One person with a grudge and a keyboard can wreak havoc on a physician's reputation simply by going onto the plethora of physician rating websites and trashing him. Sometimes physicians sue these guerilla commenters for defamation, but a lawsuit generates yet more bad publicity and can be challenging to win. A possible lesson here: When a few offhand remarks by a physician make a patient or family member so mad that he wants to carry out an internet vendetta, a simple apology by the physician might diffuse the situation.

Last year, David McKee, MD, a neurologist in Duluth, Minn., walked into the hospital room of an 83-year-old patient who had just been moved out of the ICU after suffering a hemorrhagic stroke. The patient's family, gathered in the room, was on edge and had never met Dr. McKee before. The neurologist later recalled that he tried to introduce a little levity into the situation by telling the patient he had "to spend time to find out if you were transferred or died," according to court documents. The patient's son, Dennis Laurion, recalled Dr. McKee commenting: "44 percent of hemorrhagic strokes die within 30 days. I guess this is the better option." Dr. McKee denies saying this. Mr. Laurion also accused Dr. McKee of leaving the room scowling, without saying a word to the family, but Dr. McKee insists he did address the family.

The younger Mr. Laurion felt the doctor's behavior was extremely insensitive to his ailing father. According to Dr. McKee, the son then made more than 100 web postings criticizing the neurologist's bedside manner and describing the hospital room encounter. Mr. Laurion also wrote that an unnamed woman who had allegedly worked with Dr. McKee called him "a real tool." Dr. McKee hired a private investigator to track down this woman but failed to do so. He now asserts that Mr. Laurion fabricated the remark, according to the neurologist's attorney, Marshall H. Tanick.

Dr. McKee attempted to defend himself against Mr. Laurion's online attack. "This site, and similar sites are an unreliable way of assessing physicians," he wrote in a statement on the "Vitals" website. "They are easily abused and virtually no surveillance is undertaken by the site to prevent this. ... Mr. Laurion's entries have been dishonest and those of his acquaintances pure fiction. Vitals should not allow anonymous comments and should make it easier for physicians to remove blatantly false or fictional ones."

Dr. McKee also filed a defamation lawsuit against Mr. Laurion, seeking more than $50,000 in damages. Mr. Tanick says his client "suffered a diminution of referrals and of regard for himself in the community." But a judge dismissed the lawsuit before it reached trial, finding none of Dr. McKee's accusations could be considered defamation. For example, the judge said, the description "a real tool" is definitely negative but is too vague to be defamatory. "Taken as a whole, the statements in this case appear to be nothing more or less than one man's description of shock at the way he and in particular his father were treated by his physician," the judge concluded.

Dr. McKee has appealed the dismissal. A day before the hearing, Mr. Tanick and Mr. Laurion's attorney, John D. Kelly, spoke to Outpatient Surgery Magazine. In light of the negative publicity stirred up by the lawsuit, Mr. Tanick said, it is preferable to quietly settle such cases, but Mr. Laurion refused to accept a settlement offer.

Mr. Tanick said three-fourths of the defamation cases he sees involve comments on the internet, but they are not easy to prove. Online ratings often involve opinions, and "opinions aren't defamatory," he said.

Mr. Kelly said his client always identified himself in his online postings and did not post anonymously. While he conceded that his client may have made some rude comments, "rude speech is not defamatory." Mr. Laurion was simply trying to describe his own impressions of his dealings with Dr. McKee, Mr. Kelly said. "We all know of physicians who are technically very skilled but do not have a great deal of sensitivity." Could an apology from the doctor have averted the internet dispute and subsequent lawsuit? "I don't know for sure, but I think so," said Mr. Kelly.

Leigh Page