I was talking the other day with a nurse about social media and the phenomenon of people rating their doctors on Angi and other online databases. “It’s a problem,” she said. “People just don’t know. Some doctors are really nice and not very good; some are really good and not very nice.”

She’s right, of course. It’s why many doctors of my acquaintance look upon social media and patient ratings with disdain. Most patients simply don’t have the right kind of information or perspective to make meaningful physician ratings. They invariably rate friendly, communicative docs higher than surly docs with poor bedside manners–regardless of how well the docs perform as healers.

The thing is: it doesn’t matter, for at least two reasons:

1. People have always rated their doctors. Angi and other doctor-rating services such as RateMDs.com and HealthGrades are only formalizing and extending a practice that has existed since Hippocrates. People ask their friends and relatives for advice about doctors, and their friends and relatives are only too happy to oblige. The fact that patient opinions are out there on the web for everyone to read is new, but it’s different only by degree. Doctors have always been subject to word-of-mouth evaluations, and social media are giant word-of-mouth platforms.

2. The genie is already out of the bottle. And it ain’t going back in. Millions of people are already rating their doctors, and they believe they have a right to do so. When asked whether she thought patients should be able to rate doctors on Angie’s List the same way they rate plumbers, one patient put it this way:

Emphatically, Yes!! It’s time we got out of the dark with regard to doctors and started telling everyone what each one is like. Too many have touched patients inappropriately. Too many doctors have refused to listen to their patients as if they are sub-intelligent. Too many doctors have harmed their patients and not been terribly upset about it. It’s time we shared our opinions of them.

Harsh but true. The web has empowered patients to tell the world about everything they like and don’t like, including the way they’re treated by doctors.

Let’s put it this way: a 2009 study said that 89% of American doctors find the Internet an indispensable source of health information. Why should doctors expect their patients to be any different?

So what are you supposed to do if you’re a doctor? How do you guard against getting slagged online by disgruntled patients?

Participate in the conversation.

You can’t control what people say about you online. But it’s ridiculous to imagine you can bury your head in your little black bag and pretend it isn’t happening. You can have your say, too.

Remember that people are hungry for health information online, and people are looking for authoritative voices they can trust. Doctors who blog and share ideas via Facebook have the potential to reach a huge audience with their opinions and advice, which can’t help but affect what people say and think about them.

Understand that communication and compassion are as important to patients as healing.

A recent study in the UK revealed that patients want “thoroughness” most of all from their doctors–but, close behind, they want doctors who know them well, doctors who are warm and friendly, and doctors who don’t make them wait too long and have flexible appointment schedules. This certainly varies depending upon patient needs: a patient with cancer wants something different from a patient with a head cold. But even a patient with cancer is likely to rate a friendly, compassionate doctor higher than a brusque, discourteous doctor.

Friendliness might not be what you, as a doctor, would value most highly. (Check out this nurse’s opinion.) But–please hear this again–it doesn’t matter what you want. That’s Marketing 101. I’ve spend a lot of time talking about “what we want patients to do” and “how we want patients to behave.” But patients are going to behave how they want to behave, especially when it comes to evaluating, researching, recommending, and choosing doctors.

Participate in the conversation. Do your best to treat your patients with kindness and respect–not just because it’s the path to higher ratings, but because it’s the right thing to do. Know that patients are hungry for good health information–and they’re getting it from the web. They can get their information from a smart, compassionate healthcare professional. Or they can get it from some guy in Vancouver who suffered from the same condition and thinks he’s an expert.

Which means this: if you’re not participating in the conversation, the loudest voices in health care are those of the amateurs. That’s not good for any of us.