By Jeff Segal, MD, JD, ByrdAdatto and Medical Justice

Have you heard of Botto Bistro? It's a pizzeria in the Bay Area. Chef Davide Cerrentini, who emigrated to the US in the '90s, opened the restaurant's doors in 2009.

Cerrentini is famous for asking happy diners to give him a one-star Yelp review. That's right—one star.

Botto Bistro has accrued thousands of these reviews, and was at one time ranked as the worst-rated restaurant on Yelp. To Cerrentini, that was a badge of honor.

By the way, he is immensely successful.

Here's what happened, and why Cerrentini embraced the lowest of the low reviews.

Shortly after the restaurant opened, he received calls from Yelp salespeople. They suggested he buy ads on Yelp. When he told the salespeople, "No thanks," he observed that some recent five-star reviews had disappeared.

"I came from Italy, and know exactly what mafia extortion looks like," he said. "Yelp was manipulating reviews and hoping I would pay a protection fee. I didn't come to America and work for 25 years to be extorted by some idiot in Silicon Valley."

Cerrentini then turned to the dark side. He wrote his own five-star reviews to replace the real ones that were removed. He also wrote negative reviews of neighboring restaurants.

Ultimately, he gave in. He started spending $270 per month to advertise on Yelp.

After six months, he pulled the plug. He found the service "useless" and cancelled his advertising. Then, his star rating dropped.

In the spring of 2014, after turning down another Yelp salesperson, Cerretini claims that four five-star reviews were filtered from his page, and three one-star reviews were suddenly catapulted to the top of the page. For the chef, this was the final straw.

"What if I don't give a s*** about reputation?" he said. "What if I take away their power by actually making it worse?"

One morning in September 2014, he placed a simple sign in front of Botto Bistro: "Give us a one-star review on Yelp and get 25% off any pizza! Hate us on Yelp." (The discount was later increased to 50%.)

The next day, business exploded. Cerretini was making money hand over fist. Botto Bistro quickly had more than 2,000 reviews. Most of the ratings praised the food and the service, and then gave it one star.

"Botto Bistro sucks," wrote one reviewer. "Delicious food priced fairly. One star."

"Seriously, who puts meat on pizza?"

"Don't try the pizza, it's so good you will come back every night, it completely ruined my social life cause each night I only want to go there. I hate this place."

"I ordered meatballs and they were served upside down."

A Yelp support member sent Cerrentini an email chiding him for offering incentives in exchange for a review. That was a violation of Yelp's terms of service. Hmm.

Other business owners have followed Cerrentini's lead. Some have posed "No Yelpers" signs in their windows.

A new documentary called Billion Dollar Bully catalogues the Yelp controversy. Click here to check out the trailer.

Cerrentini has been very successful with his high-risk gambit. It took a lot of guts.

"Most people are not ready to stop caring about reviews—it's a big risk," he said. "But I'd rather sit alone in my restaurant then get business from Yelpers."

What do you think? Particularly related to Yelp in the health care space?

We understand the temptation to ignore outlets like Yelp is strong, but we urge doctors to resist the urge. By ignoring a problem post on Yelp, you are denying patients access to a counter-narrative. And if there is no counter-narrative, there's an increased risk the doctor will be defined by that problem post.

This is a bad outcome—patients prematurely reject doctors who are qualified to treat them, and doctors miss the opportunity to treat patients.

So what's the remedy? We advise doctors take a proactive approach. Before you get blasted online, populate the internet with accurate descriptions of your quality of care. In this way, when the inevitable happens, you have a defense against the angry, the uninformed and the malevolent.

Medical Justice has designed a program that addresses these obstacles. The program exists for two reasons—the first is to keep your online reputation out of the crosshairs, and the second is to help new patients find you.

Jeffrey J. Segal, MD, JD, is a neurosurgeon turned serial entrepreneur turned attorney at ByrdAdatto who has literally been in both business and medicine. Segal was a neurosurgeon in private practice before beginning the second phase of his career as a serial entrepreneur in the health care field. He then founded or co-founded four separate health care startups. Segal lives and breathes health care and understands it viscerally.