< First, Do No Harm


Friday, March 20, 2009

BROOKE GLADSTONE: And I'm Brooke Gladstone. If you’re hungry and looking for a good meal, the choice you make based on review sites, like Yelp, is not a matter of life and death, but if you’re sick and looking for a doctor, it may well be. Patients are turning to the Web to review physicians in ever-greater numbers, both their bedside manner and the quality of the medical treatment itself. Many doctors have cried foul, not just because they can't take the heat, they say, but because federal law prohibits them from identifying their patients and thus from responding to their critics online. Into the breach has stepped a group called Medical Justice, which provides physicians with a release for patients to sign that would restrict them from opining about their doctor online. Jeffrey Segal is a former neurosurgeon and founder of Medical Justice. He says his intention is not to silence patients but to treat what amounts to an epidemic.

DR. JEFFREY SEGAL: What we are reacting to is a collection of now over 40 mostly anonymous Internet rating sites where doctors are forbidden to rebut because of state and federal privacy laws. We think that Internet rating sites can be done better. The current crop of rating sites fail. And what the waiver is designed to do is to create a mechanism to allow us to pause and get it done right.

BROOKE GLADSTONE: How many people have signed it?

DR. JEFFREY SEGAL: We have two thousand physician plan members. Each doctor probably sees anywhere between one and three thousand patients a year. I don't know the exact number, but it is a big number.

BROOKE GLADSTONE: Now, in your literature you state the reasons for this waiver or release. First you say that the information on these sites is medically unhelpful at best or irresponsible at worst. We looked at a few of these sites, and a lot of the reviews, actually most of them, read like this – you know, always runs late, unorganized, interruptions from nurse, distracted, slow with test results. That’s one of 56 reviews for a doctor on RateMDs.com. What’s the harm in that?

DR. JEFFREY SEGAL: We have no problem with a patient saying a doctor is a jerk. If there are 50 patients that say the doctor is a jerk, pretty good odds the doctor is a jerk. Where we struggle is when people start defining quality of care, something that is a little bit different than grading plumbing or roofing. On occasion, someone feels as if they've been treated badly because of bad customer service, for lack of a better word, and other times they feel as they've been treated badly because of their perception the quality of care was poor. Now, these sites conflate those two into one.

BROOKE GLADSTONE: It seems extraordinary that a doctor would ask a patient to not express their opinion in advance of providing service.

DR. JEFFREY SEGAL: It’s our argument that in 2009, because of how pervasive these sites are and how damaging they can be to reputations, we would like to see a reframing of the discussion to figure out how we can do it better. Number one, many of the sites are anonymous, so what we'd like to do is verify that the patient is indeed a patient. Number two, we would like to see a minimum collection of comments before they go public, and we know some sites are doing that. We'd like to see more comments be aggregated before they go public. And, number three, limit the commentary to subjective impressions as opposed to technical details. If indeed you want to post technical details, it needs to be backed up by some type of expert evaluation.

BROOKE GLADSTONE: Well, let's talk about the technical knowledge, the patient’s perception of the care that they're getting. Doctors say patients really can't begin to judge the quality of complex medical care. Now, many patients say that this is a way that doctors have always shirked any oversight that doesn't suit them. They hide behind technicalities which are opaque. Is there some middle ground on this issue?

DR. JEFFREY SEGAL: Doctors need to take the lead, I think, in defining what is quality of care. I don't think we throw our hands up in the air and say, we never will be able to do it. I think we will be able to do it. But there are some differences between defining what’s good in health care and what’s good about a roofer or a plumber. First, medicine is not a spectator sport. I mean, you have participants. So if the doctor tells the patient, this is what I think you ought to do to get healthy, the patient is an active player in this. Number two, health care is not only delivered by one individual, it’s delivered by a system. And care is often fragmented, and often patients don't even know who their doctor is. And, number three, care is delivered over a continuum of time. We don't really know the true result until a fair amount of time has passed. And then, fourth and finally, not all patients are equal, and some patients have greater risk factors. It’s more difficult to compare apples to apples. I've defined how hard it is. I haven't said it can't be done. I just said it’s very difficult, but it must be done.

BROOKE GLADSTONE: I know that you've said that this isn't a gag order, that a patient can go to another doctor, if he or she doesn't want to sign the waiver, but it certainly feels like one.

DR. JEFFREY SEGAL: Patients are free to communicate to friends, family, other doctors, medical licensing boards, peer review committees. We believe that because there are so many rating sites out there, overall they've done more harm than good. We are free speech advocates. We would like to see responsible speech. And the mere fact that we're having this conversation, I think, is getting us closer to the point where some of the more credible sites will self-police. Once we get to that point where there’s a credible site, we think the other sites that have no credibility will just be graffiti and noise.

BROOKE GLADSTONE: All right. Dr. Segal, thank you very much.

DR. JEFFREY SEGAL: Thanks kindly.

BROOKE GLADSTONE: Dr. Jeffrey Segal is the chief executive officer and founder of Medical Justice.