Rating Doctors Online

Dr. Nonnie Estella was less than thrilled as she scanned the comments of 22 patients who had, anonymously, rated her performance online, on a website she had never heard of.

"This is a scary concept," Estella said, eyeing the "lovely little smiley faces" that signified a positive comment and frowning icons pinpointing a critical one.

The Lowell ob/gyn wasn't familiar with the growing phenomenon of consumer websites that allow patients to opine about their doctors just as they would a new coffeemaker. "She is the most compationate (sic) doctor I have ever had," raved one patient on the site, called RateMDs.com. "She has no bedside manner what-so-ever," carped another.

"I'm either a monster or not a bad person," Estella said. "That doesn't seem like a way I'd want to choose a doctor for my family."

Consumers may beg to differ. Americans' penchant for rating everything from tech gadgets to restaurants to professional services online - sometimes in novella-length missives - is extending to health care professionals, and entrepreneurs nationwide are cashing in on the trend.

This spring, Angie's List, a national consumer rating service once focused on home improvement, started offering ratings of doctors, hospitals, and other health care providers. Since March, the Indianapolis-based, members-only service has logged between 8,000 and 10,000 health ratings, 250 of them in the Boston area, said founder Angie Hicks.

Restaurant rating empire Zagat in January teamed up with health benefits conglomerate Wellpoint to score doctors on criteria including availability and communication. Other health rating ventures include Vitals.com and DrScore.com, with the oldest believed to be RateMDs.com.

"It's been one of the biggest requests from consumers, to expand into medical services," Hicks said. "They're taking much more control over their decisions than they were 10 years ago. I could envision that someday the medical ratings could eclipse the others - it's one thing to find a good roofer, but finding a great pediatrician or dentist is even more valuable for consumers."

Angie's List, like other sites, does not independently check a doctor's credentials but provides a link to the local medical board so consumers can check.

Angie's List and RateMDs.com both employ human reviewers to scrutinize comments. RateMDs.com removes ratings considered not credible or potentially libelous, such as saying a doctor is a drunk or has violated the law.

"There's an information gap for consumers, and these sites are filling it - partly," said Dr. Robert Wachter, a nationally known patient safety specialist based at the University of California-San Francisco. Patients want to know more about their doctor's personality, bedside manner, and timeliness, and whether the office runs efficiently, he said.

But, he cautions, these sites pick up "the poles - people who are ecstatic about their experience or really [ticked off]. They don't pick up the silent majority."

Plastic surgeons, dermatologists and dentists, whose practices involve elective care and are built by marketing and word of mouth, are more likely to pay attention to these rating sites to protect their reputations. In contrast, specialists such as neurosurgeons or cardiologists, whose patients typically are referred by other physicians, may care far less, Wachter said.

A physician's technical competence - diagnostic ability, surgical skills - is far more difficult for patients and even medical experts to evaluate than, say, bedside manner, Wachter said. "Our ability to measure quality is still in its infancy," Wachter added. Until then, he said, these sites will "capture only a small sliver of what people are looking for when they're trying to choose a doctor."

Then, too, some physicians are trying to affect their scores by asking patients to rate them positively, said John Swapceinski, founder of RateMDs.com, an offshoot of a university professor rating website he started while a college student.

The three-year-old site now includes about 500,000 ratings of 139,000 doctors. Both human reviewers and computer software check for anomalies suggesting that a doctor or patient rater is trying to spam the site, Swapceinski said. He stands firm in the face of some doctors' complaints that they are being treated unfairly and seems unconcerned about a $12 million lawsuit filed by a Canadian urologist who claimed the site published defamatory comments about him.

From the consumer's standpoint, online ratings appeal when recommendations from friends, family or other physicians aren't forthcoming. In some cases, they can be surprisingly prescient.

In one case on RateMds.com, a Hyannis doctor had received numerous negative reviews a year before his license was suspended by the Massachusetts Board of Registration in Medicine. Angry consumers later linked to the document suspending his license and news stories detailing allegations of fraud and poor patient care.

"I think other people's opinions can give you a strong sense of what to expect," said Nancy McGrath, a Framingham software engineer in her mid-50s who has rated several of her doctors, all positively, on Angie's List. "I don't feel any differently about doctor's ratings than if I were looking for a 40-inch television."