First, Do No Harm

Friday, March 20, 2009


If you think your doctor has cold hands or worse, has made a mistake in your medical care, what better place to sound off then an online review site. There are dozens of such sites, but now doctors are fighting back. Dr. Jeffrey Segal, founder of Medical Justice, provides releases to physicians that when signed, prohibit patients from inveighing online.

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Comments [13]

JoshLevine from Somerset County, New Jersey

*cont from previous post*

I like my own gp okay but would sooner go without a doctor than the right to free speech.

Incidentally, I am glad Angie's List exists but find the barriers to its own information (one must sign up to access it, and cannot post anonymously) an impediment to getting the needed info. At least in my case, in doing research I check google opinions, epinions, yahoo, maybe yelp and one or two others before making a relatively important consumer decision (in addition to speaking w real live humans if possible). I find that comments by consumers are much more accurate and fair than comments on, say, local newspaper websites, where a few kids or bigots just ruin the forum. As long as the doctor can respond to criticism (in fact that in itself is a sign of character, I would imagine) -- and in rare cases have the right to challenge the comment itself (though I've never seen a comment about a service or product that I felt was so unfair that it warranted removal) then I see no problem in ranking docs, profs etc.

Years ago I thought of setting up a yelp-type site for doctors -- how else would you find a good one? (Not your insurer, that's for sure!) but was scared off by the thought of whiny, litigious doctors. How silly. Go yelp, go internet. Talk about a cause worth fighting for.

Mar. 30 2009 02:45 PM
JoshLevine from Somerset County, New Jersey

When I heard your dr sizzling on the skillet here, I remembered why I love the internet.

Bringing the arrogant down a notch -- especially when they are so arrogant they wouldn't otherwise see it -- is a favor to the subject and consumer alike.

Does the doctor take your insurance? Is their waiting room roiling w pharma sales babes and their lil overnight bags? Will the dr bring up or even discuss alternative treatments? Follow up w a phone call or email? Do they look up while talking to you? Is their handwriting legible? Are your records easily available to you? Quality of referrals? Is a tracking of your condition or complaints presented annually? Do you feel like you are important to the doctor after being treated -- like, as important as the Queen of England is after she has been treated -- or do you feel like you just got ripped off? Do you know what treatment you just received and how much it cost (even if your insurer is paying)?

And importantly, how active are they, as industry professionals, in improving the overall health care system that they might resent but has also made them and their family quite wealthy (generally speaking)?

*cont on next post*

Mar. 30 2009 02:45 PM
Angie Hicks, Angie's List founder from Indianapolis

Asking patients to sign a gag order promising not to publicly discuss the care they receive stifles free speech, which should alarm every American. But there’s a second alarm ringing loud and clear. The doctor-patient relationship is supposed to be built on trust. If a doctor will go so far as to gag you from talking about the care you’re about to receive, how much should you trust that doctor? The doctor doesn’t trust you; does the doctor trust his or her own abilities?
Changes in the health care system put more responsibility and choice in the hands of consumers, making it imperative for consumers to have more information, not less. Consumer reviews are an important part of the research toolkit, and consumers are smart enough to discern rants from meaningful commentary. An Angie's List member wrote “Just because a doctor is a jerk doesn’t mean he isn’t a great oncologist, and when push comes to shove, I’ll take the healing powers over easy small talk…But it also doesn’t mean that I don’t want a head’s up before I go to the office that he’s a jerk.”
Angie’s List offers consumer health care ratings that convey a real-patient experience with physicians and other health care professionals, as well as links to regulatory and accreditation sites that speak to the physician's clinical standing.
Angie’s List also goes to great lengths to maximize accuracy and fairness.
We don't allow anonymous reviews.
We hold our members responsible for accurately reporting their experiences.
We alert health care providers the first time a member reports on them.
We also offer an alert for any future reports.
We encourage providers to contact patients who've posted about them.
We encourage them to respond.
Rather than dismiss the opinions of consumers, we encourage members to draw on all available resources - including subjective consumer feedback and objective clinical data - to make the most educated decision for themselves and their families.

Mar. 27 2009 01:31 PM

I'm sorry, but I think these sites are a boon for healthcare. I've worked in a number of doctors offices and my impression is that one of the biggest problems is that different patients want and need different styles in their doctors, and new patients simply have no way to judge what they're getting. If it's a bad match bad things happen, or patients move to the next doctor, often repeating tests, and raising healthcare costs overall.

IMO the biggest risk of getting complaints or lawsuits is when the patient's expectations are a bad match with the doctor's strengths. Why would you want patients who are fanatical about how much time you spend with them to be coming to you if you have a rushed and busy practice? If bedside manner isn't your strength - why would you want patients looking for handholding above all to show up in your office? If you return calls every few days but the patient expects to be called back within an hour - that's just a disaster. Etc. Etc.

I think the arrogance here is that these doctors are assuming that patients are idiots. People can read these comments and use their common sense in how much credence to give anonymous reviewers, and whether the specific criticism is important to them. Also, I went to a few of these sites and looked up doctors I knew and I was surprised by how on target most of the comments were. Good doctors tended to get glowing reviews and problem doctors tended to get critical reviews. Moreover the specific critiques were amazingly accurate. This was especially true *the more reviews there were.*

My feeling is that - unless you are a complete hack - doctors who have their patients sign this gag order are shooting themselves in the foot. They're going to be wondering why they have so many more "problem patients," complaints and friction than their colleagues who feel comfortable being reviewed.

Mar. 26 2009 04:52 PM
Trisha Torrey from Central NY State

I've written extensively about doctor ratings sites and Medical Justice, too.

I advise patients to take ratings sites with a grain of salt. We have no way of knowing whether it was the doctor's spouse, kids, competitor or stock broker or anyone else with vested interest sharing that rating.

I have advised patients who are given a Medical Justice form, or any other waiver of their rights, to leave that doctor's office and take the form with them.

Any doctor who feels the need to hide behind a lame guarantee such as Medical Justice offers should instead be spending his/her money on communications training.

re: the question about Yelp: Do a search for Yelp and doctor ratings and you'll find references to Yelp's efforts to extort money from doctors who have received bad ratings.

American healthcare is not about health or care. It's about sickness and money. This question about ratings sites, Yelp and Medical Justice is supporting proof.

Trisha Torrey
Every Patient's Advocate Guide to Patient Empowerment

Mar. 26 2009 09:09 AM
mc from Brooklyn

Err, Michele, you're mixing up two segments. The Yelp" segment was about reviewing restaurants.

dljohnson, I hope that physicians and others listen more to the hard research rather than ranting by patients.


Mar. 23 2009 12:34 PM
dljohnson from Rockford, IL

I had to download this portion of your presentation to make sure that I was hearing correctly. Since when is it easy to find another physician, even if one has health insurance? And the number of physicians who are reprimmanded by state licensing bodies is almost non-existent. For too many years physicians have tried to hide under their professional status and patients have silently had to endure whatever comes their way. What the internet has done is to allow patients to engage their doctors in potential dialogue - maybe even suggesting a treatment that the physician did not know about. Most patients understand that the physician is not God. Segal is correct that today's medical practice involves more than just the physician. The day of allowing physicians to "practice" medicine by just offering an opinion without hard research to back it up is hopefully fading away.

Mar. 22 2009 11:55 PM
Christopher Fredrick Gautz from Pomona, Ca

What Dr. Segal put forth a patient [being a layman] is in no position to comment on the quality of their health care; what he fails to say is that many people find out they have receive substandard care when they go to another physician. The code of silence doesn't just exist with cops, Doctors too, often adhere the code of silence.

Mar. 22 2009 10:34 PM
Michele Horwitz from Seattle, WA

Instead of listening to the arrogant doctors coming to the aid of their brethren, perhaps we should be listening to a few constitutional scholars. The waiver that Dr. Segal claims is so necessary is highly questionable and may not even be legal. In these times -- when those who are lucky enough to even have medical insurance are expected to sign away rights or find another doctor (not too easy when one is facing a medical cirisis) -- I'm much less concerned about the bruised egos of the doctors than the rights of patients.

And I would suspect that any doctor who's seriously worried about a negative Yelp review probably deserves one, and knows it. But after listening to Dr. Segal continually insult plumbers and roofers, I would remind him that contractors are just as susceptible to bad Yelp reviews and have more to lose by receiving negative press: All it takes is one unhappy customer to ruin a contractor's reputation. Not so for doctors.

Mar. 22 2009 10:03 PM

right on.

Mar. 22 2009 01:33 PM
mc from Brooklyn

In her rather one-sided questioning of Dr. Segal, Brooke seemed not to take into account this: roughly one third of the $2.4 trillion that we spend on health care in the US is wasted on unnecessary, unproven and sometimes harmful procedures. Given our money-driven system where device and drug makers aggressively market their products to an inexpert public, some doctors may be doing everyone, including their patients a favor when they decline to do a treatment or sign a prescription that is not medically indicated. Offended patients then can sound off to sites like this and no one is the wiser. Yet we are all poorer if doctors cave in to these kinds of demands.

Mar. 22 2009 10:06 AM
Gary Wardell from Washington, DC

I agree that things written on any review should be taken with some skepticism; however, if 80% of the reviews are negative there, and there are a sufficient number there, something might be wrong. Likewise, if there are 80% positive, this might be a good candidate.

I also take exception to the waiver thing. And I look a bit askance at his calm that many people have signed them. After all, when you are sitting in a guys office thinking you are dying, you're going to sign anything they put in front of you, no matter what it is. Also, it isn't till after you've received the service that you know if it's bad or good and if you want to write about it.

Mar. 21 2009 07:36 PM
Laurel Reinhardt, Ph.D. from North Carolina

As a trained psychotherapist, I would have to advise anyone reading a comment on such a site with a grain of salt. I know from first-hand experience that doctors of any kind can be extremely good/effective with one client/patient and completely "off" with another. Factors like transference and counter-transference play a role in medical situations just as much as they do in the psychological realm. The best way to determine whether or not any doctor is a good fit for any client/patient is to meet with them and see what you think and, more importantly, how you feel about them. Some people want to be heard by the doctor, others want to listen only to what the doctor has to say. Figure out what you want, and go looking for it yourself; don't rely on the experience of even your closest friend, because they are not you.

Mar. 21 2009 05:20 PM

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