Be careful what you sign at the doctor's office

Angie's Blog > February 2009 > Be careful what you sign at the doctor's office

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Posted: 2/24/2009 8:33:50 AM By Angie | 33 comments

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In a small, but scary trend, a growing niche of health care providers are requiring their patients to sign away their right to comment openly, anonymously, publicly and privately about the level of service they received from that physician – good or bad.

So, even if you’ve had a great experience with your doctor and you want to share that information on a forum where expectant mothers gather to chat, or even with just your friends and family, you can’t do it if you sign that waiver. Well, we’re completely against any attempt to stifle free speech. Consumers – or patients – should be free to post doctor reviews, just as that doctor has a right to respond to that review.

One complaint from the medical community is that online rating services are filled with anonymous and critical reviews of doctors. But Angie’s List reviews aren’t anonymous – we, and the doctor being reviewed, know exactly who submitted the report. And, for the most part, the vast majority of the health reviews submitted to Angie’s List are positive.

What do you think? Should patients be required to waive their right to free speech in order to receive care from their doctor? Would you allow a surgeon to operate on you, knowing that if something goes wrong you have lost your right to make others aware of that doctor’s performance? Have you had to sign a privacy waiver yourself?

Check out some recent press on medical gag orders on Fox Tampa, Fox News and Florida Health News.

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Comments

	Colette
	I personally have never seen such a form. If my doctor gave me that paper to sign, I would tear it up, throw it in his face, and walk out. There's always another doctor. It seems to me that a good doctor has no need of such a form. Only doctors who deliver poor service would even need one of these forms. The solution to this is simple-don't sign. If the public at large refuses to sign it, then the doctors will give up.
	6/29/2010 2:41:01 AM
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	Cris
	I agree with the physician. I fyou do your job to the best of your ability and see your patients as people who most of which seek to have good health you're golden. The practitioners who see every person who walk through that door as money, and nothing more..... bad. Bad bad bad.... You cannot sign away your rights. Freedom of speech is ours. I can't imagine anything of that sort would hold up in court! If you have to do such things in your practice you have issues. As a patient I would never, I'd walk out the door and never return.
	12/9/2009 9:36:06 PM
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	jmo
	as patients we have the right to shop for a doctor, their are good ones and bad ones, how come a doctor does NOT have the right to shop the patient their are good ones and very bad ones. a patient has the right to do or say any thing about the dr but the Dr can not do or say anything about the patient. the lawyers have made it so the doctors MUST protect them selves against rediclious law suits. why is it freedom of speach for the patient but not the doctor. btw I am NOT a doctor.
	10/29/2009 3:33:52 PM
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	Anne Z.
	I live near Pottstown, Pa. I have been seeing my Dr. for a number of years now and am very satisfied with him. In june 2009 his practice was bought by a corp.who are buying up hospitals and Dr. practices in this area. Now my Dr.s office is calling me to send any records they don't have from other Dr.s to them; that I have to get a mamogram; and instead of seeing him every six months that I have been doing for years I now have to see him every three months. I told them that I own my body and no company is going to tell me when I should see my doctor. I was told that I can sign a waver. I have not seen the waver yet, but I have a feeling when I see it I'll be looking for a new Dr., which will be hard because this corp. has bought most of the practices in the area. This corp. is a for profit corp. and they are doing this all across the country. They made billions of dollars in profit in 2008. Is there any info on this out there? It should be stopped.
	10/20/2009 11:45:03 AM
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	Maureen
	most of the posts here focus on the right of free speech under the 1st Amendment. What ISN'T being discussed is the fellow and EQUAL rights under the other Amendments, namely "free speech by doctor not allowed by HIPPA", secondly, "protection of the doctor against FALSE ACCUSATIONS", thirdly, "right of doctor to FACE HIS/HER ACCUSER, especially on EVEN GROUNDS", fourthly, "the right of PRESUMED INNOCENCE of the doctor until proven otherwise in court of law, not in a blog" there is no way around this last one-doctors will have to be judged on empirical data not mere opinions which could have resulted from patient being fired for drug seeking behaviour, yelling at staff, failure to show up for appointments, doctor shopping, non-compliance with treatment, and so on. These are emotional issues similar to divorce or long term dating break up, and people say and do things they shouldn't and wouldn't do if they knew they would be held liable for what they said. Finally, postings could easily be seen as libel or slander if directed against the doctor under conditions noted above or similar conditions---where does the doctor go to get his/her repu-tation back even if posts end up getting retracted/removed. Many of us practice in small towns and news travel fast, once the damage is done is hard to undo, no matter how innocent the doctor may have been. Finally Angieslist could be held jointly responsible for some of the situation pointed out above. I am not a lawyer, just a doc, but if I can do the above off the top of my head in 20 minutes think what a great lawyer could do with months to work on it. The doctors I know do report bad doctors, I have done so myself, and as Chief of Medicine I enforced removal of a doctor from staff and reporting it to the state who removed his license. That is the arena where this should occur, contact your State Medical Board or Department of Health. They have attorneys who investigate these things but they also investigate the patient too, so is fair. The government is in process of rating doctors and hospitals based on scientifically empirical unbiased data, it may be going slow, but is better than ruining a career in a blog that the doctor MAY NOT EVEN BE AWARE EXISTS!!!!! remember the old saying about the US Justice system---"It is better to let 100 guilty men go free than to punish ONE INNOCENT man".
	10/12/2009 8:22:32 AM
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	Dentist Plano
	Yes, exceed the expectations of your patients.
	7/21/2009 4:58:08 AM
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	Dan T.
	First, I am sorry tosay the Constitution provides no protection from such abuse. It merely prohibits Congress from passing a law abridging the right of free speech. A private contract between persons is not regulated by the First Ammendment. It is possible for an applelate court to rule such gag clauses to be against public policy and therefore invalid, but that cannot happen until someone is taken to court by the person attempting to enforce the clause. Bear in mind that such non-disclosure agreements are common in certain commercial settings and in contracts for personal services (such as a nanny to a child celebrity), so they are not entirely repugnant to the legal system. Always read and obtain a copy of what you sign, especially when you are under pressure or otherwise emotionally vulnerable. In many instances, the doctor or hospital routinely asks for signatures on documents that they desire but are not actually required to get the service you need, so ask what would happen if you don't sign and ask for a written statement of the consequences of not signing. If the doctor will not give you this, run away.
	3/25/2009 3:58:13 PM
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	M. King
	Welcome to the New World Order - where freedom is the freedom to be positive or shut up. Very similar of current trends in US Government
	3/24/2009 6:33:38 AM
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	Jane Doe
	What if we encounter malpractice? What if we don't know what we signed, thinking it was just one of those standard forms we'd been signing for years, and perhaps it was but we're afraid to ask now, since we've encountered malpractice? What recourse do we have? I am considering reporting the doctor in question to the medical board. Surely this does not deny me this right. There is a serious need for the board to review charts to see if this is a habitual practice of this knife happy doctor.
	3/24/2009 5:12:50 AM
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	Dyck Dewid (not all-knowing)
	We can publicize the fact of what medical practices have for patients to sign, like in Angie's list. (Public media won't sell time to anyone for this purpose). There are other appalling things to sign too, often at the last minute before surgury or taking a test. Many of these are financial, like the disclaimer that says Medicare or Insurance will probably not pay and that you are responsible to payment-- Without Any Cost Disclosure, even when the procedure is known. BTW, Medicare is a culprit because it says for certain expensive procedure it won't tell you if it's covered until after it's done. And no one has mentioned the current floating contract of medical practices, banks, credit card companies, internet, etc.. This allows them to change terms anytime. And if you Don't object you imply consent. Some don't even notify us. They say it is our responsibility to periodically read the entire contract. Personally, this doesn't seem like a contract between two persons at all. Yet millions of people are agreeing to it. And so the objective: To be without Responsibility, is accomplished. So, these things are happening because we allow it. We, the public don't read contracts. We seem to want whatever we want so badly that we'll do anything. We seem to be weak in our state of wanting and grasping and greed. We seem incapable of taking responsibility for our own acts. We point our fingers, but we are really they. Am I not the employee, practitioner, government, etc., who seeks more money, power, control or whatever? Could it be that this is the result of weakness in living such a contrived life?
	3/22/2009 9:51:59 AM
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	Amy
	Angie, Thank you for bringing this to everyone's attention. As I see it, a very power entity is trying to hide the horrific mistakes and behaviour of their peers. I agree whole-heartedly with Micheal, Betsey and Carla. I would like to share something else I bet very few realize. HIPAA is not there to protect you or your privacy. By signing the HIPAA waiver you sign away your rights to privacy. I made a complaint against a doctor, who inturn removed my confidential patient info (PHI) from the hospital, shared it with others, and used it against me. I filed a complaint with HHS/Civil Rights Div and I was stunned at the response. If a patient so much as makes a complaint against a doctor, not even a lawsuit--the physcian has the legal right to use your PHI in any way he/she deems necessary. I preasured Amy Kaplan of the HHS with: 'So, if a patient has info in his/her records that could ruin his/her life--such a an STD, an abortion, drug use, depression, maybe had an affair and was tested for an STD, is the physican allowed to make that info public to defend himself?' The answer was "yes". We have legal black mail in this issue. A patient may have to choose between making a complaint against a doctor and having his/her life exposed and ruined, or letting the offender go in order to save dignity, marriage, etc. Furthermore, when PHI goes live to the world, every healthcare worker will have every bit of your info and will have the same opportunity to threaten you in the same way. Keep quite or your life will be exposed. I ask everyone to verify this for yourself--please. This too is another way in which we are being silenced. It is a choice a patient should not have to make to complain about a bad doctor.
	3/18/2009 10:51:05 PM
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	Carol
	Slander and libel are NOT protected speech.
	3/18/2009 2:17:31 PM
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	Carla
	Your PRO-ACTIVE stance is WELL appreciated Angie!! Thank GOD you are here! The medical profession has fallen very short of where it used to be. One reason: the "White Coats" ring of silence. Even if another doctor knows of a colleague's poor care of patients, they will remain silent. You'd think they were all in lock down, afraid of being labeled a snitch, and shanked in the shower! The good doctors, and there are PLENTY out there, need to do a better job of policing/policying their own! PERIOD! Over 100,000 patients DIE each year from medical "oops" -- that's MORE then DOUBLE the death of car accidents per year (God rest their souls!) Look what pressure the auto industry has to ensure safety!! And compare that to the medical profession! YEAH -- pretty scary. You are more likely to die at the hands of a doctor then in your car, but I bet you didn't know that!! The AMA at its finest!! "To YOUR Health!!"
	3/18/2009 12:31:22 PM
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	Kate
	The idea of using your feet instead of signing would be fine if there were enough doctors to allow that. Right now it is very hard to find a doctor who is accepting new patients particularly Medicare. This is probably a bigger problem in rural areas than in big cities.
	3/16/2009 1:23:52 PM
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	gloryoski
	It's pretty sad that in some cities store clerks, waiters etc. can get "written up" publicly, in newspapers and blogs for allegedly not dealing correctly for things like Mcnugget malfunctions, but doctors, who we entrust with our health and lives, think they have the right to pull this. Just another example of the two-tiered society that we are getting.
	3/16/2009 10:45:56 AM
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	heartlandjen
	I agree with 99% of what most others here have said, including Betsy, but even if some doctors have broken trust with patients, I take a less pessimistic view and believe that any rift can be repaired if both parties are interested in closing the gap. However, it does take work and willing feet...and perseverance. We are a strong society, as evidenced by the fact that we can have this conversation! :) The majority of people, as soon as they know someone is trying to fleece them still stand up for what's right. The love of money (not money itself) is the root of all kinds of evil, and the practice in ANY business of working for profit instead of the greater good will always be harmful, but take heart!! Call it karma or the golden rule, but "what goes around comes around" and eventually those who measure life by all these external things like money will be very poor indeed when they can't take the money with them where we all one day go...
	3/16/2009 9:36:03 AM
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	Betsy
	"With great power comes great responsibility".I think that, unfortunately, the Medical Community has brought this on themselves. We all know of MD's who have practiced incompetently for years with total impunity. Some who have even had to leave a community because the word of mouth was so bad...only to set up shop in another part of the country and do harm to a whole new set of unsuspecting customers. DR.s could have kept themselves above the fray, but they allowed managed care, big pharm and insurance co.'s step in and take a sacred art and change it into big business, controlled by MBA's and J.D's and CPA's. So now, medicine is driven by motive for profit, instead of by the vision for healing that it should be. You can't expect to charge people outrageous fees, give no reasonable assurance of quality or standards, refuse to hold your colleagues accountable when they are incompetent, and then expect people to accept your knowledge, skill and judgement blindly. Life just doesn't work like that. And I'm sorry, but medicine is not hairstyling. Your hair grows back in a matter of weeks. Health is forever, and the destruction of health or loss of functioning or needless suffering that occurs because of incompetence is just unnacceptable. Any practice that includes a gag order in it's policy for patients seems to be shouting to the world that they aren't worth their salt. The medical profession have broken that sacred trust and it is unlikely that it can ever be repaired. They reap what they sow.
	3/13/2009 12:00:03 PM
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	Michael
	It's absurd to openly criticize doctors. Especially when the doctor cannot defent himself without violating doctor patient confidentiality. DOCTORS are bound to this but patients are not.If you don't fit with your doctors personality...MOVE ON. Just like you'd just find another hairdresser.
	3/12/2009 5:56:18 PM
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	David
	Part of the problem is that some unscrupulous practice managers recruit their friends to flame their competitors online and to talk up their own practice.
	3/12/2009 9:04:23 AM
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	Roberta
	We've become a CYA paperwork society unfortunately, so expect to take extra time when you commit to ANYTHING! Read carefully! I signed something like that when I was laid off from my job, volumteered for charity work, bought an appliance...you name it...
	3/11/2009 9:42:34 AM
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	melanie
	what part of the country is this happening? i live in the texas panhandle and i've not seen this done - yet! melanie
	3/11/2009 2:54:25 AM
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	Ellen
	This is the first I have heard of this and I am extremely upset. What has happened to freedom of speech? I once had a very bad experience with a specialist and I immediately told my referring phsyician to make sure that he put on my record to never refer me to this Dr. again. I guess this would prohibit even that conversation! My group has a sign in their office stating somelthing to the effect that the best referral they can have is one coming from their patient. This would also prohibit that! This is very bad news!
	3/10/2009 8:14:44 AM
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	Reb D.
	Although I'm not in favor of the waivers, I would disagree with Robert Johnson, J.D., in that it toys with unconstitutionality. Unless its the government demanding that free speech be stifled, the Constitution doesn't have any effect. A private citizen (the doctor) has every right to set the conditions by which he/she will engage in a business transaction. Likewise, patients have every right to vote with their feet.
	3/10/2009 4:29:43 AM
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	Rene Lane
	Just because you SIGN doesn't mean that you still can post comments or speak out loud. Not to mention changing your name to get the info out about a bad Doc or Instutions.
	3/9/2009 4:48:20 PM
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	Jesse Barron
	Let them. I have already thought of a few ways that a lawyer could turn that around on them in a malpractice suit. I can also see how a lawyer could argue for higher damages from a gag order of such.
	3/8/2009 4:54:51 PM
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	Lindavan
	There are 1 in 400,000 people that have Endothelial Dysfunction Causing Coronary Artery Spasms. Would like to hear about or from any of those people. Lindavan
	3/8/2009 3:27:07 PM
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	Robert Johnson,J.D.,Ph.D.
	I fully agree that a prospective patient should read any documents they are asked to sign carefully. If they contain the type of waiver in question I urge them to find another physician. If, for any reason, the person feels he or she has no choice but to sign up with a particular physician and the waiver is later a matter of contention my advice would be to contact a good civil rights attorney and seek an injunction against the waiver. I agree with Dr.Rankin and I also suspect that a physician who requires such a waiver is toying with unconstitutionality - unless of course he or she can claim it is a matter of "National Defense"
	3/8/2009 2:36:18 PM
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	Barbara Consumer
	I have not run into this. It puts a consumer in a quandary. If she refuses to sign, what than? The best and worst form of advertising has always been word of mouth. We rely on it as a necessary discernment tool. I believe such a "rule" is unenforceable. People talk. Who's to say who spoke first?
	3/8/2009 1:55:29 PM
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	Debbie Riffel
	Well, fair is fair, I think if we require this, then so should daycares against anything going wrong, restuarants from any problems, insurance companies on behalf of their customers against any "negative comments" or liability for their actions. And lawyers against anyway they effectively or poorly represent their clients against any outcome. Where would it end? Oh come on, the word would get out anyway! Wake up! Just as the law forbids you to give a "bad" reference to someone listing you for a job application you simply say I cannot comment and they know what you mean by your voice and your facial expressions, they say it all. Doubt it? Check out the new show Lie to Me, google it and take the test! and no I am not affilated with them. On the other hand, be sure to recomment the doctors and dentists and their teams who do good work, everyone wins then! God bless you all!
	3/7/2009 2:29:10 PM
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	Elaine Lewellyn
	So what happens when I cross out that section (right to communicate) and then sign the form? Does the doctor refuse to see me? Then where do I go for medical treatment?
	3/6/2009 10:57:33 AM
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	Joan
	Thinking that I was signing a HiPPA form, I signed one of those agreement to not discuss my doctor. Can I ask to get it back? I asked for a copy which I read more thoroughly later and was upset. I had never seen anything like it and will be more careful about what I sign in the future. I shouldn't have been so trusting and am warning others
	3/5/2009 1:58:59 PM
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	Marcia
	Asking/requiring patients to refrain from reporting about the level of service received by any type of medical practitioner/facility is a violation of free speech and certainly would lead to a compromised medical/dental care. The doctors and any other professionals would have no reason to strive to improve their abilities. It is a horrible practice and should be outlawed in all States.
	2/25/2009 11:36:51 AM
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	Patrick Rankin, MD
	As a physician we are not above criticism and we all like compliments. I would suggest to my colleagues that the best way to avoid criticism is try to exceed expectations for your patients. Patients are aware that we aren't perfect and that we can't keep everyone happy. They are also the first to stand up for us if they think someone is being unfair in their criticism.
	2/24/2009 5:15:49 PM
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