Some doctors resorting to making patients sign gag orders to cover their butts

Posted by melodieshouse on March 5, 2009

Here in the U.S. defensive medicine seems to be the norm. Choosing a course of treatment that has more to do with CYA than what’s truly in the best interest of the patient. It also seems to be the norm for doctors to hurry through patient visits as a result of heavy workloads, hence many people don’t get to develop much of a patient-doctor relationship. Yet there have been studies published that show lack of communication between the doctor and patient has more to do with complaints and malpractice suits than actual negligence or medical errors. Many doctors fail to sit down and talk with their patients about realistic expectations with regards to treatments and procedures. Heck, most fail to sit down and just talk, much less listen to what their patients have to say or ask them. After a brief greeting, some quick obligatory questions, and an even quicker examination with a few short comments, they hand you your Rx or hand out a sheet with a checklist of complications with consent forms and maybe say, “If you have any questions, let me know/call the office/call my nurse” or something to that effect and that’s it.

Just take a look at these links to see what I mean:

Communication gaffes: a root cause of malpractice claims
http://www.baylorhealth.edu/proceedings/16_2/16_2_huntington.pdf

MD Consult: Law and medicine: Communication and malpractice (very short excerpt, but makes the point):

February 17, 2009

By S. Y. Tan, M.D., J.D.

Question: Doctors who are most subject to lawsuits:

A. Are ultrabusy practitioners.

B. Have poor interpersonal skills.

C. Talk down to patients.

D. Are often in high-risk specialties such as neurosurgery and obstetrics.

E. All of the above.

Answer: E. All choices are correct. The first three speak to hasty evaluations, poor communication, and arrogance. These behaviors predictably get doctors into trouble. Option D describes doctors who must inevitably deal with cat…

Counseling of Physicians at High Risk of Malpractice Claims Lowers the Level of Patient Complaints:

THE PROBLEM

Medical malpractice studies in Florida conducted by VUMC researchers indicated that physicians who lack interpersonal skills are more likely to be sued. The studies indicated that patient perception of a physician’s interest, accessibility, and communications ability was more important than the technical quality of care as a predictor of the physician’s malpractice claiming experience. The research also suggested that physicians who are frequently sued generate higher rates of complaints even from patients who do not suffer an adverse outcome.

In light of these findings, the project director hypothesized that patient complaints about interpersonal aspects of care could serve as an “early warning” for physicians and service units at increased risk of generating malpractice claims.

And last but not least:
Difficult Patient-Physician Relationships and the Risk of Medical Malpractice Litigation – This article was just published in the March 2009 issue of the American Medical Association journal Virtual Mentor. Here’s a quote that’s most pertinent to where I’m going with this blog post:

Increasingly, doctors view patients as potential adversaries. One study reported that concerns about malpractice liability caused three-fourths of 824 specialists surveyed to view every patient as a potential litigant [9]. Moreover, physicians who had been sued and adopted the potential-litigant view of patients were more likely to practice defensive medicine, which further eroded their relationships with patients, regardless of the quality of clinical care.

I found an AP article in my local newspaper online yesterday that rubbed me the wrong way:

N.C. surgeon helps docs track, stop online reviews

The Associated Press
© March 4, 2009

By Lindsey Tanner

CHICAGO

The anonymous comment on the Web site RateMDs.com was unsparing: “Very unhelpful, arrogant,” it said of a doctor. “Did not listen and cut me off, seemed much too happy to have power (and abuse it!) over suffering people.”

Such reviews are becoming more common as consumer ratings services like Zagat’s and Angie’s List expand beyond restaurants and plumbers to medical care, and some doctors are fighting back.

They’re asking patients to agree to what amounts to a gag order that bars them from posting negative comments online.

“Consumers and patients are hungry for good information” about doctors, but Internet reviews provide just the opposite, contends Dr. Jeffrey Segal, a North Carolina neurosurgeon who has made a business of helping doctors monitor and prevent online criticism.

Some sites “are little more than tabloid journalism without much interest in constructively improving practices,” and their sniping comments can unfairly ruin a doctor’s reputation, Segal said.

Segal said such postings say nothing about what should really matter to patients — a doctor’s medical skills — and privacy laws and medical ethics prevent leave doctors powerless to do anything it.

His company, Medical Justice, is based in Greensboro, N.C. For a fee, it provides doctors with a standardized waiver agreement. Patients who sign agree not to post online comments about the doctor, “his expertise and/or treatment.”

“Published comments on Web pages, blogs and/or mass correspondence, however well intended, could severely damage physician’s practice,” according to suggested wording the company provides.

Segal’s company advises doctors to have all patients sign the agreements. If a new patient refuses, the doctor might suggest finding another doctor. Segal said he knows of no cases where longtime patients have been turned away for not signing the waivers.

Doctors are notified when a negative rating appears on a Web site, and, if the author’s name is known, physicians can use the signed waivers to get the sites to remove offending opinion.

RateMd’s postings are anonymous, and the site’s operators say they do not know their users’ identities. The operators also won’t remove negative comments.

Angie’s List’s operators know the identities of users and warn them when they register that the site will share names with doctors if asked.

Since Segal’s company began offering its service two years ago, nearly 2,000 doctors have signed up. In several instances, he said, doctors have used signed waivers to get sites to remove negative comments.

John Swapceinski, co-founder of RateMDs.com, said that in recent months, six doctors have asked him to remove negative online comments based on patients’ signed waivers. He has refused.

“They’re basically forcing the patients to choose between health care and their First Amendment rights, and I really find that repulsive,” Swapceinski said.

He said he’s planning to post a “Wall of Shame” listing names of doctors who use patient waivers.

Segal, of Medical Justice, said the waivers are aimed more at giving doctors ammunition against Web sites than against patients. Still, the company’s suggested wording warns that breaching the agreement could result in legal action against patients.

Attorney Jim Speta, a Northwestern University Internet law specialist, questioned whether such lawsuits would have much success.

“Courts might say the balance of power between doctors and patients is very uneven” and that patients should be able to give feedback on their doctors’ performance, Speta said.

Angie Hicks, founder of Angie’s List, said her company surveyed more than 1,000 of its consumer members last month, and most said they had never been presented with a waiver; 3 percent said they would sign one.

About 6,000 doctors reviewed on the Angie’s List site also were asked to comment. Only 74 responded, and about a fifth of them said they would consider using them.

Lenore Janecek, who formed a Chicago-based patient-advocacy group after being wrongly diagnosed with cancer, said she opposes the waivers.

“Everyone has the right to speak up,” she said.

While she’s never posted comments about her doctors, she said the sites are one of the few resources patients have to evaluate physicians.

The American Medical Association has taken no position on patient waivers, but President Dr. Nancy Nielsen has said previously that online doctor ratings sites “have many shortcomings.”

Online doctor reviews “should be taken with a grain of salt, and should certainly not be a patient’s sole source of information when looking for a new physician,” she said.

Dr. Lauren Streicher, a Chicago gynecologist, got a glowing recent review on Angie’s List, but also remembers a particularly snarky rating from a patient angry about getting brisk treatment after arriving 30 minutes late to her appointment.

She said she sympathizes with doctors who ask patients to sign a waiver.

Streicher said she has seen shoddy doctors praised online who she would not trust “to deliver my mail much less my baby.” Conversely, bad reviews can destroy good doctors’ careers, she said.

“Are there bad doctors out there? Absolutely, but this is not a good way to figure it out,” Streicher said.

Dr. Segal, a neurosurgeon (one of the most likely to be sued) has started a company that sells subscriptions to a service that’s supposed to prevent frivolous malpractice suits. A benefit of subscription is providing ready-made gag order contracts to other docs for their patients to sign so they won’t submit a complaint online. This shows extreme arrogance not to mention a very adversarial stance toward patients. A doctor that gives a new patient a gag order to sign probably has something to hide, or at least gives that impression. There’s no way I’d trust my health and life with a doctor that wants to compel me to keep my mouth shut in exchange for his/her care. I’m all for Mr. Swapceinski’s idea of creating a “Hall of Shame” of docs who require waivers (gag orders) on RateMDs.com. There’s an easy way to know who to avoid.

I understand online reviews are not a perfect system, they’re far from it, but considering the sorry state of health care in the U.S. and the nearly non-existent relationships doctors have with their patients anymore, how does trying to remove bad reviews and getting patients to sign waivers help? There’s a serious lack of transparency with regards to physician backgrounds and track records. There absolutely needs to be a patient-based feedback/review system for doctors since hospitals and state medical boards refuse to publish patient complaints. However, I think anonymous feedback should not be allowed, so those with complaints can be held to backing up their claims.

Look and see what Dr. Segal’s company Medical Justice is all about. Do you think the overall tone is appalling?