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Angie's Blog > March 2009 > Medical gag order coverage

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Medical gag order coverage

Posted: 3/18/2009 4:48:40 PM By Angie | 111 comments

Check out the most recent Angie's List coverage on medical gag orders at the Magazine's site.

They've done excellent reporting, and we've already gotten some great feedback from readers--feel free to add your comments, questions and thoughts below.

Edit 5/28: Please remember that all comments must follow the blog comment policy or they will not be posted. Thank you!

Trackback URL: http://www.angiehicksblog.com/trackback/2371e1b6-7a84-4a0c-8f81-6406f3b30d01/Medical-gag-order-coverage.aspx

Comments

Morris

The March 18 story on medical gag orders ignores an important aspect of rating service providers of any kind -- the difference between reporting behaviors of the provider vs. reporting characterizations of a provider without the backup of specific examples. The difference, however, is well-illustrated in the first few paragraphs -- two vastly different ratings about the same Boston area doctor. The first described the doctor as "difficult and rigid," also "moody, controlling, and the coldest fish known to womankind." While these opinions are not unimportant, they should not be given the same weight or the same level of prominence as ratings that reflect specific behavior. The second review of the same doctor contained some of these elements: "gives time and does not rush," keeps records "up to date," and is "very good about referrals."

In my opinion, Angies List would serve members best if it provided a means by which members would be encouraged to give specific behavioral examples of what they liked or didn't like. Not only could other members evaluate for themselves how important that specific characteristic is, but it would increase the value of the feedback to the provider. If someone calls me difficult and rigid, I can't really improve unless you tell me what I did to give you that impression. But if you tell me I am consistently 30 minutes late for your appointment, I can take steps to change that. A change in the reporting structure along these lines should therefore improve the credibility of the ratings with doctors.

I am unimpressed by the providers' fear of "character assassination." My guess is most Angies List members are sophisticated enough not to base a judgment about a provider on one member's rating. It's the pattern we look for. If most ratings are quite positive, we are likely to discount one or two negative ones. Likewise, if most ratings are negative, we are quite rightly going to be wary of that provider.

3/18/2009 4:59:50 PM

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Dr. Erika

With all the lousy medical service around, a service like this is very important.

3/18/2009 5:00:26 PM

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Jonathan

Pretty clearly there should be no limitations on free speech as a general rule, and I see no reason why the situation with doctors should be any different or why any of them should be allowed to pursue and actually insists on contracts disallowing it. On the other hand, doctors should be allowed to respond, so while good outfits like yours should indeed pursue disallowing these contracts, they should with equal vigor pursue changing the laws so the doctors can respond to specifics brought up by their patient. I'm no seer, so I can't tell you exactly how this should be done, as it's a complicated issue to say the least. But I bet the AMA would help you there, and you might well be able to come up with a common position on the whole issue, and that would be a potentially quite a really positive result.

3/18/2009 5:00:59 PM

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Thomas

The physicians’ arguments are garbage on more than one account. First, any privilege of confidentiality belongs to the patient and can be waived by the patient at will. This is true by law from the common law origins of privileges in communication. Therefore, a patient can without fault or liability “rate” the physician and the quality of the medical service provided and the physician has no more cause of action against the patient than a contractor does against a dissatisfied customer. It’s just the fact that those who society allows to develop a God-complex as a function of their training and prestigious position in the community don’t like being told by some commoner that the physician is less than God.

Second, I have researched HIPAA extensively to advise my clients about its provisions and limitations. It does not apply to a patient who chooses to disclose his or her personal medical information and expenses publicly by hard or electronic copy. The patient’s power falls within the same parameters as the waiving of the doctor-patient privilege. HIPAA is to protect the patient from the provider, not vice versa.

Doctors practicing junk medicine, charging inappropriate fees, and loophole billing insurance carriers and patients ruin the entire profession. I suspect it is the practical application of the saying, “A few bad apples spoil the barrel” but it is impossible to know if all patients are prohibited from rating the doctors. What a horrible thought that the former-nurse wife might have to drive a Lexus rather than a Mercedes or that the kids attending prestigious, private schools and universities might have to attend public schools or state universities.

3/18/2009 5:02:21 PM

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Susan

If people could submit legitamate complaints to medical review boards, then cases could be reviewed and that information could be posted for the public. I think that governments are not doing their job in this area and that is one reason this problem is rearing its ugly head. Most doctors end up completely exonerated whenever complaints are filed. I think there could be a website setup where folks could look up specific doctors review objective information about a doctor. That might actually be useful information that would satisfy both doctors and patients. When a doctor does something that harms a patient that information must be available to the public.

3/18/2009 5:02:47 PM

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Andrew

Here’s the issue: the doctors have no opportunity to respond without possibly violating confidentiality. Additionally, when a consumer buys a toaster, or a car, or a new roof, they know what to expect. When they go in for brain surgery, neither they nor the doctor, know exactly what they are going to find…

People often forget that while medical research is a science, practicing medicine is an art – and everything I’ve ever read says that Picasso was a real ass… Would you rather have a grumpy doctor (who is a person and has bad days like everyone else) who is a genius with a scalpel or a happy, cheerful doctor who tries to fix your ACL with a butter knife?

3/18/2009 5:03:29 PM

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Nick Slenkovich, MD

Angie,
I just joined Angie's list tonight. As a physician that does ask patients to sign what you refer to as "gag orders," I am very interested in this issue. I can’t comment for other physicians, but I can reply to your question “What ails the doctors?”

First, let me say that I believe that Angie's list IS doing it right in every way. The list of steps you outline in your post are as thorough as I’ve seen and are truly aimed at obtaining open and honest reviews.

From what I saw of your physician ratings in the Denver area (and, by the way, I did not see that I had been rated), there were many positive comments. Unfortunately the number of reviews for the docs in the area is far too few so far to be anything like a representative sample, but hopefully that will come with time.

While your site has exceptional protections to avoid anonymous slander, random irresponsible comments and "cheating" by others posting against competitors, I am afraid that you are the exception. From my understanding, it is exceptionally difficult to get online comments removed from websites and that site hosts are under little (if any) legal obligation to comply with a physician’s request to do so.

Please understand that I have no fear of being rated on your site, and I invite any of my patients to post their experiences!

At the same time, I do have a family to support and a lot of medical school loans that are still in repayment. I have worked for many years to obtain professional training, expertise and skills. And my fear, as I believe was mentioned in the Houston Chronicle article mentioned in your post, is that a few random, non-representative, "anonymous" comments could threaten my livelihood unfairly.

I am coming to fear this less and less, however, and as more and more information gets "out there," I believe the public will be well served and be smart enough to interpret the whole range of reports and comments on physicians.

Accordingly, I am working to get my reputation "out there" on the Internet, as ultimately this is the best protection for me and for patients and will serve everyone's interests.

I only wish I had 20 reviews on Angie's list--if a reader couldn't get a pretty good idea of my bedside manner, the dedication of myself and my staff to helping patients reach their goals, and my outcomes from that... I don't know what else could do it.

Unfortunately, however, your site is the exception. The majority of doctor-rating sites that I am aware of (just google "doctor reviews" and you'll see plenty), are businesses that make money selling ads on their sites. Some are good, some are not.

The barriers to entry for starting a doctor-rating site are a good bit smaller than those to becoming a plastic surgeon. I believe that such sites are often started by searching databases to collect information, a significant portion of which is incorrect. I have yet to have one of these sites go up with the correct information about me. For each of them, I've had to submit many corrections about what state I practice in, my address, my primary specialty, etc. I'm not here to say that this is wrong, just that the goal of these sites is to make money, and they clearly don't have the resources to go out and verify that the information they are posting is accurate.

The same goes with the anonymous posts. There is little requirement for site operators to verify accuracy or even that the author of the post is even a real patient of a physician’s. Perhaps I am unrealistically worried about the potential trouble out there, but if I do feel that a site has recklessly threatened my ability to practice at the highest level of professional care and ethics, I would like to have some possible recourse.

In a physician-patient relationship, all information about that patient is confidential. Even in the absence of laws such as HIPPA that prevent the release of patient information, simple professional ethics prohibit this. That some sites allow physicians to rebut a posting is of little help, as it would be unethical, illegal, and inappropriate for me to publicly comment in response, and even this would only be hypothetically possible in the scenario where a post was indeed made by a real, non-anonymous patient.

In summary, I applaud your efforts and would be more than happy to discuss this with you at your convenience. I have not asked any site to remove any post or any information about me (save for many, many factual errors), nor do I anticipate doing so in the future. So it is safe to say that I do not feel that I have a “gag order” on anyone. But I do put myself, willingly, on the line for my patients each and every day and wish to be able to do so for a long time to come.

My business is not like that of an internet-site owner. If the site fails to make money, the Internet entrepreneur is on to the next project or job. This is my career, my chosen profession, and I’ve invested the majority of my adult life into it. That said, I will review my current practice of requesting that patients sign our mutual privacy statement (which in no way abridges one’s rights to discuss their care or experiences anyone they chose) and ask for more patient feedback on this issue. In the many discussions I have had with patients to date, I have not had a single patient resent this request, refuse to sign it or otherwise complain that it was inappropriate.

Keep up the good work; I again applaud the impressive level of diligence you have shown in your effort to obtain honest, real reviews. I do hope you get enough reviews of professionals to be a more representative sample, as I do not feel that just one or two is sufficient. Physicians see thousands of patients. Until we can find a way to get many, many “real” reviews out there, we are likely to continue to see the extremes—the super-happy patients and the rare patients that have had a bad experience.

I would look forward to talking with you.

Regards,
Nick Slenkovich MD
Director, Colorado Plastic Surgery Center
Denver / Littleton, Colorado
http://www.ColoradoPlasticSurgery.com

3/19/2009 3:49:41 AM

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Joy

I think rating doctors is a good thing. Because some knowledgeable
folks shared their experience with doctors on-line, I was finally
able to find the doctor who restored my health -- but after 20 years
of poor health and little hope.

However, my doc's protocols, while effective, are not currently the
most popular treatment, although they once were. Recently, similarly
minded doctors in my state have been hounded by the state medical
board to change their practice.

I don't want that for my doctor so I will never post his name on your
site or any other unrestricted site, even though he could be of help
to others. It's an aspect of doctor rating you should be aware of.

3/19/2009 9:22:09 AM

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Dr. Thomas F.

These types of websites are exceedingly deceitful, because often people that end up submitting reviews are frequently those with as grudge.

I had 3 postings with very similar verbiage which I believe came from a particularly onerous patient who objected to the fact that he had to pay his bill, and when he refused and I sent him to collection, I receive negative feedback on several different sites. Even the phrase is where the same.

The problem is that these sites are anonymous, and it's entirely possible to post a negative comment about a physician who conceivably never even had contact with the patient.

People do better where there is a real survey mechanism in place, such as the local version of consumers reports, which I believe is called consumers digest.

I was ranked as one of the top 100 physicians in 5 Counties, yet still received a negative review.

So if people choose a doctor based on these reviews there crazy.

It's wiser to take the time to go in and meet the physician, and ask for an interview but be realistic, and be willing to pay for the interview.

My personal rule, is that I don't think I could go out and have lunch with the patient, they are not the right patient for me.

Remember, the relationship is a two-way street. If you don't have a friendship and high comfort level with your doctor, you're in the wrong office.

3/19/2009 9:23:19 AM

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Bonnie

In reference to the "Medical Gag Order" --- It is outrageous to think that any Doctor would expect anyone to sign such a document. That would certainly be a "red flag" to me and I would immediately turn around and leave to find another medical practice. A doctor is hired to provide a service to you and it is a contract just like hiring a plumber. There should be no fear of criticism from capable and caring professional Doctors.

3/19/2009 9:23:47 AM

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Norm

Doctors have no more right to a gag order than my plumber or car mechanic.

Norm

3/19/2009 9:24:03 AM

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Dr. Gilmore

The point of ratings is to show the way to better care. Some voices here seem to want to use it as a weapon against doctors who they believe have had too good a life practising poor medicine. There are already avenues available to complain legitimately for doctors who practise poor medicine. The key to a ratings system should be to make it as reliable as possible by taking out the some of the subjectivity and vindictiveness. Is it really helpful if you hurt good people in the process of what you call "providing a valuable service"? Not in my profession. We are not allowed to hurt a few so we can cure a few. I have reviewed this issue extensively elsewhere and there is a middle ground.

3/21/2009 5:20:10 PM

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Sue

There is also a website where students can rate teachers. I find that it is the inadequate teachers who are against it. Good teachers have nothing to be afraid of and are all for it.... myself included. Sure, there may be a rare disgruntled student or patient who says something that may not truly describe the professional--- but people can figure that out. For the most part these type of sites are very fair-- and I think very helpful. I am hoping to see more and more of them.

3/23/2009 2:16:09 PM

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John

If this attitude is held valid, it implies that it does not matter
which occupation is in focus. Freely substitute "plumber",
"salesman", "rapist", "drug dealer", "crook", or "terrorist" for
"doctor" with equal validity. Gagging doctors should be targeted as
"unscrupulous with intent to commit malpractice (UICM)".

3/23/2009 2:17:19 PM

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Lori

I think the doctor story is great and I think we the people should have the right to speak our thoughts on doctors for others to see and read.
Do you have any more stories like this in the Indianapolis area? I had a problem with a doctor in Indianapolis,Indiana.

3/23/2009 2:18:08 PM

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Tim

Yet another example of Profit Care coming before Patient Care.

3/23/2009 2:18:41 PM

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M.P.

I would cancel an appointment if a doctor asked me sign away my right to tell my friends and acquaintances whether I was satisfied with his/her care of my health.

3/23/2009 2:19:02 PM

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Marian

Why not, We have personal and financial rights, Doctors have been able to advertise for several years now. The best advertisement is word of mouth which is what Angieslist is all about. If the individual doctor is doing the right thing for his/her patient, they should have nothing to worry about, it's those who aren't that we want to know about.

3/23/2009 2:21:00 PM

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Audreianna

I once was asked to sign a form agreeing to pay for a dental appointment if I was unable to cancel 24 hours prior to the appointment. After telling the dentist I would sign the form, IF, he would sign the addendum I had written at the bottom of the form, which stated he would pay my hourly wage while waiting beyond my “appointed” time for care. He laughed, shrugged and waived the form.

We have every right to speak the truth about the care, service, treatment, attitude, and outcome of every experience we encounter with “professionals”. If they really give the glory to GOD for their abilities, then they will give the grief to HIM too.

3/23/2009 2:22:27 PM

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I am an Angie's list subscriber and an internist
I think its FINE for patients to comment as long as the comment can be answered by the physician-eg you give up your HIPAA rights , the doctor can reply . The doc should also get a copy of this comment .

My biggest concern is patients who are abusers of prescription pain meds. I have been in practice in the same place 18 years , I am not perfect but my practice is over-ful, people wait years to get in sometimes. New doctors are vulnerable, they don't have a patient base, all the drug users come to see them and one of them can torpedo a new doctor on this site at no risk to him/herself .

Prescription drug abusers often threaten to complain to the insurance commissioner, their insurance company, my employer or the ACLU (why the ACLU?) when I catch them getting prescriptions from more than one provider or selling the leftover drugs or stealing pain meds from a family member with a legitimate prescription. If they are selling or stealing rather than just overusing I turn them in to the police, who have "bigger fish to fry" . They also learn that no one else will give them medications, so they often drive to another town for "better" medical care .

When they complain to a board or insurance company , there is an arbiter who investigates before this is made public.

3/23/2009 2:23:17 PM

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George

Sorry it's taken me so long to send a comment, but I never realized when I retired some 20+ years ago that an ol' fud can be this busy.

Of course, a lot of the busyness consists of meeting new people, most with MD or RN after their names, with whom you're going to interact in one way or another (but at least I still remember when I meet them again in a week, month, even year, that we've met before). Of those I've met over the past years, none has ever asked me to sign a "no public comments" waiver, which is a good thing. First, because that would limit my reports to Angie's List. Second, it would take away my First Amendment rights. Third, because I wouldn't do it--in fact insistance on a signature before treatment would prompt me to mention that's the one thing I might well file a lawsuit for.

I understand that doctors and nurses are people, people who sometimes make unintentional mistakes. I realize, too, that I am not an automobile that a good mechanic can guarantee a fix for whatever is wrong. I have met medical people I didn't agree with, or like, but that just means get another opinion and/or don't go back to that person.

The ethnic Pakistani surgeon who did my quad bypass was an excellent practioner with a terrible bedside manner. But I would go back to him in an instant if now, 12 years later, I needed another heart job. Actually, I do, but at my age (82), and heart condition (not good), a further operation won't be necessary.

But we've become a very litigious society, to the point where another doctor I know (as a person), perhaps the best neurosurgeon in Nevada, dropped his practice because, even tho to my knowledge he had never been sued, his malpractice insurance had gone so high it wasn't worth it to him to stay on and keep up with his field. That's a shame.

3/23/2009 2:24:50 PM

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Beverly

If a doctor knows that they do their job to the best of their ability then they should not be concerned about these lists. One cannot please every single person and should expect a bad review or two because of that but consumers also need to look at the big picture. If a doctor has 10 reviews and only one of them is a bad review then the consumer should realize that either the doctor was having a bad day (not an excuse) OR it is a review written by a patient that cannot be satisfied for whatever reason and took it out on the doctor.

I would be very leery of any doctor that asked me to sign one of these and would go to another doctor. It would also make me doubt the abilities of that doctor and wonder if they had anything to hide.

On another note, if doctors can be judgemental and deny treatment to a patient that is an attorney, married to an attorney, or has been in a lawsuit of any type then it is only fair that people can give their opinions on doctors care. The world does not revolve around doctors and some doctors need to learn that and if they have to learn by getting bad reviews then that is their own fault. If you can't stand the heat then get out of the kitchen.

Thanks for the vent and have a good day!

3/23/2009 2:26:59 PM

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Janet

I am a new member (who hasn't posted anything yet). I appreciate your coverage of this story. I hadn't heard of it before reading the lead article, and I'll certainly make it a point to look at the last pages of all the stuff we have to sign next time I go to a new doctor so that I don't waste time completing the other forms. If a doctor has nothing to hide, there should be no objection to free and open comments about his/her practice. If a doctor has something to hide I certainly don't want to go there. Also, I would like to be able to recommend a fantastic doctor!

It appears our freedoms in America are coming under attack: lately religious freedom, and now freedom of speech.

3/23/2009 2:27:38 PM

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Larry

I think Doctors should be fair game for Problems and opinions reported by patients. But, like any other complaint, make sure it is Factual and True. You don't want to be sued for slander. Also, if you like the Doctor or what he/she does, give them some parise.

3/23/2009 4:05:16 PM

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Beth

Doctors should definitely be fair game. I recently had a mini stroke that affected short-term memory and motor skills. I requested to be referred to a psychiatrist. It was a nightmare. Instead of counseling and suggesting of dealing with my new condition, she tried to get my family to commit me. When they refused, she called DSS. They could find no reason to remove me from my home but agreed that I needed some temporary help. I repeatedly called the psychiatrist, who never returned a single phone call but called various agencies, asking for counseling and training. I finally asked for my medical record from her. They are full of distortions, misrepresentations, and a few blatant lies. I have decided to report her to the licensing board and have been informed that if I do, she will have DSS investigate me again. Although I have documentation proving my case and am now doing fine, I spent a year terrified to leave home and under constant scrutiny. I am hesitant to begin this again.

3/23/2009 5:21:04 PM

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Tracie

These "gag orders" seem like another preemptive strike against consumers, much like mandatory arbitration clauses. Why are providers/businesses asking consumers to give up certain avenues of legal action? What kind of relationship starts with one asking the other to make a sacrifice? And, spare me the tired tale of the thousands of frivolous lawsuits that justify these "get out of jail free" cards. Most frivolous cases are thrown out before they get anywhere. If anything, let's improve our court system, not dismantle it with cheap, off the book private agreements like gag orders and arbitration.

3/24/2009 10:02:12 PM

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walker

While patients are free to see any doctor they want to and to say anything they want about those doctors they want, doctors should be free to see anybody they want and not see people who won't agree to their terms. The patient can go to another doctor.

3/26/2009 9:07:19 PM

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Lorraine

Just because a doctor graduates doesn't mean he knows anything. The medical practice is also a two way street. Patients expect a doctor to cure all their ills without any self responsibility.

3/30/2009 6:18:33 AM

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John

I would agree that both sides have a strong position and a solution that better represents both parties and courageous opinion would benefit the profession.

To cite one example, I was a university professor for a number of years and for the benefit of the administration, at the end of each term we were individually evaluated by students. The cross section of each class always included one or two students that disliked me or my methods intensely while the rest offered glowing reports. If this were made public, the law of averages would be my only saving grace while the conflicted detractors could harm my career and reputation by mood or preference. Teaching today requires the capacity to entertain. Boredom is considered malpractice! What is generally not stated is that bad reviews could be the disposition of the patient or student whose emotional resilience is not capable of offering positive feedback. You know, their coffee tastes bad every morning!

Regarding doctors and other high liability professionals, if career-ending litigation were not an ever haunting reminder in a culture that sues for fun and profit, this would not be much of an issue. My feeling therefore is that the doctor and the patient ought to fill out the same, brief form and both sign the form in the presence of a third party. In this manner they would have to honesty look the person in the face and voice their disgust, satisfaction or pleasure. A lessor example of this is the feedback system on EBAY where at least the seller can respond to the buyer's feedback. And yet another example is the webpage entitled "Rate My Professor". http://www.ratemyprofessors.com/. Similarly, you can read reviews of past students which when read collectively gives a reasonably picture of an individual's personality, expectations and skills.

I generally find that only responsible people take the time to offer genuine reviews, or their alter egos, angry Bob or Betty, who want revenge frankly for being alive. Rarely if ever is their negligence but rather a variation in preferences and expectations not unlike the type of shoes you might select each morning. MY South American girlfriend thinks my Stan Smith Adidas tennis shoes look like nurses shoes and she hides them. If this were a more serious issue, she might say that I am confused about my profession and the available resources are not satisfactory.

Responsibility of choice is what this is all about. Americans must STOP blaming and acknowledge that their lives reflect with precision their own choices. There is a saying that people generally criticize in others what they dislike about themselves. One might say that any criticism is at least in part a reflection of the individual offering a critique whose standards and expectations, demeanor and general vibe is different than others. Bad reviews could reflect poor luck or poor choice far more easily than incompetence or questionable bedside, chalkboard or office manner.

While in line at the grocery store the other day, I noticed the smiling man in front of me lifting his food and domestic items with two fingers and slamming, literally, each item onto the check-out carousel and telling the happy clerk that he knows how this works and answering her questions before she asked them in single word declarations like, "CREDIT," and "PAPER" and "GIVE IT HERE!". This is clearly the clerk's limited capability right? The irony is that his food choices included high sodium, high salt and generally microwavable processed food. Might there be a connection? The clerk does not get an opinion and is only there to collect money politely! I say we go back to being humans rather than service machines and the knowledge of performance would be local lore and legend rather than a statistical data from customers, clients and patients who may be in an eternally bad mood.

Both patient and doctor, or student and teacher ought to both sign the same document and have read the other's review if a review is required at all. It's curious that our culture interprets honesty to be most honest when anonymity is provided. Fear is the weakest link. I think honesty is best rendered when you are looking at the other person, whose strengths and weaknesses compel strong feelings about oneself, right in the face.

Regards, John

3/31/2009 5:01:56 PM

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Peter D. Ph.D.

My perspective as a psychologist is that consumers of care do need some kind of infomation about providers, but internet reviews may have more harm than benefit. The two problems are that negative information about someone irrationally weighs much more heavily than either no information (which often indicates satisfaction with care) or than positive information (because the brain is just biased towards the negative). But also, especially in my field, the outcome of psychotherapy often depends on the match between therapist and patient. It really is the case that a therapist who is great with one person may be dreadful for another. Furthermore, again especially in my field, the problem which may bring a person to therapy could be a problem of interpersonal relations. Such a person's displeasure can be a reflection of their very problem rather than a reflection of the therapist's competence. That said, sometimes the person's displeasure is truly a result of the dread fulness of the therapist, a person who might be pretty bad for most people. How can a consumer tell if a bad review reflects a true deficit in the provider or a simple mismatch between the two or a reflection of the reviewer's own problems? Reviews by friends are often useful because one can take into account what one knows about the friend, something not possible on the internet. And one can ask health providers for recommendations. We do not really have a good way to evaluate providers yet, especially in mental health. But I fear that anonymous reviews just cloud the picture.
Peter D, Ph.D.

3/31/2009 5:02:52 PM

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Eric J.

The "Medical Gag Order & Angie's List's Ratings" problem exists for 2 reasons. One is that people move around a lot these days and lack an easy means to find doctors they would otherwise locate through relatives, friends, and neighbors. Angie's List attempts to solve this concern in what I believe creates opportunities for conflict.
I have many doctors now and I am 58 years old. I have lived in the Washington DC area for 42 years. Many people around here are new to the entire area. I have discovered that if you are not sure about a surgeon at a particular hospital - that the nurses there are a great source of information. You can cancel a surgery any time - emergencies excepted.

The second reason the problem exists lies in the medical profession as a whole. There are no Physician Police. There is no one in a surgerical room to look out for your rights when you are unconscious. No one is recording the procedings so that there is no question as to what happened. I believe someone independent of the medical professions should be digitally recording any procedures that occur when a patient is unconscious.
If everything goes right the recordings can be disposed whenever the patient wishes. Malpractice will show up quickly, bad doctors can then be dealt with by the AMA or the courts.
Probably all consultations should be audio recorded by both parties.
Eric J

3/31/2009 5:03:31 PM

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Ray

I work for a doctor owned facility and believe in word of mouth. Most patient's that leave our facility after surgery have nothing but complements for the valet staff all the way to the dietary and housekeeping, in addition to the medical staff. We pride ourselves on customer service and continue to be successful even in these hard economic times. When our patients speak out (good and bad) they just want to be heard, and we should listen!

3/31/2009 5:03:59 PM

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Patty

Dear Angie's List,
Thank you so much for beginning to do something about giving patients a way to make an informed decision their medical care. I am a retired nurse. When I was nursing, I knew exactly which doctors I would prefer to see because I worked with a great deal of them daily at the hospital. Now that I have retired and moved far away from my nursing community, I really miss not having this feel for the medical expertise of the doctors in my community.

As I once read, some doctors graduated with an A from the best medical schools in the US, some with a D from the worst. Currently, state medical boards only report the most egregious behaviours. As our communities get larger, with more and more doctors available in the community, the consumer needs objective information to choose the best doctors. Unfortunately, this kind of information is very hard to come by.

Currently I have one friend whose judgement I trust, whom I call for her recommendation for a doctor for a new medical illness or procedure. I also listen to friends and acquaintances experiences with doctors. Since I know these people, and I experience working as a nurse, I can usually make an informed judgement about what is being said.

I also wonder if many of your Angie's List members do what I do, which is only write in positive comments and experiences with doctors. I bet many people do this. So if I were to use Angie's List to search for a doctor, I would heavily rely on the number of positive comments.

Anyway, I can't thank you enough for this ground breaking approach to evaluating the quality of medical care. Much in medical practice needs to be reportable and available to the public.

Sincerely,
Patty

3/31/2009 5:04:35 PM

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Russ

The story regarding “Medical muzzle” goes to the heart of long-time feelings concerning the medical profession by both patients and medical professionals themselves. It’s reflected in jokes like the one in which God is described as occasionally appearing on Earth to “play doctor.” Like all jokes, it reflects a certain amount of truth.
Reflecting a healthy self-image my doctor found the jibe hilarious but some wouldn’t. There are 17 doctors in my family including my father and his brother. I am also in my 60’s and have suffered a nearly fatal incident. My wife has had three strokes that left her bed-ridden so I have a lot of experience with medical providers from private practitioners to hospitals to nursing homes as well as on a personal basis.
I have seen doctors and other medical practitioners ranging from angelic to arrogant fools. I have observed a doctor in a hospital arrogantly tell the family of a dying man at 3:00pm not to be concerned and that he’ll tell then when to start worrying (the man was my roommate). I knew the man was dying, the nurses knew the man was dying and his family, fortunately felt he was dying and stayed there with him. He died at 5:30pm the same day. Only his doctor was clueless.
By contrast, when I suffered my nearly fatal illness, my doctor was there for hours every day for several days to comfort my wife and look after my care. (I learned of this after the fact because I was mostly unconscious.) In the end he saved my life. But he can get rather sharp with a patient who refuses to take medication or follow basic instructions.
I can say this with assurance; doctors are human beings just like the rest of us. They possess a great deal of knowledge concerning our health—a universal concern—and, when it’s threatened, a profound concern often giving rise to fear and panic. We expect the doctor to treat the human body, perhaps the most complicated thing on Earth, and very often to correct problems arising from years or decades of neglect and abuse. We expect them to treat God’s creation and, therefore, grant them god-like powers. Some medical problems are, indeed, beyond human ken but we still want to “get well.
Our relationship with our doctors and other medical providers is as complicated and beset with conflict as are all human relationships. Different people have different expectations. Some patients want to “know the truth” no matter what. Some patients want the truth hidden from them “to the very end.” Some people are never satisfied. Others are grateful for whatever they get. And on and on.
In the United States, the most litigious country on Earth with three times as many lawyers as the country in second place, we have tried to solve problems in human relationships with litigation. We call upon the judicial system to exercise the “wisdom of Solomon” thereby bringing its god-like powers to bear on the god-like powers of medical practitioners. Then, having placed these matters in the hands of the gods, we sit back and watch the “battle of the titans.” Is it any wonder that some of these professionals have begun to assume a god-like outlook? And yet, most of them are practicing medicine out of a genuine desire to help people and make them healthy. This, even, though many of us seem determined to do otherwise.
Doctors in particular spend nearly all their waking hours—often losing sleep—engaged in their profession. The notion of doctors out on the golf course every Wednesday is as much a myth as the notion that God occasionally likes to play doctor. It should come as no surprise that they should get frustrated with patients that show up late for appointments or hypochondriacally waste a doctor’s time with imagined illnesses. On the other hand, such patients come with the territory and, frustrating as they might be, doctor should at least try to deal with them as best they can. There are doctors in my family working for clinics that haven’t had a raise in salary in 15 years—mostly due to the policies of insurance companies—but they carry on.
Medical professionals are already paranoid enough due to often outrageous awards in malpractice cases. Juries often perceive the awards as coming from insurance companies with deep pockets. But the insurance companies are merely brokers standing between the medical practitioner and the plaintiff. Our justice system does not fully understand the difference between the unknown and the incompetent and our society has the expectation that compensation is due to anyone who no matter what the reason. This is why malpractice premiums today run into the hundreds of thousands of dollars. Even allowing for inflation, this is at least 120 times as much as similar premiums 50 years ago. And the irony is that many patients who would have died 50 years ago recover today.
But bullying patients is not the answer. On the one hand, practitioners could easily benefit from criticism—justified or otherwise. It’s a window into their patient’s perception of them. A busy doctor, focused on the clinical aspects of patient care, might easily overlook simple facts of human relations. It’s also an outlet for frustrated patients with no one else to turn. Well-meaning office and nursing staff often try to “protect” their employer but putting off patients with legitimate concerns. This often discourteous treatment is usually unknown to the doctor. I know of a case in which a supervisor was convinced his subordinates “loved” him. In fact, they hated him. When a general assessment of employees by a blind management assessment revealed this he was understandably devastated. But, on the balance, it allowed him to reassess his management style and improve to the joy of everyone.
As far as a forum to defend themselves, I think it would lead to unproductive adversarial exchanges. In spite of the seeming “justice” remember that patients pay and patients receive the service. It’s in the interest of the provider to make the patient happy if possible.
If doctors and their patients can’t establish an adequate dialogue between themselves, the system will deteriorate. The salient concept is two-way communication. If on-line postings are not the answer, then the profession must come up with a suitable alternative. All-in-all on-line postings are probably the best solution. It is in keeping with the times. The medical profession should give their patients credit for knowing how to separate the wheat from the chaff. I read product reviews all the time. I find some of the gung ho reviews fatuous or self-serving. Some of them are clearly postings of advertising copy posted by the manufacturer. Some of the extremely negative postings are equally absurd—such as giving a bad rating of the product because the carrier (e.g. the USPS) damaged the merchandise or gave bad service. We’re intelligent enough to filter out doctor reviews just as well as we can evaluate movie reviews, product reviews, someone’s opinion of sports teams, or the opinions of friends and family. We do it all the time!
I, for one, would never agree to such a contract. I would be very suspicious of what the doctor was trying to hide. The idea that Angie’s List or any reviewing mechanism will make or break a doctor’s reputation is itself, foolish. A few negative reviews amongst many positive reviews are meaningless; the argument that people complain and do not praise notwithstanding. We are all aware of these things. We deal with them every day. The fact that a few people will be misled is no reason to condemn the majority. Those few will be misled in many ways other than Angie’s List. Most, not all, doctors will get more positive than negative reviews. And, in some cases, the reviews will direct people to a doctor closer to there personal ideal. Consider the TV commercials for The Cancer Centers of America.

Russ

3/31/2009 5:05:39 PM

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