As Will Rogers said, “"It takes a lifetime to build a good reputation, but you can lose it in a minute.” But today – with close to 50 physician-rating sites – a reputation can be ruined by a click. Some doctors, who are trying to prevent this from happening are getting a lot of flak for having patients sign what some patients are calling “medical gag orders or contracts.”

Some of the opposition to these contracts is being aired by, and on, rating sites. RateMDs.com and Angie’s List are highlighting doctors who ask their patients to sign these types of forms. RateMDs.com, which has over a million visitors a month, has a "gag contract" wall of shame that Co-Founder John Swapceinski, says was started more than a year ago. There are about 11 names on the list. Angie’s List, which provides ratings for 200,000 healthcare providers, highlights 14 doctors that have asked their patients to sign such a contract. Angie Hicks, co-founder of Angie’s List, views the contracts as an “aggressive way to think about online ratings.”

“The patient-doctor relationship is built on trust,” she said. “You want a doctor that is willing to hear your feedback.”

Angie’s List doesn’t allow consumers to post anonymously and it provides e-mail alerts to physicians whenever a report is made.

“They can respond to any report that is on their profile,” Hicks said, and it will appear right next to the report.
Swapceinski says the contracts appear to come from a common source – Medical Justice Services, Inc. Medical Justice, headquartered in Greensboro, N.C., offers physicians a “mutual agreement,” which provides them with “ a tool to address fictional or slanderous posts” according to its Web site.

Founder and CEO Jeffrey Segal, MD, says the agreement doesn’t limit patients to where they can post, but provides that the copyright gets transferred to the doctors, giving the doctors the tool to take it down if they want.

“As the owner of the copyright they can determine the destiny of the document,” he says.

In the event, that a physician wants to take down a post by his patient, the rating Web site host will receive a notice from the Digital Millennium Copyright Act saying that a customer is hosting copyright infringement material, says Swapceinski.

Then the site will have to file a counter-notice, which he says, RateMDs.com generally does within 24 hours.

Once they do that we are allowed to have the rating visible again, said Swapceinski.

“Sometimes our Web host doesn't make us take the rating down at all since we are fast at filing the counter notice.  But when we have had to take down a rating, the longest it was down was for just a few days before our Web hosting company (theplanet.net) let us put it back up,” he said.

Medical Justice has 25,000 members, and according to Segal, 50 percent are using this tool actively in their practice.

“We’ve really made an evolving effort to balance the rights of patients with the concerns of doctors,” Segal said. “Our honest position is patients deserve good information and talented doctors appreciate constructive feedback. Hopefully the best rating sites will move the ball forward and serve all constituencies. I’m fairly confident this will happen over time.”

He said the organization is speaking to a number of rating sites, in order to help them “get ratings done right” – where useful ratings will be provided for all those that are interested.

Sites that he views as moving in the right direction are Vitals.com, RealSelf.com and DrScore.com.