Like many doctors, Benjamin Schlechter, a plastic surgeon near Reading, frets about the power the Internet has given disgruntled patients, competitors - anybody, really - to bash his practice more efficiently than any town gossip could ever imagine.
A growing number of consumer review sites - one expert estimates there are close to a hundred - let patients evaluate their doctors, and the results can be brutal. Then there are the online chats, Facebook pages, and blogs where patients can praise or criticize doctors. The doctors feel they can't fight back publicly because of patient privacy protections.
"It's really a problem, to be quite honest," Schlechter said, referring to "this online baloney."
Schlechter now tries to combat the handful of negative reviews by asking happy patients to post.
Still, to his great frustration, he has what seems to be an unfixable problem on his own attractive, well-designed website. Go to the directions link and this fragment of a review appears with the map: "I have the greatest respect for Dr. Schlechter. He is a caring ..." But click on his name and this one from June 14 appears to be inextricably linked with the Google directions: "Dr. Schlechter and his staff are simply rude. They don't listen, and they don't even look you in the eye when they talk to you."
Schlechter has tried to get that one removed. Because he wants patients to have the map, he feels stuck. He is not alone among doctors in wishing he could fight back.
"I wish we could rate patients," he said, "and then it would kind of even the playing field."
Not only are the review sites a burgeoning industry, they are also spawning another: companies that help doctors (and other businesses) fight bad reviews and create a more positive online image. Even doctors who don't hire these companies may feel compelled to try blogging, tweeting, and writing Facebook updates.
Eric Benton, president of Reputation Management Consultants in Irvine, Calif., called the growth of his business in the last two years "logarithmic." He said hundreds of doctors now pay him from $900 to $5,000 a month to improve their online reputations. Most sign on, he said, after their business drops by 10 percent to 30 percent. Among other things, the company solicits positive reviews that can dilute and push down the negative ones. Benton says his firm can manipulate the order in which review sites appear after a search.
The situation raises questions about the credibility of the sites and the legality of efforts to game the system. It also is leading to a greater emphasis on customer service in some practices, and prompting some medical professionals to improve communication with patients to prevent nasty reviews that won't go away.
In an extreme effort to protect their reputations, some doctors and dentists have required patients to sign contracts that give medical professionals the right to suppress negative online comments. In November, the consumer group Public Citizen filed suit against a dentist who threatened to sue a patient who wrote a negative review.
The Center for Democracy and Technology filed a complaint with the Federal Trade Commission saying that Medical Justice, a North Carolina company that sold the contracts, was engaging in "deceptive and unfair business practices" and that the contracts, which rest on copyright law, were "legally unenforceable."
Medical Justice, founded to help doctors with malpractice cases, quickly backed down. "While we believe these agreements are honest, ethical, and legal, we are going to use this situation as an opportunity to retire these written agreements used since 2007," it said in a statement. A company official declined to answer questions about how many doctors had been using the documents or how they would be notified of the change.
It said its new eMerit system solicits reviews from patients, written while they are in doctors' offices and on tablets supplied by the doctors, then posts them at review sites.
Amanda Beerens, now a landscape architecture student at Louisiana State University, encountered one of the Medical Justice contracts while visiting Ken Cirka, a Philadelphia dentist. She says the office staff handed her a stack of documents, which she signed without paying much attention.
Later, she found out that Cirka didn't take her insurance. "They were just incredibly rude about it," she said. "They tried to make me feel like two inches tall." She expressed her displeasure on Yelp in June 2010 and within a couple of days got a "cease and desist" e-mail from Cirka, along with a copy of the agreement she had signed.
She took down the comment even though she thought Cirka had no right to ask her to. She's still angry about it. "It's really important that patients be able to review [doctors and dentists] honestly," she said.
By e-mail, Cirka said he stopped using the contracts last spring. "Patients could feel as though we were trying to hinder freedom of speech," he said. "I never wanted that to be the case, so I dropped all contracts immediately once my viewpoint changed and I could see it from the patient's perspective."
Critics have concerns about Medical Justice's more positive approach, too. John Swapceinski, cofounder of RateMDs, a doctor rating site, reported that "we have found six IP addresses, all registered to Medical Justice, that have submitted 86 ratings for 38 different doctors in 14 different states. Every one of these submitted reviews is positively glowing, with a rating of 5 out of 5 in every category."
He blocked the addresses and says he routinely blocks posts that seem to come from businesses trying to bolster doctors' reputations. "It's happening all the time," he said.
Medical Justice has said the reviews in question were posted during a pilot study of the new program, but would not answer questions about how it is operating now.
Eric Goldman, a professor at the Santa Clara University School of Law, says review sites need to provide assurance that the comments they post are credible. He worries about reviews that patients allow doctors to post. "Filling out a review in the doctor's office makes me wonder if consumers will be fully honest and open about their perspective," he said.
He says doctors worry too much about the occasional bad review. Patients are smart enough to spot a crackpot, he said, and they are also leery when they see nothing but praise.
Cirka said he is no longer ruffled by the online reviews and focuses instead on improving patient satisfaction. He asks patients for feedback by e-mail immediately after each visit.
Here are some of the changes he has made as a result: The office texts reminders to patients' phones an hour before appointments. Cirka gives patients his e-mail address. He bought wider chairs for the waiting room and space heaters for exam rooms. Hygienists wear name tags so patients can remember their names.
Schlechter now asks patients to write reviews and has created a web address that links to nine of the most popular sites. Patients rarely take the time to do it, he said.
W. Grant Stevens, a California plastic surgeon who teaches a course on reputation management, carries cards with him that have a different review site address each day. He doesn't ask all of his patients: "I wait for an effusive outpouring of appreciation and support." Then he hands a patient a card and says, "Would you share that with the world?"
Even then, only one out of four follows through.