An oft-used maxim in U.S. health care is that patients ought to be treated more like consumers. Their feedback about medical services should be valued, and they should be given a chance to express their concerns.

But with more patients speaking up — via hospital surveys and third-party rating websites — inevitable tensions are emerging. Negative comments sting. Doctors targeted by them get angry. And in some cases, the feedback from patients gets labeled something else entirely: defamation.

A steady drip of legal disputes over online reviews is putting those tensions on display. In Texas, a pair of freestanding emergency rooms recently filed a legal petition seeking to force Google to share the identities behind 22 screen names connected to negative comments about the providers’ services.

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In another closely watched lawsuit, a plastic surgeon in Cleveland is suing a patient over negative reviews she posted on RealSelf and other sites. The dispute is unusual in that it may actually proceed to trial (most get settled), potentially leading to an influential precedent.

Participants in the doctor rating business say those cases are flashpoints in an inevitable, if messy, transition to a more open marketplace. And while some providers are balking at unfavorable reviews, other hospitals are taking a counterintuitive approach to the problem — calling for more reviews, and posting them on the hospital’s own site. That effort aims in part to put negative ratings in context. It’s also a way to deliver a more straightforward message to physicians: If you don’t want negative comments, do your job better.

“The big impact [of reviews] is on the people being measured, not so much on the consumer,” said Dr. Thomas Lee, chief medical officer for the patient survey company Press Ganey. “It makes people raise their game.”

University of Utah was the first hospital to begin posting unedited patient comments online in late 2012. Since then, dozens of hospitals have followed suit, including Cleveland Clinic, Duke, Geisinger of Pennsylvania, and Brigham and Women’s Hospital in Boston.

Some critics of publicly airing patient comments argue that they put doctors in an untenable position. Due to federal privacy laws, doctors cannot respond in a way that would compromise patient confidentiality, leaving them with limited ability to rebut complaints. Physicians are also uniquely vulnerable to public criticism, given the deliberateness most people take in choosing where to get health care.

So, many providers, including the University of Utah, give physicians an opportunity to review their comments — and to appeal to an internal committee to get them tossed out if a doctor can show a comment is particularly unfair or untruthful.

In some ways, hospitals’ decision to post more reviews is an act of self-preservation amid a dawning reality: Their doctors were already getting publicly rated on third-party sites like Healthgrades, Vitals, RateMDs and others. In many cases, such sites only feature a handful of comments on a given doctor. If one or two are negative, it’s easy for doctors to feel they are being presented unfairly.

Although third-party sites themselves are shielded from liability, the individual commenters are not. Libel lawsuits remain rare. More common are threatening letters from doctors and their attorneys seeking to pressure commenters into removing or retracting their statements. Last year, Aaron Schur, senior director of litigation at Yelp, testified before Congress that the company regularly receives supboenas from plaintiffs involved in an array industries who want to get Yelp users’ personal information to press their legal claims.

In testifying for greater protections for consumers, Schur cited a letter from one Yelp user who said he removed his comment — even though he maintained its truthfulness — after a dentist sued him for $100,000.

Though effective in some instances, such tactics are often expensive and risky, especially if they lead to litigation. Dr. Jeffrey Segal said there are more effective ways to respond. Instead of fighting negative comments, he said, providers ought to solicit more of them.

“I call it the denominator problem,” said Segal, chief executive of eMerit, which helps doctors collect and post reviews from patients. He said doctors who feel their reputation is being harmed by a few negative comments can combat the problem by opening the floodgates to all commenters.

It’s a tack that a wide variety of businesses — from hair salons to laundromats — have taken in the online era of “reputation management”: hiring firms to help solicit good reviews or respond to consumers who leave negative ones. As the health profession belatedly embraces online reviews, a number of firms have sprouted up specializing in just this kind of digital spruce-up.

Segal said his company does not screen patient comments or advise that only positive reviews be posted. He said that would quickly undermine their credibility, causing consumers to pass them off as marketing puffery.

Segal, who also founded Medical Justice, a firm that helps doctors deter frivolous malpractice suits, is among many doctors who have done an about-face on the value of patient comments. He said he initially thought they offered limited value in improving quality, while giving disgruntled patients a chance to take potshots.

Then he started to look into it more deeply. Examining data from insurance carriers on specific procedures, he found a high correlation between the outcomes data and what patients were saying about the doctors online. “I went from being opposed to it, to figuring out how to do it better,” Segal said of online reviews.

He acknowledged lawsuits will continue. But he cautions doctors not to file the kind of frivolous claims he spent so much energy trying to protect them from. “Litigation is probably something that should be used sparingly, infrequently, and with full eyes open,” Segal said. “There probably are occasional circumstances where it probably is [warranted], particularly if your practice is clearly damaged. But those are the exception. They’re not the rule.”

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  • I would like to ask Dr. Richards a question. In short, I went to a dentist for a cleaning and was told I had only one tooth that needed to be repaired. They did not do the cleaning but repaired the tooth. I paid in cash because I had no ins. I rescheduled for the cleaning. I came back for the cleaning and then I was told I had many issues in my mouth. I was under a dentists care for several years. This dentist lied to me by telling me that my bridges on both sides of my mouth needed to come out. The teeth under the bridges were bad. I listened to him because I trusted him. My dentist took off the bridges and started opening up many other projects in my mouth, one after the other. He cause me so much pain and suffering by pulling out teeth and leaving so much dental work undone. I could not eat good, I was always in pain. When he put my bridge in my mouth that his lab made for me, it broke when he said to bit down. He yelled at me and said now, you broke it! He made a temp. bridge on the other side and left it there for almost two years. My gums started to grow over the temp. bridge, then I needed gum surg. because every appointment I had he was too busy opening up something else in my mouth. Today I can hardly eat on one side. The other side I can’t eat at all. On my upper jaw he put a crown on that broke off when I was eating. Two other teeth he pulled out, for what reason I still do not understand. He told me they were bad but they never hurt me. This is only the short. I will stop here because there is much more suffering I went threw. I begged him for my money back, while crying in front of him. We are talking several thousand. He told me he will see and call me back. He tried to make me wear a bridge on the side of my jaw were he did gum surg. The same day I was crying while asking for my money back. That bridge hurt so bad I had to take it back out of my mouth. He told me it fit well. I started crying again because it was at this time I realized he didn’t care about my pain. I told him I was not coming back. He only cared about the money. I kept calling about three months and the office ignored me. I went to file a complaint at the state Board of Dentistry. I called today and the board said they are still trying to settle with him. Meanwhile, I can’t eat properly and I’m biting myself all the time. Many missing teeth and I do not want this to happen to anyone else. He has very bad reviews and all of a sudden right after I put my complaint in he all of a sudden received 5 star reviews. I was so stupid not to check his reviews years ago. If I knew all that, I would have never went to him. Should I write the truth in a review about what happened to me? I do not want anyone else to suffer what I went through. I was thinking about waiting until I get the letter from the board. I also want to say the exact truth that I read in all the other bad reviews because he did the same to me. I would just like to validate the other comments because they are 100% true. I am sorry for the way I wrote this question/ info. to you. I was crying while typing this. I’m very scared about ever going to another dentist and I have bad dreams when I’m sleeping. Can you please give me you opinion? Thank you so much for your time.

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