Cox tells everyone that he signed Sacred Heart up for rateyourdoc.org, a website where patients rate their doctors. In the halls, the Janitor continues to annoy everyone by using his cowboy voice. Elliot and J.D. chat with one of Elliot's terminal patients, Shannon, who Elliot has formed a close bond with. At the same time, Cox and Turk begin a contest to get higher ratings on the website.
Shannon tells Elliot that she purposefully overdosed to try and kill herself before she gets really sick. This goes against everything Elliot stands for and she's deeply upset. In the cafeteria, Cox, Turk, and other doctors review comments left about them on the site. J.D. stops by to rub in the fact that he's rated number one.
Carla tells the Janitor that his relationship is a lie and won't be real until Lady knows the real, much nuttier, him. In a hall, Turk tells Cox that they can't lose to J.D., no matter what it takes; after all, winning is more important than friendship.
Elliot and J.D. discuss Shannon's situation, and J.D. tells her she can't let her patient kill herself. Elliot thinks she can handle that and maybe it's the right thing to do. The Janitor takes Carla's words to heart and reveals his stranger side to Lady, including his penchant for stuffing animals with other animals. Carla steps in and puts a stop to it before he totally ruins his new relationship. She advises to "dole out your crazy in little pieces."
Turk has Todd pose as J.D. to force his rating down on the website. J.D. is pissed that Turk would do this to him. When Turk asks if there's anything he can do to make it up to him, he offers to let him win at basketball while the nurses watch. Outside, Elliot says goodbye to Shannon, who thanks her for being such an amazing friend even as she heads out to follow through on her overdose plans. On a positive note, Turk comes clean about Todd and J.D. returns to being the top-rated doctor for Sacred Heart.