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The question: I’m looking for a doctor to do some cosmetic surgery. How reliable are the websites that rate doctors?

The answer: You can gain some useful insights into doctors by checking them out online. But you need to be aware that such rating systems have limitations – including the fact that doctors can, in certain cases, pay to have negative reviews hidden.

Among Canadians, is the most popular website for assessing doctors, says Dr. Jessica Liu, a staff physician at Toronto General Hospital and co-author of a study that examined online ratings of doctors.

Story continues below advertisement was launched in the United States in 2004. A decade later, it was acquired by a Canadian-based company, VerticalScope Holdings Inc. Then, in 2015, TorStar Corp. – the parent company of the Toronto Star newspaper – bought a controlling interest in VerticalScope.

So what began as mainly an American website is now in Canadian hands – although the lion’s share of RateMDs’ business still comes from the United States, says Chris Goodridge, VerticalScope’s chief investment officer.

The main thing you need to know about RateMDs is that it has a dual purpose. First, it serves as a forum where patients can anonymously post reviews of health-care providers. And second, doctors can use the site to promote their practices.

RateMDs relies on patients to create the doctor “profiles” – which include comments and a one-to-five star rating system, taking into account the doctor’s staff, punctuality, helpfulness and knowledge.

A doctor can then “claim” his or her profile and respond to any comments. (Doctors can also set up their own profiles if patients have not done so.)

If doctors are willing to pay a monthly fee of US$179, RateMDs offers various promotions, including the ability to hide up to three comments, place banner advertisements on the profiles of other doctors and receive electronic appointment requests from patients.

“If someone is searching for a particular type of specialty in a given geography, you can make sure you are in that search result – if you pay,” Goodridge says.

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For a higher monthly fee of US$359, a doctor’s banner ad will appear in three times more spots than with the lower-priced package.

These marketing techniques may be well-suited to the United States, where the delivery of health care is often based on a business model. But such measures are less relevant in Canada because patients don’t usually pay out-of-pocket for physician services, and they’re not really free to shop around for doctors. The major Canadian exceptions are certain types of plastic surgery and cosmetic procedures.

Many Canadian doctors resent RateMDs – particularly the ability of people to post comments anonymously.

“It’s open to abuse,” says Dr. Nowell Solish, a dermatologist at Women’s College Hospital in Toronto. He says he once received a series of comments critical of his office staff. He later realized that a disgruntled ex-boyfriend of his secretary had posted them. “He was trying to get her fired,” Solish says.

Although doctors can respond to the online comments, few choose to do so. “You will never be seen as being professional, especially discussing confidential information in an online setting,“ says Dr. Joel DeKoven, a dermatologist at Sunnybrook Health Sciences Centre in Toronto. He also feels the website lacks transparency because the public is unlikely to know that doctors have the option of hiding comments.

Goodridge, however, defends the practice of doctors paying to remove up to three comments, emphasizing that it does not change the health-care provider’s overall score. The star rating of the deleted post is still included in the average.

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Possibly the biggest drawback to an online rating system is that it’s based on a skewed sample of patients, DeKoven says. People have to feel very strongly – either for or against – to make the effort to express their views in an online forum.

Another potential problem is that some doctors may be encouraging “satisfied” patients to rate them in order to artificially boost their scores, Solish says.

Liu and her fellow researchers recently published a study that examined eight years of RateMDs’ data, between 2005 and 2013.

“When we actually looked at the data, on average, physicians tend to be rated favourably over all – contrary to what a lot of people think,” Liu says.

But there can still be significant variations in how patients feel about individual doctors. These differences highlight the fact that not all patients are looking for the same attributes in their health-care providers.

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“Some people want a doctor to spend a lot of time with them,” Liu explains. “For others, bedside manner may be less important so long as the doctor is technically proficient.”

Even physicians who don’t like RateMDs acknowledge that the website can be a valuable tool.

“If there is a common theme that comes across over and over again, you have to take it seriously,” DeKoven says.

For instance, “if you constantly see on the site that a doctor is always late or doesn’t answer questions, it is going to be the real deal,” he explains. “And if those qualities are important to you, you need to take the comments under consideration.”

There’s one other thing that can be said with certainty about the online rating of doctors: “It’s not going away anytime soon,” Liu says.

Indeed, as more people use information gleaned from website ratings to book vacations and shop online, they’ve come to expect a similar option for their health care.

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Paul Taylor is a patient navigation adviser at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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