Patients are likely to seek health care information wherever they can these days, from friends, other patients and, increasingly, the Internet. They may also have the urge to add their own voices to the mix.
But information on the Internet is still information on the Internet, which means it is of uncertain credibility. And inaccurate physician ratings have the power to do a lot of damage when patients forget to take them with a grain of salt.
A company called Medical Justice from Greensboro, N.C., has been attempting to remedy what it calls misinformation by heading off would-be posters with a waiver, to be signed pre-treatment, in which patients promise not to contribute to online rating sites about their doctor.
But the idea of signing such a waiver does not sit well with some patients.
"I would not use a doctor that pushed that in any way," said Danielle Panetta, 34, who has type-1 diabetes and visits specialists monthly to care for her disease. "It's not legally binding as far as I'm concerned."
Restricting online activity in any way may be a losing battle.
According to a study from the Pew Internet and American Life Project, 74 percent of adults in the United States go online and, of those, 80 percent look for health information online. Another study from 2006 showed that 29 percent of Internet users had looked online for information about a particular doctor or hospital.
"If there are doctors who are nervous, they should be nervous," said Susannah Fox, author of the Pew studies. "This is a tried-and-true activity online, researching a product or service before you buy it."
But Dr. Jeffrey Segal, CEO and founder of Medical Justice, says the waiver his company developed is not trying to restrict information but that the company is more interested in quality control.
"There is a disconnect between what we expect of health care in general and the system out there asking patients to rate their doctors," Segal said, pointing out that the average doctor, who may see thousands of patients each year, may have only five ratings on a site.
"Patients are granted additional privacy protection above and beyond that mandated by law. In return, patients are asked not to post on online rating sites without the doctor's permission," Segal said. "It's been characterized incorrectly as a gag [order]."
Segal said that the "additional privacy protection" includes physicians refraining from giving patient information to companies that may wish to market to people with specific health problems.
Still, attempts at quality control on the Internet appear to be dubious, at best.
Dave deBronkart, 59, who blogs at The New Life of e-Patient Dave, pointed out that his own excellent physician could get a handful of nasty reviews online.
"That's just the nature of democracy," deBronkart said. "I do think it's hopeless to try to hold back the tide. And it's going to be bumpy along the way but things will improve. ... When things are transparent, things improve eventually."
And patients are looking for transparency in their health care information.
Jim Conway, senior vice president at the Institute for Healthcare Improvement in Cambridge, Mass., said the state of Massachusetts has been conducting consumer research in the past six months about what people want to know in terms of healthcare. One of the top three things users want to know is what other people think of their hospitals and their doctors.
"The perspective of the consumer is unbelievably important," Conway said. "In helping people make decisions around where they're going to seek care."
But patients know that consumer rating sites, particularly anonymous, unmonitored ones, are not the be-all and end-all source for physician information.
"It's a good thing for patients to have access to but you've got to watch out," said Panetta, an attorney in Boston, Mass., who is also actively involved in diabetes patient advocacy. "The people that are more likely to use it are going to be people who have an axe to grind, and it may be because they're crazy."
Segal pointed out that defamers could also be competitors, former employees or ex-significant others. Nor is there a way to monitor undeserved praise.
But a waiver such as the one Medical Justice proposes doctors use may not be the solution.
"I don't see how that kind of contract could actually protect the physician in any other specific way than they would have without the contract," Panetta said.
As with other printed defamatory comments, Panetta said, the doctor could ask the host site to remove the comments and, if they did not, he or she could sue, which may not be effective.
"I think it doesn't work for any of the parties," Panetta said. "You can't contract away liability."
But the wrong kind of contract can set the tone for the important doctor-patient relationship.
"Great patient care is the result of a partnership and trust-relationship between the patient and the people taking care of the patient," Conway said. "I worry that the introduction of something like this could begin to break down trust."
Segal believes the waiver, if presented correctly, can address the trust issue head on while acknowledging the patient's need to voice opinions about his or her experience.
"We don't want to repackage the problem because we know the inevitability of useful Internet rating sites," Segal said. "Try and view the program as a way to move the process forward where patients and doctors share in the solution rather than engaging in adversarial relationships."
Preventing Internet users from using the Internet as they like is a tall order, doubly so when it comes to healthcare where seeking out others' opinions is ingrained.
Blogger deBronkart knows exactly what he would do if his doctor confronted him with a waiver asking him not to post comments about him online.
"I would decline," he said. "But I would look him right in the eye and say, 'You don't need to worry about me shafting you.'"