The Canadian Medical Association and the Canadian Medical Protective Association have asked a U.S.-based website that allows patients to post anonymous comments about physicians to remove ones they believe are defamatory.

Canadian users of RateMDs.com could potentially be sued for libel, the associations warned, and they have asked for names of people and IP addresses that identify computer users making comments.

The website allows patients to vent or to compliment doctors, said the site's co-founder, John Swapceinski.

San Jose, Calif., native John Swapceinski, who founded the website and runs it, has refused, saying he won't give user information without a court order.

Conditions in Canada's sometimes struggling health-care system may be contributing to the popularity of the website. About one-third of the doctors listed on RateMDs.com are Canadian, as are about two-thirds of the visitors to the site.

Swapceinski acknowledged at least one doctor's office made multiple, glowing postings in an effort to boost ratings.

The site tries to screen offensive comments and prevent more than one posting from a computer.

Outlet for frustrated patients

Comments on the website range from deserved criticism of poor people skills, to unfair, unfounded gossip.

Dr. Lynne Harrigan is a specialist in internal medicine and chief of staff at the Valley Regional Hospital in Kentville, N.S.

Of the 19 postings about Harrigan on the website, eight are negative, complaining she made them feel rushed or she lacks compassion.

Although the other postings are full of praise, Harrigan said the resulting overall rating of "average" is devastating.

"The terrible insecurity I feel with having that out there when it's not true, and I have no way to defend myself," said Harrigan. "So to me it's an example of how terrible the internet can be, and how damaging."

Strained system

Stressed doctors can sometimes be brusque, and the site has tapped into patients' feelings of helplessness and frustration at trying to navigate an overburdened health-care system, where there is pressure and waiting lists to see doctors, said writer Brad Mackay of Ottawa.

Mackay examined the website and its impact in Tuesday's issue of the Canadian Medical Association Journal.

"Poor bedside manner is just part and parcel of a strained health-care system," said Mackay. "Right or wrong, this just shows it."

There is no way to tell if the information is reliable or valid, said Dr. Ajantha Jayabarathan, a family physician in Halifax, who received mostly positive ratings on the site.

If a patient posts a concern, there is no way to bring it to the attention of a physician.

"There is no opportunity for remedy," said Rhonda Church of Doctors Nova Scotia.