-mails we receive, doctors are often unhappy with what we are doing. But patients approve almost unanimously, as evidenced by their words, and by our steadily increasing Web site traffic."

The dangers of anonymous ratings

The biggest problem with these online ratings is that they're often based on opinions from only a few patients-anonymous ones at that-or even on just a single visit to a doctor. For example, NDDB lists only two ratings for a family physician in Illinois: one highly favorable, one "awful." As a result, his overall average, based on scores in several different categories, is a mediocre 52 percent. A surgeon in Los Gatos, CA, earned a 50 percent grade based on four reviews, summarized as "highly recommended," "not recommended," "superb," and "yuck." The latter patient apparently gave him a zero in every category. As one physician complained to RateMDs, "At the very least, you should refrain from posting 'ratings' of doctors who have less than, say, five 'ratings' in your system."