Some doctors have started fighting back against ugly Internet reviews by asking patients to abide by what are effectively gag orders that bar them from posting negative comments online. Physicians are taking action as online ratings services such as Zagat's and Angie's List grow in popularity and expand their reviews beyond restaurants and plumbers to include medical care.

“Consumers and patients are hungry for good information” about doctors, but Internet reviews provide just the opposite, contends Dr. Jeffrey Segal, a North Carolina neurosurgeon who has made a business of helping doctors monitor and prevent online criticism.

Moreover Segal said such postings say nothing about what should really matter to patients — a doctor's medical skills — and privacy laws and medical ethics prevent leave doctors powerless to do anything it.

His company, Medical Justice, is based in Greensboro, N.C. For a fee, it provides doctors with a standardized waiver agreement. Patients who sign agree not to post online comments about the doctor, "his expertise and/or treatment." Segal's company advises doctors to have all patients sign the agreements. If a new patient refuses, the doctor might suggest finding another doctor. Segal said he knows of no cases where longtime patients have been turned away for not signing the waivers.

Ratings services such as Angie's List and Zagat allow people who have used a business to comment on the service. Such companies have expanded beyond restaurants and plumbers to include medical care.

Angie Hicks, founder of Angie's List, said that although only a small number of doctors have started using the waivers, no one should be forced to sign one. "No one should be giving up or be required to give up their freedom of speech before receiving medical care," she said during an interview with a Flint, Mich., TV station.