The course of the doctor-patient relationship does not always run smoothly,
but it runs a lot more publicly now than in the days before the Internet.
Web sites where patients post candid reports of their experiences with
doctors are proliferating. Their goal is to reveal peoples' opinions of
doctors' personalities or competence and inform prospective patients trying to
choose a physician. Many remarks are positive. One site owner says that's the
case for 70 percent of the comments posted on his site.
However, the negative comments seem to draw greater attention, anxiety, and
Once upon a time, a patient with a complaint might write to the local
medical society or state licensing board or call a malpractice lawyer. There
were high thresholds for those steps, though. An offense had to be
sufficiently egregious to warrant consideration for disciplinary action or
The new ratings Web sites present a much lower bar for patients, who need
only a computer and a desire to let the world know what they think of their
doctors (M.D.s Not Boarding E-Mail Bandwagon discusses another way patients
communicate with doctors).
Skimming through half a dozen such sites suggests that patients who
complain do so less about botched appendectomies than about customer-service
issues. Complaints about doctors' rudeness, patronizing attitudes, too-brief
office visits, and brusque office staff abound. That may leave psychiatrists
particularly vulnerable, since their specialty includes a lot of
"Psychiatric patients with severe personality or psychotic disorders
may not be the most objective reporters, but even the best psychiatrists have
patients who leave for arbitrary reasons," said John Luo, M.D., an
associate clinical professor of psychiatry and director of
consultation-liaison psychiatry at UCLA Medical Center, who writes about
applying technology to psychiatric practice for
The Web comments, no matter their degree of truth, hardly represent a valid
survey of either patients or physicians. Many sites have long lists of
doctors, but relatively few that have been rated and fewer still with more
than one comment. Searching one site under the Baltimore ZIP code that
includes Johns Hopkins, for instance, led to a list of 100 psychiatrists, but
only four reviews—all positive.
"I'd like to see a more representative sample, too," said John
Swapceinski, co-founder of
which he said receives about 600 to 800 new reports each weekday. "We
can't rely on the medical profession to give patients a venue for their views,
so we display what we have now. There's an unmet need for this
Epidemiology aside, unfriendly comments never make enjoyable reading for
their targets, as a few examples suggest.
"You will leave feeling no better but maybe worse because he is not
empathic," wrote one patient of a psychiatrist—thoughtfully
adding: "His receptionist is nice."
Some postings contradict each other. One patient complains that her
psychiatrist is "austere" and "unfriendly," while
another says the same doctor is "compassionate, caring, kind, effective,
Yet another patient posted negative comments about a third psychiatrist.
Contacted by Psychiatric News, this psychiatrist (who requested
anonymity) said he could guess who the patient might be, although he had not
seen or read the posting himself. He believed the comments came after he
confronted certain manipulative behaviors by the patient.
This psychiatrist regretted that a patient felt bad about the care he
provided, but felt the public comments have not harmed his practice. He was
equally philosophical about his options to respond.
"There's nothing I can do about it," he said. "Suing is
just as hostile and would probably only make things worse."
In fact, several roadblocks probably prevent the emotional satisfaction of
knocking down one's critics in court, said Nancy Wheeler, J.D., a Maryland
attorney in private practice and coordinator of APA's legal information and
consultation plan. That's what she told another APA member who thought that a
troubled expatient was writing scurrilous things about him on several Web
sites, possibly leading to a loss of some expected referrals.
"For one thing, most of these postings use pseudonyms, so it's hard
to prove who's doing it," said Wheeler, recalling the old line about how"
on the Internet, no one knows you're a dog."
Furthermore, the law on defamation, libel, and slander makes clear that"
truth is a defense," said Wheeler. Statements that can be refuted
by the public record—like court judgments or licensing board
actions—are one thing. Opinions are something else and give the writer
much more leeway under the First Amendment.
In addition, the Communications Act of 1996 states that Internet service
providers cannot be sued for any allegedly defamatory statements. The Web
sites all make a point of citing this shield, but many also have systems for
reviewing remarks before they are posted.
"We employ human reviewers to read all ratings as they come in and
use guidelines to avoid libel or simply far-fetched statements," said
Swapceinski. His site also uses a "red-flag" system that allows
any reader—presumably including the physician in question—to send
the comment back to the reviewers for another look.
"Maybe 5 percent get flagged, and of those, 10 or 20 percent are
removed or edited," he said. "We also use a computer program that
looks at the sender's address and other information to remove multiple ratings
from the same source."
The Web sites may serve a purpose if they stimulate greater discussion of
patient satisfaction among doctors and the people they treat, suggested the
psychiatrist quoted above. "You can get real feedback from
patients," he said.
Swapceinski agreed: "If doctors polled their patients and posted the
results online, they could put me out of business."
which began as a hospital rating system, doesn't use written patient comments
for physicians and has a very different business model. The site contains a
database of all 650,000 physicians practicing in the United States, with
information on their training and board status and any state or federal
disciplinary actions against them. Visitors to the site fill out a"
patient experience survey" covering convenience, knowledge and
skill, shared decision making and communication, outcomes, and whether the
patient is likely to recommend the doctor to others. The responses are
aggregated into ratings, but specific comments aren't posted. Thus far, they
have received about 150,000 survey responses.
Doctors can't opt out or change their survey reports but can add things
like subspecialties or research publications to their profile. Unlike other
charges visitors $29.95 to download a doctor's profile. Physicians can also
pay a "minimal" sum to
which it would not disclose to Psychiatric News, to make their
profiles available free to site visitors, presumably increasing the number of
potential patients who see the profile, said Scott Shapiro, vice president for
corporate communications and marketing for
in an interview.
Physicians may simply have to adjust to a world in which anyone can make
any statement available for anyone to see, said Luo. "Part of the
problem is that there are too many sites, so it's hard to tell what's valid or
useful. It's like trying to pick out which car dealership to visit."
If it is any comfort, physicians are not the only ones dealing with
publicly posted opinions of their work. Swapceinski also started
group of Web sites that rates 13 categories of products or services from
veterinarians to child-care providers to car mechanics to prescription
drugs—and lawyers, who, as a group, might be even less happy about their
reviews than doctors.
The following are addresses of some of the Web sites that post ratings of