A recent New York Times article mentioned that the very famous Nina Zagat was entering the Doctor rating business for insurance company Wellpoint. The article goes on to worry about the dangers of rating doctors. I agree that the rating of doctors is both a vital, and a tricky issue. Patients are competent to speak to the doctor's manner, and approach, but how many patients are qualified to rate the doctor's professional skill? If the insurance company rates the doctors, based on life expectancy and cost, it could be a boon to some, but in one situation I am aware of a group of six diabetes specialists were rated by an insurance company, and five of them received high ratings, and one achieved the lowest rating and the group was aghast, because the sixth doctor was the expert to whom the other five referred their most difficult and intractable cases. On a rating system which did not adjust for complexity and risk, the most specialist doctors can get the lowest rating. What we need to create is a more robust and transparent set of institutions to share and adjudicate reputations -- across all parts of the internet. For example, eBay should publish its seller and buyer ratings more broadly -- making them a service for any and all sites; Amazon too. In medicine, as these rating systems become populated with content, someone will certainly aggregate the different ratings -- and give some background on the quality and value of the rating process. This should help the patient understand who is saying what about whom. In my optimistic mind, I believe that we will find a way to keep these reputation sources -- perhaps through per rating service fees -- financially independent because God help us if doctor's ratings follow the path of the bond rating agencies who let us all down at our time of need -- due to the fact they were paid largely by the bond issuers.