Online doctor ratings have their flaws

I recently searched several doctor rating Web sites to see whether other people like my OB-GYN as much as I do.

On Angie's List (angieslist.com), better known for rating plumbers and handymen, I paid a monthly fee of $8.75 to find out she had received an "A."

Still, the grade was based on just two reports. So I tried a free service, vitals.com. There, three people thought she was great. And on ratemds.com, which is also free, she was given a smiley face and a "good" quality rating (instead of average or poor) based on five anonymous reviews.

Consumers say they want online physician "report cards" because doctors are at the heart of critical health care decisions. But while the sites confirmed my experience, none had enough reader feedback and reliable data to make them very useful.

"The main problem is that the information out there isn't very good yet," said economist Ruth Given, who reviewed 33 physician rating Web sites for a report published on The Health Care Blog (thehealthcareblog.com). "Even the ones that have good models don't have enough information."

Most sites offer both objective data and subjective opinions, or patient rants and raves.

Objective data is expensive and limited; it might tell you whether a doctor is board certified or has been disciplined. But it still won't give you a doctor's Caesarean section rate or figures on how often he or she has performed a colonoscopy.

Subjective information on user reviews is a little like gossip. On Angie's List, I read about a genetic counselor (whom I've actually seen) who allegedly pushed a woman to terminate a fetus. Another person wrote that her doctor was "friendly, but condescending, and ultimately not helpful," as she tried to make a major decision about treatment for fibroids.

A patient's experience can be biased and manipulated - how do you know whether the opinions about a physician even come from that doctor's patient? - but Given said a bigger problem is that there's not enough information posted yet. Ratemds.com, for, example, has ratings on 12 percent of U.S. doctors, Given said. In Canada, the site has information on nearly 60 percent of physicians. Moreover, even if the sites start to get more feedback, it's not necessarily representative.

With so many kinks to work out, some doctors say the sites are unfair. In fact, some have started asking patients to sign agreements not to post negative comments online. One nasty comment left by a patient who wanted a drug that wasn't medically necessary, for example, could damage a reputation or career.

Then there's my doctor's biggest gripe: "There's absolutely no objective way to make such a ranking," she told me in an e-mail.

Still, rating goods and services _ whether it's cars or college professors _ is a fundamental part of consumerism. Patients are now health care shoppers who want partnerships, transparency and some way to find a quality doctor. When health benefits provider WellPoint teamed with Zagat Survey earlier this year to allow members to evaluate their physicians as if they were restaurants or travel destinations, a medical ethicist called online ratings "a recipe for disaster." But even if they are, "they're out there and not going away," said Given.

The best way to use them, then, is cautiously and with other resources. At a minimum, investigate free physician Web sites to get a sense of whether a doctor is in hot water with a licensing board, said John Santa, director of the Consumer Reports Health Ratings Center, which provides information on doctors but doesn't yet rate them.

Ultimately, the best "user reviews" are still recommendations by relatives and friends, not anonymous postings on Web sites. I found my OB-GYN by word of mouth. And when I learned she was a cyclist _ and would likely understand my need to work out while pregnant _ I made my first appointment. Others might find her obsession with cycling and Lance Armstrong irrelevant to quality medical care. I bonded with her over it. And the next time I visit a doctor rating site, I plan to add it to her review.

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RATE THE RATING SITES

Tips on how to use online doctor rating sites from the American Board of Medical Specialties, which oversees physician certification.

Confirm the information. Many Web sites include self-reported physician information. A doctor may list a specialty, but that doesn't guarantee that he/she is board certified in that particular area of medicine. Check with ABMS to verify specialty certification.

Search for online physician ratings that allow consumers to read comments on an individual physician from a variety of sources, including other doctors, nurses and patients.

Remember that many online physician ratings don't consistently moderate content or review the comments before posting.

When choosing a doctor, consider several sources of information rather than relying solely on a doctor rating Web site.

For a small fee, consumers can also check for disciplinary actions against individual physicians through the Federation of State Medical Boards at www.fsmb.org.

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