Los Angeles —- Distraught over the results of cosmetic surgery on her nose, Katherine Chen did what many people do when they're unhappy with a doctor. She consulted a malpractice lawyer and filed a complaint with the Medical Board of California.

But the 22-year-old college student from West Covina didn't stop there. Chen logged onto her home computer and wrote a tearful review about her experience, posting it to a Web site that encourages consumers to rate their health care providers.

"I wasn't nasty about it," Chen said. "But I posted a comment about what I went through. These Web sites are useful. Doctors still have a lot of power."

Chen and other consumers are trying to rein in that power. They're saying what they think about the state of health care and, more specifically, the doctors who provide it. Dozens of Web sites that permit people to rate, review, spin or flame their doctors have sprung up in the past year, operating in much the same way as online services that help people find hotels or plumbers.

Patients and site operators say the trend is good for consumers and good for health care. Thoughtful doctors, they say, will provide better customer service because of the feedback, and the bad ones will no longer be able to hide. Many physicians say the reviews on RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by disgruntled patients and are unfair, pushing some doctors to near-ruin after a single post.

"These sites don't yield enough power yet to get bad doctors to change. And in the meantime, they may hurt good doctors," said Dr. Phyllis Hollenbeck, a Washington family physician and author of "Sacred Trust: The Ten Rules of Life, Death and Medicine," a new book promoting patient empowerment. "It only takes one or two scathing comments and a doctor is put in a terrible position."

The sites, more than two dozen of them, vary in their scope of information and efforts to be fair. But the trend is toward free, anonymous, no-holds-barred forums.

Some sites have grown out of existing ratings services. Five years after he started the hugely popular RateMyProfessors.com, John Swapceinski and his business partner launched RateMDs in 2004.

"You can find ratings on cars and flat-screen TVs, but it's hard to rate professional services," he said. "I think that's overlooked."

Angie's List, a membership-based service that allows consumers to rate service providers, added health care services in March.

The operators of Vitals.com, which launched in January, say their goal is to provide people with free, fair and balanced information to help them select a doctor.

"We think of it as something closer to Match.com, in which we want to match up patients with doctors who are right for them," said Mitchel Rothschild, chief executive of the Lyndhurst, N.J., company.

The restaurant survey company Zagat has even teamed up with the health benefits company Wellpoint Inc., parent company of Anthem Blue Cross, to provide Blue Cross members with an online tool to evaluate doctors.

Sharing information via the Web has given consumers a powerful tool.

"There is a lot of pent-up frustration," said Dr. Kevin Weiss, president of the American Board of Medical Specialties, an organization that sets performance standards and certifies doctors.

"Costs are going up, and people are paying more out of pocket. Plus, there is a lot of data now on how the health care system needs to do better in terms of quality and safety."

Chen says she did her homework —- checking the doctor's credentials and history of malpractice lawsuits and studying his Web site —- before the surgery last year to shorten her long nose.

She found no red flags in the surgeon's background. The results of the operation, however, horrified her.

Chen says her nose was crooked and much too short, and that she was left with breathing problems and nosebleeds. She filed a complaint with the Medical Board of California, a process she later abandoned, and consulted a lawyer who discouraged her from filing a lawsuit because of the cost. She was also facing surgery to correct her nose. Ultimately, Chen says, she felt exposing the doctor on the Internet was her only recourse.

Later, pleased with her revision surgery, Chen also used a ratings Web site to write favorably about the doctor who performed it.

"I wanted people to know about my experience with him because he didn't really have any feedback on the site," she said.

Some state medical boards provide consumers with limited information on doctors, such as any disciplinary actions recorded and whether their licenses are current. Moreover, state governments, insurance companies and private organizations have attempted in recent years to gather data on physician performance that can be compiled into report cards to help consumers choose doctors wisely. Such measures have been shown to improve health care quality, according to the Agency for Healthcare Research and Quality. But those tools are in their early stages and are rarely consumer-friendly or easy to locate.

Dr. Richard Fischel, a thoracic surgeon in Orange, says his life was turned upside down after a patient began posting vicious remarks online regarding a surgery Fischel performed.

The operation went well, Fischel says. But after the surgery, the patient complained about a previously discussed side effect that can sometimes occur as a result of the surgery.

"He decided his life was ruined and destroyed," said Fischel, who is director of thoracic oncology at Hoag Hospital in Newport Beach.

Online, Fischel says, the patient posted "slanderous rants and raves."

Fischel's business was affected and he suffered monetary and emotional costs because of the patient's postings.

Federal laws protect patient privacy and prohibit doctors from discussing an individual's health care in public. But the right of patients to criticize their doctors online has been established. Federal law asserts that the hosts of Web sites on which consumers post anonymous opinions are immune from charges of defamation.

Doctors shouldn't be rated like products or service providers, Weiss said. Each medical case and doctor-patient relationship is unique.

"With TVs and cars, people can subjectively talk about their experience because you have a consistent product," Weiss said. "But with health care there is so much blended into the experience, it's hard to do an evaluation. You want a doctor who is both technically competent but also one who can communicate and understand the human dimensions beyond the technical aspect of good care."

RATE ME:

Punctual? Yes No

Helpful? Yes No

Knowledgeable? Yes No

RATE ME:

Good bedside manner? Yes No

Courteous staff? Yes No

Accurate diagnosis? Yes No

RATE ME:

Accurate diagnosis? Yes No

Helpful? Yes No

Punctual? Yes No

RATE ME:

Good bedside manner? Yes No

Accurate diagnosis? Yes No

Courteous staff? Yes No

INFORMATION, PLEASE

> Dozens of Web sites that permit people to rate, review, spin or flame their doctors have sprung up in the past year.

> Federal laws protect patient privacy and prohibit doctors from discussing an individual's health care in public. But the right of patients to criticize their doctors online has been established.

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Clip 'n' keep!

WEB SITES FOR OPINIONS —- SECOND AND OTHERWISE —- ON MEDICAL PROFESSIONALS

Web sites that rate and review doctors, and sometimes other health professionals, have sprung up in recent years as patients have extended the consumer-empowerment movement into the health care field. Here's a sampling of sites:

> RateMDs.com

This free site for consumers was launched in 2004 by the founder of RateMyProfessors.com. It provides a 1-to-5 rating scale in four areas: staff, punctuality, helpfulness and knowledge. Consumers can add anonymous comments and join a member forum to chat about a doctor.

> DrScore.com

Founded in 2005 by a doctor, the site allows consumers to rate doctors anonymously using a 1-to-10 scale. Only aggregate ratings are posted. Safeguards make it impossible for patients to skew results by repeatedly rating a doctor. Doctors can subscribe to detailed reports that analyze the data provided by consumers.

> Healthgrades.com

Healthgrades began as a pay-based service, but about 90 percent of information on doctors is now free, including doctors' education, training, insurance plans, group practice information and aggregate numerical patient satisfaction ratings. The site does not post anonymous consumer comments. Some physician profiles include videos of the doctors explaining their approach to health care. Consumers can order a physician quality report, which includes additional information such as board certification, malpractice judgments and fee information, for $29.95.

> Vitals.com

A free service for consumers that provides three types of information on doctors: consumer ratings and comments, credentials and experience, and doctor-peer reviews. Doctors can contribute information on themselves to the site. The site also helps consumers select an appropriate doctor for specific symptoms or conditions.

> Nursesrecommenddoctors.com

A free service for consumers that enlists nurses to provide anonymous ratings and reviews of doctors they work with or who have cared for them or family members. Nurses rate doctors using criteria such as communication and rapport, competence and experience, and whether the doctor treats his or her staff with care and respect. The site lets patients and doctors provide input as well.

> Angieslist.com

A membership-based service that allows consumers to rank and review various service providers, from gardeners to doctors. Service providers are ranked with a letter grade on price, quality, responsiveness, punctuality and professionalism. Dues for consumers are $5.25 per month.