Most physicians admit that one of their most valuable assets is their reputation. Medical practices are built through word of mouth and trust. However, anonymous Web postings by disgruntled patients—or those posing as patients—can threaten not just the good of a physician's name but also the entire practice. It takes only one negative Internet posting to impact the livelihood of a physician. It's a simple truth that even a frivolous allegation will last a long time. 

The Pew Internet and American Life Project released numbers in 2010 that document just how important the Internet has become as a source of information regarding medicine and physicians:

  • Sixty-one percent of American adults look online for health information.
  • Forty-nine percent of Internet users report researching a specific disease or medical problem on the Internet.
  • Forty-seven percent report seeking information about their physician or other health care professionals from online sources.
  • Finally, 5 percent of e-patients have posted an online review of a doctor.

It is these reviews that form the basis of a physician's reputation online.

In The Future of Reputation, Daniel Solove writes, "Reputations are forged when people make judgments upon the mosaic of information available about us" (New Haven, Conn.: Yale University Press, p. 30). Viewed in this light, ratings, blog postings and Web pages are the online pieces of the reputation mosaic.

Problems with Health Care Rating Sites

There is no question that it is critically important for consumers to have access to accurate information about a doctor's reputation. Choosing your personal physician is an integral right in American health care. However, we at Medical Justice believe the current rating sites have two main problems that need fixing.

Problem 1: Some Rating Sites Are Not Taking Responsibility

The rating sites are immune from any accountability due to an arcane nuance of cyberlaw (Section 230 of the Communication Decency Act), and many rating sites have taken the position that they will not monitor or police any content. We maintain that when it comes to people's reputations and livelihoods, such a stance is irresponsible.
 
Problem 2: Stretching Freedom of Speech

In the United States, the antidote to offensive speech is generally more speech. True freedom of speech carries a great deal of responsibility, including being accountable for what you say. However, physicians are prevented from posting information regarding the patient's medical record to correct any factual inconsistencies. We don't want that to change, as privacy between patient and doctor is critical. But we believe it should go both ways. Anonymity is part and parcel to Internet culture. Unfortunately, anonymity also creates a willingness and boldness to criticize. Online criticism (anonymous or not) that strays over the line into inaccuracy and even libel is indefensible.

This entire issue begs the question: Should there be an industry standard for rating sites? While consumers should be educated on their doctor choices, shouldn't they also be educated on the quality of the ratings they are reading online? We believe the answer is yes.

The doctors we know are genuinely interested in constructive feedback. They want to promote patient safety and better service and, in general, want to improve the experience for the patient. Viable, actionable and statistically significant feedback is beneficial to patients and doctors alike. We are working to ensure that.

Standards for Health Care Rating Sites

Medical Justice has been approached by a number of doctor rating sites asking how they can improve. After careful consideration and consultation with our own and outside experts, Medical Justice has outlined four minimum industry standards we are encouraging health rating sites to follow:

Verify the poster. Offer general verification that the poster is, in fact, a patient of the physician.

Use sample size. One review, whether it's good or bad, is not valuable to the consumer. Rating sites should save reviews in a queue until they have collected a fair sample size, allowing for a balanced representation of the physician.

Require subjective posts only (or offer technical experts). Require that commentary be subjective, not technical in nature. When a patient posts comments regarding such issues as long waiting times, a doctor who uses jargon that's difficult to understand, etc., that's perfectly acceptable feedback that patients and doctors alike should take into consideration. However, when a patient gets into the technical aspects of his or her own specific case and care, it becomes a dangerous scenario that easily can be misunderstood. Each patient's care is unique and has underlying issues that may not be addressed in a simple Web post. That said, we recommend that if a rating site decides to allow reviews that are technical in nature, they should at least have a medical expert on hand to monitor the information for accuracy and fairness.

Use a caveat. Post a caveat on every rating site: "Commentary is not a surrogate for objective measures of quality of care." Health care is incredibly complex. "Dr. Smith" might have several negative reviews, but he also might be the highest trained specialist in the United States, seeing only the worst possible cases and far fewer patients than other physicians… therefore skewing the results and patients' outcomes.

These four standards are clear, concise and simple to execute. If implemented by respectable rating sites across the board, we will drastically change the quality of information consumers have at their disposal. Our mission is to promote a transformational health care system in which patients can make informed decisions using the Internet as one means. The issue of quality health care reviews has been a moving target, but the marketplace has responded with meaningful and substantive options, and the most reputable sites now are working hard to be fair and balanced. Medical Justice is working with a number of rating companies to get ratings done right and implement these standards, including companies like Doctor Score and Real Self.

We challenge readers to join us in pushing these standards through. These changes will benefit both doctors and patients, and the Internet will be an integral part of the long-term solution.

Jeffrey Segal, M.D., J.D., is the founder and chief executive officer of Medical Justice, a membership-based organization in Greensboro, N.C., that offers services to deter frivolous medical-malpractice lawsuits, prevent Internet defamation and provide physicians with strategies for counterclaim prosecution. Dr. Segal is a board-certified neurosurgeon, a fellow of the American College of Surgeons, and a member of the American Association of Neurological Surgeons as well as the North American Spine Society.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.