My Web rating: Oh no!

Every Sunday morning I relish three things: an extra hour of sleep, my morning coffee, and reading the newspaper's food section. I savor restaurant reviews-cheering inwardly at the freshness-with-subtle-citrus triumphs, and cringing at the scathing comments of the critic who was served mediocre blandness on a cold, chipped plate.

I never really thought about how individual chefs might respond to a restaurant critic's assessment-until one afternoon I found myself identifying with those chefs. The day had gone much the same as all others: kids to school, hospital rounds, pick up my preschooler in time for lunch, head off to the office for evening hours, see patients.

Two years before, I had left a group to start a solo internal medicine practice alongside my husband, a pediatrician. Sam Johnson (not his real name), whom I had met in my last practice, was one of 19 new patients I saw that week. After exchanging pleasantries, he told me that he had come to me because he was tired of my ex-partners' "unresponsiveness." Unsure of my new address, he had used a popular Internet search engine that supplied him with directions to my office-and more. He produced a sheet of paper and said, "If I didn't know you, I might have canceled my appointment."

My heart pounded as I glanced at the printed Web page: " . . . the worst doctor I have ever seen . . . grouchy and unsympathetic . . . made fun of a retarded child in the waiting room as I listened in horror." I had to will the tears from my eyes. With my best "whatever" face, I talked with Sam, examined him, and sent him on his way.

Later that night, against my better judgment, I searched the Web site. The rating system was simple. Anyone with an e-mail address could register (for free), click on a doctor's name, and rate that doctor on a scale of 1 to 5 in three categories: punctuality, helpfulness, and knowledge. The average score was posted, along with a happy face if the doctor got a good rating and a sad face if he didn't. Patients were also invited to post comments about physicians.

In addition to the review that had been brought to my attention, there were three others. Those patients had given me 5s across the board, accompanied by glowing commentary about my attentiveness, competence, and demeanor. The last reviewer, in addition to describing me in derisive terms, had given me the lowest rating in all three categories.

I tried to remember if someone recently had left the office angry. I had dismissed several patients from my practice for drug-seeking behavior. Perhaps one of them was trying to get even. Additionally, I had been quite tired lately. Did I let it show? Was I really "grouchy and unsympathetic"? I realized, as I sat at the computer, that it didn't really matter if I was any of those things; what mattered was the patient's perception of our interaction.

Then a chilling realization set in. What if the writer of the negative review wasn't even a patient? We had recently been involved in back-to-back breach of contract lawsuits with contractors we had hired to do work on our home. Both knew we were physicians. The way this Web site was set up, anyone could write damaging comments.

Edited but not deleted

I e-mailed the administrators of the Web site and used the words "slanderous" and "malicious." They promptly edited the review but let the low scores stand.

Seemingly against my will, I began checking that Web site almost daily. In addition to looking at what people were saying about me, I read patients' assessments of my consultants. What did patients really think of the cardiologist I referred to? What about the doctor down the road who was my direct competition? How about the "world-class" doctors at university hospitals?