Doctor's Orders

Levin said he believes they can provide information sought by consumers, such as whether others think a doctor communicates well. Caplan thinks they are merely "a measure of ambiance" and don't reveal the most important information: outcomes.

"One person's brusque is another's direct," Caplan said. "It's notorious that many doctors who would score well on ambiance are not good doctors, but manage to stay in practice." As a member of the New York state medical licensing board, "I saw again and again doctors who were well beyond the border of malpractice who kept going because patients loved them."

"Not only can't patients judge doctors, other doctors can't judge doctors," Caplan added. Without knowing a doctor's mortality, complication and infection rates, rankings reveal "just a piece" of the data consumers require.

Levin agrees that outcomes data are badly needed, but he thinks ratings sites can be useful. "What you need to look for is consistency and a certain number of ratings," he said. "It's one piece of a total picture

Beth Nash, an internist employed by Consumer Reports, advises that patients dump a doctor who demands a privacy waiver. "While we have all had bad days," she wrote on the group's health blog, "I find it hard to believe that a doctor with multiple negative reviews has just been unlucky enough to be judged on those occasional bad days."

Whose Privacy?

Northern Virginia OB-GYN Nicolae Filipescu has 35 reviews on RateMDs, far more than many of his peers. He also has one review on Angie's List and five on Yelp, both posted in the past six months. One Yelp poster described him as "competent and professional," while the other said he was rude, kept her waiting 90 minutes and offered to perform cosmetic surgery on her nose.

The RateMD reviewers are similarly divided about Filipescu. One called him "the best" and said he delivered her three healthy children, while another advised, "Run as fast as you can." Several accused him of insensitivity and of telling patients, some of them pregnant, that they were getting fat. One said he ridiculed her when she told him she had fibromyalgia.

Filipescu, who has offices in Arlington and McLean, disputes the negative reviews. "I said, 'Please do not get fat,' " he said. Lengthy waits, he said, are not routine but may occur because of an emergency. And while he performs cosmetic surgery, Filipescu said he doesn't do nose jobs.

"You have to realize there are some people who are somewhat disturbed," he said. "I don't get complaints from the Medical Society of Virginia or the [state] medical board."

But Filipescu opposes privacy agreements. "It's a freedom-of-speech issue," he said. "Let them say what they want."

Denver plastic surgeon Nicholas Slenkovich couldn't disagree more. A member of Medical Justice, he regards the waivers as "self-preservation" from what he terms "garbage" on ratings Web sites that he says are riddled with factual errors.

"Perception is very important in my business," said Slenkovich, adding that he worries about being trashed by a jealous competitor or a disgruntled patient. "The Internet is out there and everyone's using it. This is my livelihood, and I have no ability to reply." So far, he said, none of his patients has refused to sign.

Although many doctors are unenthused about online ratings, Falk, the District internist, said she would support a different kind of site.

"I'd love to have a Web site where I could complain about patients," she said. "All doctors would."

Comments: boodmans@washpost.com.