THERE'S NO DOUBT ABOUT IT — SOCIAL MEDIA, in giving voice to millions of consumers and an audience of millions more — has turned the Internet into the Wild West. There are empowered opinion-slingers on one side — giving high praise or scathing rants on everything from hotels to plumbers, and the subjects of these reviews on the other side — struggling to either defend themselves, encourage their supporters to voice approval, or, as a last resort, getting sneaky and self-reporting anonymous favorable reviews of themselves.

'RATE THIS DOCTOR' With passions running high about health care, it's only logical that doctors be brought into the mix. An ever-expanding array of Web sites (a recent count showed more than 40) invites patients to rate or score their health care providers, either anonymously or with attribution.

The linchpin problem is that the rules, of course, are different for doctors. Unlike plumbers, hoteliers or restaurateurs, physicians are sworn to a host of ethical codes, rules and policies that protect doctor-patient privacy with considerable redundancy. A patient may be able to go online and describe in great detail their condition and in even greater detail why they feel their doctor wronged them, but when it comes to responding, a doctor's hands are tied.

Dr. Segal

"But I can assure you that, even though it would seem that since the patients are posting to the world the details of their medical condition, that they have implied that they have given up certain privacy rights; the truth is they have not, and physicians who post any protected health information can certainly expect to be on the receiving end of an investigation."

PRIVACY AS PROTECTION Dr. Segal has a stake in the matter. He is CEO and founder of Medical Justice Services Inc., a Greensboro, N.C.-based legal group that is offering one solution to the problem — a contract its members can ask patients to sign in which they agree not to go on the Internet to discuss the physician or the care they receive. The contract is not all that different from other contracts in which patients agree not to sue their physicians for frivolous reasons, Dr. Segal explains.

"Privacy is something that is already sacred to the medical world. Unlike responding to a review of a toaster...or a restaurant, there's simply a different paradigm for dealing with patient privacy on the Web, and we're just expanding on that, asking patients to limit one aspect of communications."

Dr. Segal says that among the 2,000 or so Medical Justice physician members, most are using the contract and have, by and large, seen a good response. "Most patients are comfortable with it; however, there is a small subset who feel strongly about their right to be able to post whatever they want on the Internet and while we respect that right, those patients may not be a good fit for our plan members' practice."

That small subset, has — not surprisingly — been vocal in its opposition, and in media reports, one patient referred to the contract as a "gag order." Angie Hicks, founder of the popular consumer rating site Angie's List, which recently added physician ratings to its service segments, was meanwhile quoted as saying, "As a consumer advocate, I would oppose this practice as nothing short of an attempt to steal the consumers' right to free speech."