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Medical gag order coverage

Posted: 3/18/2009 4:48:40 PM By Angie | 113 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 about the gag orders or doctor reviews below.

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

Comments

	Supra Footwear
	All things will come round to anyone who will but wait. We should have the patience to await, then success will not far away from us.
	6/27/2010 9:18:14 PM
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	peggy
	picking a dr. is extremely diffucult. you don't know them, they don't know you, but what you tell them.and you only know whats hanging on their wall. do they not know how hard it is to meet a total stranger and just start telling them your life story. it's uncomfortable, i wish drs. would take this into consideration, when they walk thru the door and say, hello, what can i do for you today, a total stranger, you feel like saying to them, hello what can i do for you today and let them see how it feels.
	5/19/2010 2:29:40 AM
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	elizabeth
	nurse managers who exceed their authority by falsifying incidents to implecate rns
	8/13/2009 9:31:25 AM
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	Tom
	Tom It is very difficult to know if your doctor is competent. I speak from both sides of the fence. I have been ill for almost 24 years with a disease that is controversial and poorly understood. I was also a physician before I became ill, and I trained in some of this country's best institutions. Patients like their doctors if the doctors are nice to them; being nice is preferable, but it has little to do with competence. If the patient does poorly, this may have happened under the best of care. On the other hand I have known incompetent physicians who were worshiped by their patients. I have even know psychopathic physicians who were worshiped by their patients. High price is no guarantee; some of the most exorbitant charges often come from the least competent. The patient who thinks his doctor must be good if his prices are high is simply deluding himself. Referrals by nurses are probably better than nothing, but nurses -- like patients -- tend to recommend doctors who are nice to them. If a physician is nice to all the nurses, he probably isn't sticking up for his patients. The sad truth is that the only people who know who the good doctors are are the other doctors who work with them directly. Reputations among other doctors mean nothing if the doctor doesn't manage patients with the doctor in question. I used to know the good doctors in my community -- but only the ones that I worked with. Now that most of the people I knew have retired, I'm in the same boat as everyone else. I ask around and make an educated guess. If you can find out who cares for the families of other doctors, that is a good, but not infallible indicator of quality. Another caveat is that many of the younger doctors look on medicine as a business and lack the dedication to patient care. Patients have a right to speak their minds, but usually they are deluding themselves. Good training programs and medical schools are helpful, but not a guarantee. The best thing is if you know someone on the inside who will level with you. But know them well; physicians are rightly afraid that candor will backfire and cause them harm in any number of ways. I hope this has the ring of truth. It is accurate.
	5/7/2009 12:04:51 AM
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	Chris
	It is ridiculous for some group of humans to expect and try to intimidate another group of humans, with threats of lawsuits, to not speak about a personal experience. The issue seems to be that not enough information is available, as Peter D PhD alluded to. Anonymous claims on the internet should be given very little weight; for example, an un-ethical Dr across the hall could be posting bad comments. But if that is the ONLY info available, then even a small amount of weight will tip the scale. Doctors need to develop a method to get valid information out to the public, or the public will do it for them. The problem is the insurance industry will ALWAYS be un-ethical because they are only interested increasing profits - by law, and will therefore sabotage Docs who don't play their game. That is a whole other discussion, but must be addressed to solve the issue at hand.
	5/6/2009 1:22:17 PM
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	Graham G
	While I agree completely that a patient should have the option of complaining about his or her experience with a physician, your article also underscores how relatively useless things like online evaluations can be in making an informed decision. In my more than 10 years working in healthcare (I am not a doctor), I've seen dozens and dozens of patients and patients' families variably raging at the perceived incompetence or outright maliciousness of a particular doctor or our hospital - or alternatively raving about the exceptional care - and caring - they've received from the same source. So much of the patient's (and especially the family's) perception is shaped by the circumstances of their stay, their own personalities and knowledge (or ignorance) of their condition, and even their acceptance of a diagnosis. As a patient myself, I have experienced exactly the same thing. My wife and I recently reviewed online comments regarding a particular specialty clinic that were downright nasty in their content. You would think the place was a nightmare. We became patients there anyway, at the advice of a friend, and have been very happy. This is not much different than reviews of any other service, which should always be taken with a grain of salt, especially if given anonymously. I give anonymous reviews no merit whatsoever. The issues with HIPPA do make a doctor's position more precarious however, and the lack of a right to self defense is very troubling.
	4/21/2009 8:31:06 AM
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	Annie
	Dear Angie, Thank you for your stance and support against medical gag orders. If we lose our individual right to speak out on the care, or lack-there-of, of medical doctors, a great injustice will be done to patients. The medical industry is more secretive about physician misconduct and medical mistakes than the NSA. Maybe that is why medical mistakes are the fourth leading cause of death in the US. Last year more than 4000 complaints were submitted to the OH Medical Board. Of that, less than 5% of those complaints resulted in any action. And of that, according to the Jan 2009 OH Board minutes, 'there has been an increase in private actions'. In other words, the doctors committed an offense, but the Board is choosing to keep it hidden from the community. There is no transparency and little accountability. Who does that serve? Until doctors are no longer running the medical boards, and protecting their own at the expense of the victim/patient, we need websites and the web so that our voices may be heard as a warning to other unsuspecting patients.
	4/16/2009 10:18:45 AM
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	richard mertens
	As an RN who had a serious illness requiring several surgeries, the last place I would go is to a review site such as this. One's best bet is knowing the number of years practiced; is the treatment you may receive one they administer with high frequency or only occasionally; is their caseload at a critical mass. These factors far more contribute to quality treatment than any patient would ever know unless they know their prescriber's work intimately. I did which is why I chose a hospital other than the one I worked at with the help of an MD I worked with who understood such unmeasured intangibles. Many people believe that their unhappiness with a result or an error on anothers part is enough of a slight to request the ruin of another. The quality of the American soul is low as reflected by how our society feels it has the right to destroy those who are involved in honest error or misfortune. Angie's list is just another dumping ground for the disgruntled who inflate themselves as martyrs.
	4/13/2009 11:58:38 AM
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	Connie
	I don’t think hippa (doctor’s not sharing medical information) the same thing as a patient sharing their experiences with a doctor. First of all most people may listen to someone’s opinion, and then take it with a grain of salt, or not even remember it later. However, a doctor sharing medical information with others could be devastating to your career, or your reputation, or even somehow effect your future medical attention elsewhere. A doctor’s comments are more credible because they are considered professionals. I’ve had doctors that I should have talked about (as I had a male doctor once that treated me inappropriately during an exam). See my connection to his other patients was very limited, and what he did was embarrassing to talk about. If I had told someone who was his patient, they may or may not have believed me anyway. Hence a good example of the difference in sharing opinions. That doctor is probably dead by now, he was older at the time, and even so, was a pervert.
	4/1/2009 12:20:46 PM
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	B A
	If a doctor's office handed me one of those to sign I would be out of there in less than 30 seconds, taking all of my paperwork with me. I wouldn't trust them with my private information if they weren't willing to trust me. I think there should also be a federal law making discipline actions against doctors public. (Some states do this, but not most.)
	4/1/2009 12:19:40 PM
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	George
	I read everything I'm asked to sign very carefully when it's shoved in front of me at any doctor's office. Any doctor who asks me to sign one of these things is going to have to justify very clearly to me how it is at all in MY benefit to do so. I have already had the same discussion about "binding arbitration" with a few of my doctors. The arbiters almost always side with the doctors, in large part, I believe, because there is a good chance they will be arbuitrating another of the doctor's cases in the future, while there is next to zero chance that they will be arbitrating one of my cases again. Bottom line: If a doctor is so unsure of his own ability and experience that he thinks he needs to rely on a gag order to keep dissatisfied patients quiet about it, why would I want him to be my doctor?
	4/1/2009 12:19:02 PM
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	Richard
	As a member of the List and a physician, I have strong feelings about "rating" doctors. There are, no doubt, better and worse MD's. There are doctors who should not be in practice. But whether patients -- or others who might make use of Doctor-rating sites for various purposes -- are in the best position to make such ratings is doubtful. (Disclaimer: on the one list I could find myself on, I had a top rating.) People's interactions with physicians can be affected by many things -- the doctor's people skills, the outcome of treatment, displacement of responsibility for their problem, "blame the messenger" and so on. The practice of medicine is not car wax. We certainly need empowered patients, and a "patient's bill of rights". To add to all this, the present insurance system has made the practice of medicine a nightmare of non-physician interference. There is no simple "rating" answer to this problem; what is needed is a single-payer system in which doctors are paid enough that they can spend time with patients.
	4/1/2009 12:18:19 PM
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	Gloria
	Of course, doctors don't want to be assessed by patients who have perhaps been injured by their negligence, incompetence or arrogance. However, when our lives depend on their expertise and professionalism, we have a right to assess them. I joined Angie's list so my opinions of one physician in particular could be shared, although I have had some really negative experiences in the medical community here in WNC. I have also found some fine competent physicians, who should be praised. However, those who are incompetent pose a greater danger to those us with health problems. The physician in question claims in his ads to be an expert in treating Diabetes. Yet, I can document in writing, that for three years, he refused to stick my finger when I had every symptom of Diabetes because he "knew" that my problems were far more esoteric, serious, and expensive for him to treat. I spent my self almost into bankruptcy having unnecessary tests and treatments for problems he diagnosed, but a simple finger stick seemed beyond him. Too, he strongly urged me to drink an expensive protein supplement but warned me against the artificially sweetened product. I spent several months sleeping almost twenty-four hours each day and wondering what on earth was happening until family members took me to another physician who stuck my finger. The protein supplement alone, which listed sugar as the major ingredient, could have created serious problems in several body systems. When I was diagnosed correctly, this physician immediately prescribed insulin, which I refused. A competent endocronologist determined that oral medications were appropriate in this situation. I question whether this physician should be allowed to practice. This is only the worst of his treatment in my situation. In the past, I recommended him to others, to my great embarrassment now. Thank you.
	4/1/2009 12:17:43 PM
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	Vicki
	While this issue may be considered past its prime, I strongly advocate the right of patients to express their views regarding their medical care. Yes, every case should be evaluated on its own merit and yes, patients carry some responsibility for their medical care they seek as do the doctors they see and yes, there are many patients who unfairly evaluate doctors. Regardless, if just one patient speaks out about a doctor’s malfeasance, another person’s life might be saved. The objective of this kind of feedback is not to sway people’s opinions or behavior based on a single review, but to give information to people who can then take this information and weigh it carefully in their evaluation of the doctors they see. I make up my own mind and do not depend on any one review of anything to make the decision for me. Thank you, Vicki
	4/1/2009 12:15:54 PM
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	Mark
	I can look at this from both sides. I am a business partner with a group of physicians, we own a Physician Billing Service. I am not a physician, but run and operate the business. I hear complaints from the patients regarding their visit. They never complain during the visit to the physician only after they receive the bill. Then they feel an injustice has been done, that the physician did not spend enough time with them. The fees in their eyes does not compare to the care they received. If the physician would of coded the visit different it would have been paid. These are just a few of the complaints I hear. It usually comes down to owing money. The interesting part is these patients do not leave the practice or change to another physician in the group. I had a patient complain to the Attorney General Office because one of her services $15.00 was not covered, she blamed the physician the end results was her insurance only covers this service every two years. The time and paper work to follow up with the Attorney General Office was far greater then the $15.00. The part I can't understand is she wants to continue seeing this physician. I understand if a patient was misdiagnosed or disabled for life that a physician should be held responsible. To complain about a physician because they weren't as warm as you would of needed at the time is unfair.
	4/1/2009 12:15:31 PM
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	Mark
	If there is an organization fighting to ban medical gag orders, count me in. Note: It is important to ask questions in a way that does not solicit ill-considered, inflammatory or derogatory comments of doctors. One should ask primarily about their skills, including their efforts to communicate with patients, not their personalities, race, etc. But patients then should be free to speak ....
	4/1/2009 12:13:25 PM
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	Steve
	I never have and have no intention of ever incorporating "medical gag orders" into my practice as I do not believe that they would hold up in most courts. However, since doctors are already severely restrained/prohibited by HIPAA to make any meaningful response or rebuttal to any online allegations or criticism, it creates a paradigm that limits the legitimacy of Angie's list in rating physicians or other healthcare providers to the point that it has little if any value in this regard. After all, a plumber, electrician, or most other professions could without penalty rebutt any claims made against them. However, several professions--most notably physicians and attorneys though I am sure there are multiple others--cannot make such rebuttals (Attorneys would be restricted by attorney-client privilege which I am sure why you have not made attorney ratings available. Mind you this is coming from a person who is not exactly a fan of most trial attorneys.) This essentially is the case because professionals that deal with extremely personal information are obviously restricted in sharing this information. You really should have thought of this before you opened the Pandora's box of including such professions in a public forum such as yours as it is neither appropriate nor fair. A physician on call has very little control over which patients he or she treats as we are in most cases obligated to treat whatever patient walks through the door as they are--with all of their human flaws, deleterious health habits, shortage of attention to personal health issues (due to inadequate finances/education, addiction, etc.) and a host of other factors which makes complications and negative outcomes inevitable in many cases regardless of our competence or best efforts. You may argue that the information offered is better than nothing (or word of mouth or whatever else is currently available.) I think it more appropriately falls into the category of meaningless data and that the vast majority of it should be ignored.
	4/1/2009 11:06:32 AM
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	Roberta
	Even if a medical procedure is 99% routine, if you are the 1% with a negative outcome, it wasn't routine. Any medical provider can have a negative consequence with any given patient. Good providers have many more outcomes than negative ones but if they have a very active practice, they are likely to have at least some negative outcomes. Were negative outcomes in some cases inevitable due to the patient's condition? Did the patient follow all instructions? Before selecting a medical provider more than just patient statements may be important as the individual circumstances can be vastly different. When seeking referrals it is wise to remember that. Physicians understand this too and perhaps if they better monitored and sanctioned members when necessary, they might be less worried about patient feedback in public places and maybe malpractice insurance costs might be lowered. Of course the best practicioners are likely more involved with their patients than with the practice ofcolleagues.
	4/1/2009 10:59:37 AM
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	Shannon
	I am in the minority of patients, I suppose, but I understand why these "medical gag-orders' have come into existence. I would not rate my doctors on-line, as I have a personal relationship with them and unless I told them I was doing so, it seems unethical to me to go into cyber-space and comment on aspects of my care. I was contacted by Angie's List last year to rate my doctors and responded that I was not comfortable doing so. I think commenting on a medical group practice is a little more acceptable, since one is forming an opinion on an operating business, not just an individual. If someone is not happy with the care they are receiving from a doctor or a staff member, try speaking to the doctor about the concern. I spoke with my daughter's doctor about a particular staff member's treatment and have not had a problem since. Normally doctors do not take complaints regarding staff behavior lightly and will rectify the situation. Thanks, Shannon
	4/1/2009 10:48:29 AM
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	Ann D.
	Being a nurse, I have been privy to how various doctors treat patients and how patients treat doctors. In my experience, perception is reality. If the patient perceives that she/he has been mistreated, not given enough information, etc., there is the belief that the doctor is not good. Yet, I have many times seen doctors ooze compassion, understanding, and "bedside manner" and their medical skills/diagnosis/treatment is not up to par. Yet many patients will think the outwardly "nice" doctor is the best. In my opinion, patients usually cannot judge their doctor's competency. They can only judge how they are treated (and I don't mean medically). The best doctor can have a poor bedside manner and the worst doctor can have the best bedside manner. The human body is not like a plumbing job or electrical work--it either works or doesn't work. So many factors have a play into whether and how a patient responds to treatment (if properly diagnosed in the first place). You cannot compare plumbing with medicine. So, patients, beware of internet comments about doctors. Anyway, this will be all moot under Obama's plan. You will be told where to go for your medical care and doctors will be told how, who, and how long to treat a patient. Mediocre care for all!
	4/1/2009 10:47:00 AM
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	Danny
	I live in Texas. A patient wronged by a physician in this state has become VERY limited now in what they can recover from a physician or a hospital in any medical malpractice case. In fact there is so little medical malpractice litigation in Texas few lawyers still engage in it. I was operated on a few years back by an ENT who promoted himself as really specializing in what he called "facial plastics". This guy operated on my throat, did his version of a brow lift and operated on my eyes. It was such a bad and botched job there wasn't a moments hesitation in my mind whether to sue him. My current spouse pleaded with me not to sue him because our children attend the same school. The statue of limitations has passed precluding me from bringing a lawsuit. However, I may expose him on the internet. Because I work in film and television as an actor he assumed, even though we're both married with children, that I was a closeted gay guy like him. He commented several times during social occasions prior to the surgery that he guessed he better do a good job "or how else am I going to get you in bed". I just blew this shit off until I began putting pieces together and concluded he wasn't kidding. That he was "rolling the beads" as they say to see if I'd pick them up. This guy has no business working as a "plastic surgeon". Over the years I can convulse almost on a cracker crumb. Sometimes have to stop on the side of the road and make myself throw up to dislodge whatever is in my throat.There's a knot in the middle of my forehead near the hairline that was his version of a brow-lift and which people have mistaken for a cyst. I say fight any "gag order" rule. The legislature and the Texas Supreme Court have taken away most of the rights of victim patients. Fight.
	4/1/2009 10:27:48 AM
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	Dr. Scott
	As a practitioner, it is really a fine line. In today's world anyone can publicize whatever they think, founded or unfounded. In my practice we have worked hard to EARN good comments from our patients, and treat everyone with dignity and respect. That said, it is somewhat frustrating to not be able to control what comments get posted. Overall, I believe that a focused, patient centered practice will consistently deliver the right message to patients, and therefore create consistently good comments. Anyone using reviews for any sort of service needs to filter what they read, and use judgement beyond the printed word. Overall it's better for everyone to let the voices of raving fans sign out!
	4/1/2009 10:27:05 AM
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	Ricky P.
	Hi I am Ricky P. a massage therapist with 25 years in the field of structural body work. I work with and have worked around some of the very best and worse doctors in the country. What we all need to do and understand is coding and billing. The question is like this did my 20. minute visit to my Chiropractor have 5. units of work and maybe one to two things happen to me when I was there? Did my specialist just spend seven minutes with me and tell me when my surgery was going to bee? If you can answer yes to these things find another doctor! You can not get the proper care you need with a seven minute visit $300 or more bill to your insurance company.There is big money working hear folks check the bills. Hold these people accountable I had a patient tell me the other day she was not getting better. She said she did not want to say any thing the last time she was in. She told me she did not want to tell the new person that was coming in when I ask how the foot was. We found out though she was not doing all that I had ask her to do at home. She started to ice her foot at night. Now she has recovered from her problem. But she had the right to say what was on her mind. I told her that day. I did not know if I would bee able to help her. But I did not want her to loose her freedom of speech. Even at my expense. She is pain free with her problem. She was to have a procedure done to remove a possible heal spur.Ask about the units on these bills. If it is 15. minutes they should spend that amount of time with you. Some times more than one thing can go on at a time but say the chiropractor you use gave you an adjustment and that is all that happened at his office that day. If you see traction heat and Tenze on your bill that is shall we say not quite right. Read the bills if it was not administered great if not ask when did you do this? I do not like the gag order! I can see why it is needed though. We are protecting our selves from those we need protection from. Please do not misunderstand we have some wonderful doctors who we should all bee grateful to have treat us. But we have some who are in need of a bail out like the gag order is set up to do.
	4/1/2009 10:26:25 AM
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	Randell, M.D.
	Dear Angie's List: As a longtime member of your services and a longtime physician, I feel that doctors must be prepared to allow comments about themselves, their practice, office staff, etc. Electricians, inspectors, plumbers, etc. etc. already undergo such treatment. Certainly there are patients whom no one could ever please, no matter how great the effort. But, that goes with the territory. A bad outcome in medicine has almost become synonymous with malpractice, but statistics show that doctors usually win based on the merits of the case. I think doctors need to allow this free speech, learn how to apologize when they are wrong (I have wondered many times over the years how this simple human act would have prevented many needless lawsuits). Unfortunately, we live in times when many people are angry, anxious, and worried. They take it out on retail clerks, government employees--including even the President, and I do not see the situation getting better. Someone always has to be at fault in our society. Honest mistakes, misunderstandings do not lead to human contact and conversation, but to a mediator, a lawyer, a court, etc. It is sad, but true. I would personally not use a gag order contract with my patients, but I certainly understand the urge by many doctors to do so. The HIPPA guidelines do seriously protect patient privacy, appropriately, but in the same stroke limit doctors' abilities to speak out against that occasional mean-spirited, vicious attack. But, again, it cuts across all fields. I think medicine will just have to accept it and find constructive ways to respond to irresponsible comments/attacks. I hope doctors will approach these problems in this constructive manner and not be forced to resort to legal action themselves, to protect their reputation, their livelihood, and their peace of mind and sense of fairness. I think anonynimity seriously jeopardizes the process of evaluation. Too many bloggers hide behind anonymous comments that have little merit or honesty because they will never be called to support their unfair accusations. Physicians have no such mechanism, and I hope never will, because it then truly becomes a race to the bottom. With kindest regards, Randell
	4/1/2009 10:24:59 AM
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	WMD
	One should have the right to view other medical consumer's feelings about certain doctors.
	4/1/2009 10:13:18 AM
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	Jacky
	Thanks for the great article! If there's any reason to NOT sign a "gag order," just read the book "Complications: A Surgeon's Notebook on an Imperfect Science," by Atul Gawande. It will make you realize that on one hand, doctors are people who have to learn their job just like anyone else. Only their job affects people's lives. A carpenter who makes a wrong cut can learn from his mistake. A doctor who makes a wrong cut can also learn from the mistake, but may take a life in the meantime. On the other hand, the book points out that due to anything from long hours to greed and arrogance, doctors sometimes make poor decisions and don't always face the music for years, if ever!
	4/1/2009 10:11:27 AM
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	JHD
	Typically we would not like it if Doctors rated us as patients and/or shared information about our medical records, so I understand it when Doctors do not like it when patients share their feelings about them. I think if you do not care for a Doctor after you visit them you should look for another Doctor. Another reason I do not care for people sharing their feelings about Doctors is we have no way of "reviewing the reviewer" i.e. we do not know the attitude of the patient when he/she goes into the office for their visit with the Doctor. We all know that sometimes Doctors have to tell us things we do not want to hear, A visit with our Doctor is not usually the favorite thing to do for most people(certainly not mine) so I'm not surprised if many people go into the office with a bit of an attitude at the outset. I am not a Doctor, but I believe that most of them do their best but we must remember that they are also human and while we hope they do not do it with us, they do sometimes make mistakes. If you want a Doctor that has never made a mistake good luck!
	4/1/2009 10:10:14 AM
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	Jeanette
	Angie -- You seem to forget in the article about medical gag orders that doctors, clergy and lawyers all have to maintain privilege with their clients. It's a right belonging to the client that is for more reaching and sacred than any law such as HIPAA might impose. Those of us who practice in these professions are unable to defend ourselves against unfair or untrue public comments made by patients or clients because of the privilege. Your business has always been about fair resolutions between consumer and business...but other businesses can respond which makes the process fair. Why continue to rate medical professionals when they are unable to respond? It is incredibly unfair to create a forum that is so one-sided and is not consistent with the original spirit of your business. I am truly disappointed.
	4/1/2009 10:09:47 AM
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	Hillary
	Regarding the story "Medical Muzzle" by Daniel Simmons: I am aghast to hear about gag contracts with doctors. First, the contracts are disservice to patients - they prevent personal recommendations to/from friends or family, whether the feedback is negative or positive. Second, they are a disservice to the doctors themselves . . . if you are a good doctor, there should not be a problem with anyone's feedback. In fact, I have chosen some of my favorite doctors based on friend's or family recommendations. Without that, we must rely on our health insurance or another doctor (whose reputation may or may not be good) for a doctor referral. Who is taking care of whom here? If we are to take charge of our own healthcare, as we must these days, we must have adequate and trustworthy resources at our disposal. Granted, there are bound to be some patients out there who make comments that are unfounded or biased, but it is up to the prospective patient to make that judgement call, not the court. We must evaluate reviews across a variety of categories on a daily basis - shouldn't we be afforded the same opportunity when choosing our healthcare providers?
	4/1/2009 9:32:28 AM
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	Julie
	I think if a doctor doesn’t want negative comments about his or her practice, treatment procedures, or personality than he or she needs to improve services to patients. Look, we are at their mercy and we are the consumer. If a doctor gave me a gag order to sign before treatment I would refuse, walk out, find another doctor, and then go to the nearest web site and post a rating which would read “the doc obviously has something to hide or he/she wouldn’t have given me a gag order to sign before treatment”. A gag order merely gives the physician a license to treat the patient anyway he/she wants. I have a few rules when I see a doctor and they are useful: 1. My illness, my money, you work for me, 2. If you are late, you are fired, 3. If you don’t answer my questions or condescend to me in any way, your fired, 4. If you screw up because of negligence, I’ll sue you, 5. If you stink at your job, I’m telling everyone I know, 6. I pay, my rules. Stop treating them like little Gods. Medicine is a business and we are the consumer. If doctors start losing business because of poor customer service and inadequate medical care than they will shape up. It’s your dime, not theirs.
	4/1/2009 9:31:59 AM
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	Beca
	People should be able to complain/comment on their doctors! However, the doctors should be able to give his side of the story - like when you leave a negative feed-back on e-Bay.
	4/1/2009 9:31:15 AM
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	Joel
	Which is more important - their reputations or our lives? That is the issue. For what I would like to say about that and your article, rather than type it here, could you just read the first few paragraphs of my site: www.patient-safety.com <http://www.patient-safety.com> Patient advocate Becky Stephenson saying that patients can figure out who is good or bad in medicine by the means she suggests is so naive as to make suspect anything else she might say about medicine. It's covered on my site. Yours, Joel
	4/1/2009 9:30:46 AM
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	Tom
	If doctors would weed out the bad apples in their industry, their malpractice insurance would be lower and they wouldn’t have to worry about bad ratings. When was the last time you saw a doctor testify against another doctor? I’ve been in insurance for 34+ years .. and I know. The various medical associations do virtually nothing about bad doctors, EVER!
	4/1/2009 9:28:33 AM
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	Pat K.
	The very idea is absurd that doctors have a special right to prevent patients from speaking out and describing good or bad treatment or experience with them (the doctors). Rather, patients have a special right to learn whether a particular doctor has a good or bad treatment history of previous patients. Only in this way can patients find good, well-qualified doctors and avoid doctors who should be avoided. Patients' good health is crucial to everything else; if their good health isn't assured, their everyday life--job performance, lifestyle, etc., etc., could be completely destroyed. There are too many cases of exactly this happening. When I choose a plumber, roofer, etc., I pay close attention to the comments of their clients/customers as to their good and bad qualities. In choosing a doctor, I need to be able to apply the same attention regarding the experiences of their patients. The idea that doctors should be exempt from having patients speak out about them is frightening, to say the least. If any legal order should be enacted, it should be to protect the rights of the public to have access to comments of any doctor's patients.
	4/1/2009 9:28:02 AM
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	C. F., M. D.
	Doctor’s simply want the same legal protection against slander and libel given to other citizens. If patients don’t like it they can visit another physician. Using your line of reasoning there is no need for any laws protecting people against slander and libel because “if you haven’t done anything wrong no one Will defame you.” Unfortunately this is not the case and doctor’s are entitled to the same protection under the law as other people.
	4/1/2009 9:27:10 AM
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	Jacqueline
	I would never sign such a contract. I would simply seek treatment from another provider--one who recognizes that I am sophisticated enough to realize that any physician will have happy patients and unhappy patients. I do think an overwhelming preponderance of negative remarks would send me elsewhere.
	4/1/2009 8:55:25 AM
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	Brenda
	Patients not only have a right to report or discuss their experiences with physicians, good or bad, they have a responsibility to warn other potential patients about negligent or incompetent treatment! These ratings should give doctors an incentive to improve their bedside manner as well as their skills & practices. It is totally unethical for a physician to require such contracts to be signed before rendering treatment to patients. "Frivolous lawsuits" are problems for the court systems & Bar Associations to deal with attorneys about! Unfortunately, in an attempt to curb frivolous lawsuits, some state legislatures (Tennessee for one) are now making it impossible for patients to recover damages for malpractice by sealing records (reports of infection rates, etc.), making it impossible for patients to bring legitimate malpractice suits because they are unable to obtain the proof to make their cases. These were public records in the past. Too much is being done to protect doctors & not enough is being done to protect patients.
	4/1/2009 8:54:43 AM
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	Howard
	Thanks for the interesting article. The results from Angie's List users were entirely predictable. Why? Because these individividuals already use a major (i.e. Angie's List) consumer rating service. That your members would be in favor of posting comments about medical providers is not a surprise. What would be a surprise? If they had voted any other way. In tthis case, freedom of speech for consumers needs to be balanced with responsibility and some protection for the medical providers. A very, very basic question is whether any consumer's medical review site makes any attempt whatsoever to check on the validity of the information being presented. I am sure that the answer is "no." I hope that ALL of your subscribers are above base motivations, but I doubt it. It is possible that someone might be using a rating service to settle a score with the doctor or service provider for a relatively mundane problem (such as overbilling, or a personality clash) that has little to do with the quality of care provided. There is also the question of whether a patient (or relative) genuinely understands the complexity, risk or difficulty involved in many medical procedures. Americans have become greatly influenced by shows on TV where medical miracles are routinely performed but real life is very different. The medical profession should not be exempt from "consumer" reviews. And Doctor's already have the option of suing for slander or libel if the person posting the comments is lying or significantly altering the facts. The problem for the medical profession lies in the more ambigious area where the facts are not greatly in question but the patient's opinion of the severity of the illness or the quality (or the results) of the treatment are significantly different those of the medical professional. The medical profession is already regulated very very differently than almost any other American profession (as it must be) since practioners make life and death decisions, often on very very short notice. Even in more mundane cases involving medical care, the reaction of two medically similar individuals to the same medication or treatment can vary dramatically. The medical profession will resist becoming involved in creating uniform rating standards and criteria, and probably will resist even the numerical "results" tables already generated by the federal government for judging the quality of care in hospitals and clinics. If reviews are to be useful to other consumers and relevant to someone's ability to estimate the medial competence of a doctor or medical service provider, there must be some criteria established to ensure the reliability of the information and the uniformity of the rankings (i.e. a mediocre doctor with a history of mediocre results but a great "beside manner could (and probably will) get better rantings than a highly competent practioner who is taciturn or ill-mannered.) In the neart term, without the cooperation of the medical profession, there are only two ways to proceed: A) Individuals will continue to post comments and a doctor will sue someone who posted an unfavorable comment. The courts will then decide the limits of free speech for rating the medical profession. Almost unquestionably, this would eventually go to the Supreme court and take many, many years to resolve; or B) legislation to establish criteria and procedures. Initial legislation would almost certainly come at the state level, it would differ significantly by state and would be subject to court challenges by the medical profession. Even if a federal law is passsed first, it too would unquestionally be challenged but in a federal court. In either course, it would take years or even decades to resolve in the face of a well-financed legal challenge by doctors. But, there is also a third possible course. If you consider this to be a pressing issue that needs addessing now, perhaps as part of President Obama's effort to reform the medical insurance system, there is no choice but to work with the medical profession, with the "club" of possible legislation or a court challenge being brandished but not used. A system developed in conjunction with the medical profession would not offer maximum freedom to consumers and would undoubtedly offer some residual degree of protection to doctors. However, I believe a partial consumer review system put into operation now is far more valuable since it would begin to weed out incompetent doctors with the aid of consumers. A consumer review system that might be put in place many years down the road and which comes about from legislation would be greatly influenced by the medical lobby. If such a review system comes from a Supreme Court decision, its value would be far from certains since the political philosophy (as represented by the current Chief Justice) is unlikely to represent much of an improvement at all.
	4/1/2009 8:54:02 AM
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	June
	The very fact that there may be diverse opinions, as in your example, is what makes them valuable reports. In adition to wanting a doctor who is competent, different people have other expectations. for the best fit, you need someone who matches your style. I have seen some people who want to be told what to do and have the decisions made for them. That approach would drive me crazy. I once paid $1500 to have a family member transferred to another hospital because the doctor I was going to have to deal with told me I didn't need to know the answers to the questions I was asking and that even if he did answer, I would not understand the answer. Personality and perception count. Doctors are the only member of the health care team that does not have to report their errors publically, everyone else does and has to face the consequences. So anything that gets out some information is a good thing.
	4/1/2009 8:53:09 AM
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	Greg & Joanne
	Doctors are hurting themselves with this new gag-order. Patients will be fearful of giving word of mouth recommendations and that is most likely how they end up with most of their patients. Thanks for the story and your consistent reliable information in Angie's List.
	4/1/2009 8:52:39 AM
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	Jane
	I chose not to rank any of my doctors when Angie's List asked me. I said at the time I did not want anyone choosing a doctor based on my good or bad report because a doctor who had personality characteristics that I did not like, might be the perfect fit for someone else. I still believe that a ranking system like Angie's List is not the place for a patient to rank a doctor's services. I do think that one should find out about a new doctor through reading about qualifications, areas of specialty, education, years of practice and things of that nature that you can find on line. I do depend more on personal references from others who have gone through simililar medical situations. I also ask medical professionals who know me and my needs. I listen for important things for me like giving the patient full attention, taking time to validate concerns and answering questions and providing an avenue of contact for concerns that can not wait until the next visit. There are things I am willing to tolerate if I have a great relationship with my doctor. The biggest thing is waiting for long period of time. If the doctor generally does a good job in scheduling appropriate amount of time and is willing to deal with my issues that need attention, I have no problem waiting for how ever long it takes. The office however, should let people know of the delay in case the patient can not wait and needs to reschedule. We are fortunate in our area to have a number of well qualified doctors in many areas of specialty. If you do not hit it off with one, find another. Even with Stage III cancer I took the time to find the right doctor for me. If the doctor s is rude, pompous, arrogant, indifferent, say so - to the doctor, the business manager, the nurse practitioner, the hospital, etc.. If the issue can not be resolved, move on. There is a better doctor for you.
	4/1/2009 8:52:03 AM
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	Penny
	Four years ago I had a pinched nerve in my back. I was going to an orthopedic surgeon for something else and he said he could fix the pinched nerve just fine. When I came out of surgery, my back wasn't hurting but the only way I could walk was with a walker, I had no bladder control and 10 hammertoes. These are all permanent results. I had additional back surgery to clean up what he had done. I call him the Butcher of Bedford. If I'm talking to someone and they ask, I give his real name. If they don't ask, I don't tell.
	4/1/2009 8:51:15 AM
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	Mary
	We all have the right to share our experiences with professionals be they plumbers, doctors or lawyers. Angies's List has never offered advice on lawyers and I asusme that's because lawyers can sue at the drop of a hat anyone who says anything bad about their performance. Now it appears the doctors have figured out a way to discourage such feedback from patients. I think it's a clear violation of our freedom of speech.
	4/1/2009 8:49:52 AM
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	Liz
	I'm writing on behalf of a friend of mine because she's currently under a gag order, and this is even without having signed a contract not to discuss results of surgical procedures. My friend was burned and scarred from a laser procedure performed by a doctor, and she also had rhinoplasty which did not turn out right. One doctor performed the laser, and the other doctor (husband-wife-team) performed the rhinoplasty. My friend, who is being sued by these doctors, has encountered over a dozen other patients who also had negative results from this team of doctors. My friend is taking the heat, and she is fighting to keep her freedom of speech as a means to protect others from suffering at the hands of these doctors. If the public is not allowed to speak up, then the public cannot be protected. I think any patient presented with a "gag" contract should be suspicious of the doctor. If a doctor cannot stand up for his work and needs a contract in advance to keep his poor work hush-hush, it doesn't seem like he'd be the doctor of choice.
	4/1/2009 8:49:01 AM
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	Rachel
	Doctors provide a service to the public and are dependent on the good will of the public to make their exorbitant incomes. They should not be allowed to operate with impunity and above the first amendment. There are great doctors, there are good doctors and there are terrible doctors. I had a pediatrician once who refused to operate on my older daughter's tonsils because he did not believe in tonsillectomies. She had strep lodged in her tonsils and became so ill that she lost 10 lbs. His comment was "well, I don't think she's too thin, do you?" She was 8 years old and weighed 55 lbs! By the time her tonsils were removed, she had to stay in the hospital for 4 days, she was so ill. I think other parents need to know about idiots like this. I have had terrible experiences myself with medical doctors. A doctor in Greensboro, N.C. (not Dr. Segal) prescribed me so many antibiotics over a period of 5 years that he destroyed my liver. It has taken 20 years for it to heal properly. I no longer go to doctors who practice Western medicine because from my perspective, they are like a blind man stuck in a bell jar. Totally out of touch. They do not think but rely only on testing for diagnosis. Their tests are in many cases useless, but if nothing shows up on them, they declare that there is nothing wrong with you - which is often not the case. Having a medical degree does not entitle a professional to perform above the law. Ratings by patients are more than just necessary, they are essential. It is a well known statistic that the medical profession in this country is the 4th leading cause of death. It makes total sense that those of us who have suffered at the hands of these folks, many of whom put themselves somewhere up there with God, should have many forums in which to speak out about those who have harmed us. I still take my daughter who is severely disabled to Western medical professionals from time to time and have been fortunate to find some excellent ones. I'm happy to review them as such. I can only hope that those MD's who believe that they should be allowed to practice with impunity and the expectation that people agree to abide by gag orders lose patients. After all, there are plenty of doctors out there.
	4/1/2009 8:47:40 AM
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	Michael
	And the doctor-bashing continues… We are already seeing physicians leave the field of medicine in droves by way of “early retirement.” The best and brightest college students are now going into banking and law. I hope Americans are happy with the care they receive 10 years from now—not sure who’ll be giving it.
	4/1/2009 8:46:17 AM
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	M'Lou
	Many years ago someone asked me a question... "What do they call the person who graduates LAST in a medical school class?" I said I didn't know. The answer was "DOCTOR". Unfortunately, we, as patients have no way of knowing how well our physicians have done in medical school - or how good they are afterwards in their practices. Since the medical profession doesn't regulate itself very well, it is outlandish that they require people to not speak about the treatment they received so that we can make informed choices about who to see for medical issues. EVERYONE should refuse these gag orders! EVERYONE should know about them! Maybe we should have the option of not PAYING for bad service. I just heard a terrible story about Grove city Hospital (PA), where my cousin was a patient earlier this year, and came close to dying. Not only did they ignore her pain, later x-rays showing 3 collapsed discs, but they discontinued one of her Rheum. arthritis medications (steroid) that she had been taking for many years, without informing her, and her body "began shutting down". Her daughter pointed out a place on her leg that was "weeping" and when they asked the nurse if that was normal, she said it was! A friend of the family asked a friend, who was a doctor, to look at her case, since she was not getting better, her systems were beginning to fail, and they feared for her life. The doctor had her transferred to another hospital immediately, and they found that the place on her leg was a MRSA infection that she contracted at Grove City Hospital! She was put in a private room and everyone who came in was required to wear a mask and gloves. Now she is on lots of physical therapy, and beginning to walk with a walker - and is waiting for a spine operation. None of this would have ever happened if they had treated her for the disc problem that she went in with!
	4/1/2009 8:43:32 AM
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	-Ann
	Online doctor rating: I believe that the contracts are illegal under the laws of the Constitution of the United States. How far would this go? Would newspapers be banned from reporting and printing any stores about malpractice? I think the issue of PROTECTING THE PATIENTS is more important than protecting the doctor. Patients go to a doctor and place their health in his hands. We should be able to read ratings on doctors, even more so than ratings on our auto repairmen. As for the lawyer who created those contracts, he is probably more interested in making big $$$ by selling those contracts than protecting doctors.
	4/1/2009 8:42:09 AM
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	Karen
	Hi - I testified last week at the Oregon Legislature about the lax health boards in our state - how a psychiatrist can inappropriately touch a client, who then files a complaint with the Oregon Medical Board, which promptly dismisses the complaint due to "no evidence." If all consumer complaints were accessible to consumers (as they ARE in Washington State), we could find out about this "inappropriate touching" or other behavior before we make an appointment for our 14-year-old daughter. As it is, consumers continue to be victims. As for me, my complaint regarding an unlicensed and unsupervised psychologist who abused my 9-year-old son (whose only complaint was gastroenterological problems) was dismissed by the Oregon Board of Psychologist Examiners, although over 15 laws and rules were violated. Then I found out this board dismisses over 95% of its consumer complaints. Consumers MUST be given the means to protect themselves and each other - the boards charged with protecting the consumers are only protecting the profession they serve. I wish Angie's LIst had been around 6 years ago...
	4/1/2009 8:39:46 AM
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	Nora
	It seems to me to be fair to prevent patients discussing their experiences with doctors… as long as doctors are prevented from commenting about their contractors, vendors, patients, plumbers, mechanics, and any other persons whose customer they are.
	4/1/2009 8:37:41 AM
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	Rich
	If you want to learn about a used car you interested in buying, you can get car fax. If you want to learn about a home you'd like to buy, you can get an independent inspection. If you want to get your house painted, references are available and expected. If you want to find out how a has performed on other patients with a condition similar to yours, you're out of luck courtesy of HIPPA laws. They may let you speak to one patient. The only work around for my cancer condition was to get information from a survivor's group. What physicians know is the clinical side of medicine. Their knowledge surpasses the vast majority of their patients. What most patients are seeking is guidance that's beyond the clinical side. They want to understand their condition, their options, and try to understand what they can reasonably expect to happen in their situation. They're not seeking an adversarial relationship. When all information is suppressed via gag orders, it invites a backlash.
	4/1/2009 8:36:31 AM
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	Sandi
	Hi, I just read your article on, hm.....already forgot his name. The dr. with the big ego and his organization he just started. Here are a few of my thoughts: 1. Dr's don't have to read these. And, yes, if they are good dr's what are they worried about? Ego or not. 2. Anyone can fill out a form with Angies List and remain anonymous. 3. Any dr. can go to the public library, create an account and say good things about him/her self. 4. I was given one a long time ago. Signed it, Bite Me. They never said a word. A long time customer, Sandi
	4/1/2009 8:35:14 AM
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	Matt
	Dear Angie's List, I have been a loyal Angie's List member for the past 5 years. I have found your service very valuable while I have renovated my 100 year old house, and have payed a good deal of attention to the customer reviews on local contractors. I am also a Family Medicine doc here in the Indianapolis area. Although I have no issues with patients giving their opinions on physicians, I think that Angie's List is likely doing a disservice to the physician community. As you know, HIPPA laws do prevent a physician from any sort of rebuttal against a patient comment. Clearly, there are many physician offices that are poorly run, and docs who are not personable, accessable, etc. I can also tell you, from personal experience, that there are patients that are impatient, disrespectful to my staff, and in many cases very unreasonable. I am worried that these types of patients will be the most likely to fill out complaints, and unlike all of your other vendors, we physicians will be unable to respond in kind. I do want you to know that I value your service, but a physician has few things as important as their reputation. It seems unreasonable that it should be allowed to tarnished by an angry patient in a way that makes us unable to respond in our defense. Thanks for your time, -Matt
	4/1/2009 8:34:27 AM
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	Valorie
	As a health care provider myself (Clinical Hypnotherapy), I can appreciate the concerns over frivolous and/or misleading opinions. However, it should be abundantly clear to anyone who actually reads Angie's List, that serious attempts are made to weed out those whiners by the publisher and we are all expected to make an intelligent and informed decision of our own. When I search the List for a seamstress, I read ALL the reviews and make my own decision. And, I am the only one I hold accountable for the results of that choice. That's how an adult behaves. Respectfully Yours, Valorie
	4/1/2009 8:33:12 AM
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	Erik W. S.
	Regarding your reporting of “patient gag orders”: I appreciate your interest in the quality of healthcare, and as a member I have used your service to find other professionals. I am concerned that the vigor with which you are pursuing these waivers is out of proportion to the problem, and casting a bad light on physicians as a group. First of all, the overwhelming amount of the paperwork that is generated during a patient visit, including forms signed by patients, has nothing to do with the physician. Most of it has to with the many layers of regulatory compliance involving federal, state, and nongovernmental organizations, and quite frankly, the patient’s own insurance provider. In these matters, the physician is either not involved at all, or is following the advice of their business manager or attorneys. Second, the agreements you describe are almost certainly unenforceable and meaningless, other than attempting to discourage public commentary. Nothing a patient ever signs takes away their rights. For example: a patient having a surgery usually signs a consent form saying among other things that there is no guarantee of the desired outcome, that complications may occur, and that an undesirable result does not mean that an error was made. Signing that form in no way takes away that patients right to sue the physician or hospital. Third, I believe the only type of “gag order” that can be enforced is from the decision of a court of law, such as in the divorce settlement described in one of your articles. Using that term for anything else is confusing. Finally, the information available to patients on your site is very limited, mostly related to customer service and the personality of the physician, not their medical qualifications or experience. Using the same report format that you use for other businesses leaves out a lot of more useful information. The price paid is totally irrelevant because that is determined by the insurance company, medicare or medicaid. Medicine is different from most other trades you list in the amount of external regulation and licensure, and internal regulation by board certification and medical societies. All of that information is publicly available. You should recommend that patients use these other resources and point them where to look. Browsing the list, I found that most physicians listed in our area have only one report – not much to go on. Customer service is important, as is physician behavior. Most reputable healthcare providers regularly track patient opinions, and act upon that information to improve service. In this regard, Angie’s List may be another resource to improve the patient’s experience.
	4/1/2009 8:32:25 AM
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	JRyan
	The only way I would sign such a contract is if the doctor had to disclose how many times he's been sued and the outcome of those lawsuits. Courts are courts of record but settlements are often not. Restaurants have to post their health department rating, how do we grade doctors' offices? JRyan
	3/31/2009 5:26:21 PM
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	Pat
	On the subject of Doctor's Gag Orders, the only comments that should be over the line are anonymous postings. If you are not willing to attach your name to your opinion, then it should not be worthy of consideration. Sites that allow anonymous postings should be summarily ignored. Pat
	3/31/2009 5:25:37 PM
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	Randy
	I believe that individuals should be able to form binding contracts with each other. These contracts must be enforceable in a court of law unless the contract was to perform an illegal activity. Permitting contracts between private citizens to be overturned sets a bad precedent. The concept of "public interest" does not justify interfering with private contracts. People with political influence could then disregard contracts they have signed but want to get out of. Just because someone is not wise and signs a contract that they should not have signed; does not mean that anybody should be able to overturn the contract after the fact. Randy
	3/31/2009 5:24:24 PM
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	Dr. Clive
	As a surgeon, I welcome patient's comments about our practice; we're proud of it and the service we provide. I think in all fairness, the doctors should the right to respond in the same forum to the comments, just as is done on Ebay with seller / buyer ratings & comments. It is impossible to please everyone, and one happy patient will tell one other person, while one unhappy patient will tell ten others..... Dr. Clive
	3/31/2009 5:24:05 PM
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	Diana
	Why are doctors any different than any other professional? Yes, they attempt to fix your body and/or mind instead of our car or our taxes, but I STILL want to know if they are considered by others as competent, attentive, reasonably priced, prompt, etc. And I am intelligent enough to read the comments of others and decide whether I believe someone has been treated with due diligence. Finding the right doctor the first time saves me time, money and possibly my health. I hope Angie’s List continues to push for this important First Amendment right for patients.
	3/31/2009 5:23:11 PM
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	R.A.
	YES! DOCTORS LIKE ALL OTHER PROFESSIONALS SHOULD BE HELD ACCOUNTABLE. UNTIL NOW THEY HAVE USED THE PHRASE "FRIVOLOUS LAW SUITS" I DONT KNOW ANYONE IN MY 70 YEARS WHO CAN FRIVOLOUSLY AFFORD A LAWSUIT. IT IS A STUPID AND RIDICULOUS PHRASE MEANT TO REDUCE THE PATIENT TO AN "EVERYBODY HATES YOU" MENTALITY. i've been thoroughly used and abused by many doctors and dentists but i had no recourse to express my rage from these treatments. no one wants to have to endure a lawsuit wherein the victim is in an endlessly painful re enactment of his/her victimization. their lives become a 100% court event. doctors are incredibly arrogant and completely without social skills with which to make the patient feel comfortable in his/her presence. SO. I SAY LET US HAVE A FORUM IN THIS FIELD! R.A.
	3/31/2009 5:22:35 PM
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	Roger
	Providing “gag order” agreements to patients makes the doctor appear to have something to hide. I would be very uncomfortable if a doc asked me to sign a document in which I promised to not say anything about him. I would probably seek services from a different doctor. If my insurance had the doctor on their panel of approved providers, I would also complain to the insurance company’s Provider Relations department so that the next time they do their contract renewal process with him/her, they would be aware of the gag order expectation. Vote with your feet people; if you don’t like what you see/hear, walk away!
	3/31/2009 5:22:01 PM
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	Keith
	PATIENTS SHOULD BE ABLE TO SPEAK OUT. ALSO DO AWAY WITH HIPAA.
	3/31/2009 5:21:33 PM
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	Noel
	Thanks for your report on the move toward patient 'gag orders'. I also heard a lengthy report on NPR, and I am outraged by this idea, as well as by the organization that helps doctors with extra resources to prevent patients from succeeding in suing them for malpractice. I would like to make sure that I never use a doctor that is part of this group. I urge you to include the information in your ratings of medical professionals, as well as providing a link to a list of members, if it is available. Thanks for your good work, --Noël
	3/31/2009 5:20:57 PM
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	Pat
	i didn't even have to read this in it's entirety....if they can't take the heat, they can get out of the kitchen- who do they think they are? my first impression on this list when reading comments on docs was overwhelmingly: these people are afraid to even notice what's going on, much less criticize.... your first encounter should be an interview of this doc. do they pass muster? wake up people! criticize them to their face during your "visit" and stand back! if you are lucky, you'll get supercilious, patronizing etc. but more often you'll get open hostility from your "healer." it's quite common for lots of people to react to a challenge to their knowledge, expertise, humanity And authority with counteroffensive; these types are no exception. they already expect big time expect that you will be intimidated; if you are intimidated, head for the door...but sign such a thing? WHY?
	3/31/2009 5:20:29 PM
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	Ken
	The positive side of a doctor suing a patient who accurately and honestly describes his/her experience is that it then becomes public record.
	3/31/2009 5:19:57 PM
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	Rainbow
	With free press, anyone should be allowed to voice their experience on a physician/dentist/etc. It's up to the individual reading the review to determine, for themselves, if they want to pay the professional a visit or not, since the reviews may be mixed, to find out for themselves what experience they walk away with. We may have pros and cons, ourselves, on the same professional. Both should be posted, not only the negative. Our reviews need to be honest, and also fair. That's what Angie's List is all about.
	3/31/2009 5:19:29 PM
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	Way
	I certainly am no advocate of the right of a doctor to require his patient to sign a contract forbidding the patient from criticizing the doctor. But I might question the intelligence of a patient who would sign such a contract in anything other than an emergency. And I question whether the courts would honor it under such a circumstance. I also question whether Angies list is a good method of choosing a doctor.
	3/31/2009 5:18:50 PM
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	Todd
	Too many doctors are extremely arrogant. They were trained that way starting the first week of medical school. There are lectures the first week about how "You are Gods". "What you say and do is always right". (I know because I was in medical school.) Historically the A.M.A. has created an economy of scarcity by limiting the number of highly qualified applicants. I knew straight A college students who could not get in because they did not have a father or uncle who was a doctor to recommend them. It was a closed fraternity. This scarcity and lack of competition enabled doctors to charge as much as they wanted and in some cases continue to get by with inferior service and results. In recent years, the younger doctors usually do not have that attitude and many are not just practicing medicine in order to make big money. However, the scarcity still exists. We definitely need an Angie's list rating for medical services, just as we need feedback on plumbers and mechanics. Todd
	3/31/2009 5:16:34 PM
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	Patti
	I am an RN and have never run into such a “contract”. I would not sign one (or if I did, I would feel free to ignore it.) However, I would also not give much credence to most on-line postings about health care professionals. My current job involves giving health care advice on the telephone and I hear many complaints about doctors and nurses. Often, I find that the complainer does not have a good concept of the factors involved. It can be anything from understaffing, government regulations, misunderstanding on the patients part, an unusual patient response to medications or treatment or the fact that a patient has a condition for which there is just no good or simple treatment. I would pay sharp attention to a web site that had postings from other medical professionals and I wish there better ways for health professionals to express their concerns about the very few practitioners who are not competent. Patti
	3/31/2009 5:15:52 PM
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	Gyoen Psy.D.
	I am a doctor and I am confident that my patients would leave positive commentary. I am frustrated with doctors who treat patients with disrespect and a uncaring attitude when they are 1 or even 2 hours late for a regularly scheduled appointment. I am absolutely against the gag order. I can tell you from my experience that the “good doctors” will benefit from the publicity. The “bad Doctors” will get some much needed feedback on competence and patient care. I hope you keep this site open and active. Malpractice lawsuits are very rare in cases of true accident. The literature shows that doctors who admit their mistakes are far less likely to be sued than doctors who cover up facts to protect themselves. Thank you, Gyoen
	3/31/2009 5:15:13 PM
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	Alan
	I run a support group for patients with a related pair of very rare autoimmune disease called Pemphigus and Pemphigoid. Because there are only between 15,000 and 20,000 sufferers in the US, very few doctors are conversant with the disease leading to up to two years before a correct diagnosis is made, and to poor treatment decisions once the diagnosis has been made. If we could not recommend experienced doctors and warn members about poor treatment, we would all be in a markedly worse state. Alan
	3/31/2009 5:14:33 PM
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	Who
	I suggested in our local newspaper not too long ago that people should have an online site to go to where they can voice their opinion on their Dr. then others can look up the Dr and read decide if that’s someone they want to see. I think if we had a local site to go to where we can review a Dr., just like we review companies with the Better Business Bureau that doctors would make more of an effort to be a more caring, better Dr. In my town, the doctors don’t seem to care how they are looked upon as there aren’t a lot of specialists. You are forced to go to someone you really don’t care for. I once had a disagreement with a nurse where I told her she was being rude and that I didn’t appreciate it. She then went to the head of the medical center and said I said words I never did and my whole family was booted from every Dr. we were seeing in the medical center. We were then forced to go out of town to find a Dr. When I published the incident in the newspaper, I became aware that others had the same thing happen to them. We don’t seem to have any rights and we aren’t allowed to speak up. I have been in several Dr. offices where they cuss, have a terrible bedside manner, lie to you about what you will pay at your visit, etc. and these are doctors we never would have bothered to see and pay good money for if we had known in advance. We patients should have a say and the only way to do that is an online site where we can review the Dr. and others can decide if they want to go there. For instance, campgrounds have reviews. You check them out and if you have questions, you can contact the particular campground and ask them about it specifically. Then the customer decides. It’s terrible living in a small town where you have few choices and you are always worried that you will upset the Dr. and get kicked out.
	3/31/2009 5:14:01 PM
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	Susan
	I've been of two minds with the reporting on medical professionals. I've worked for a plastic surgeon for many years and have seen many patients with perfectly good outcomes complain because they aren't perfect. The doctor always explains the risks and benefits even before a patient decides whether or not to have surgery, but many patients never hear the risks part. They go into cosmetic surgery with unreasonable expectations, and if they don't look like Angelina Jolie when they come out, they blame it on the doctor. My employer also does reconstructive surgery, where the outcomes of scar reconstruction are never guaranteed. The patient's are told that the scar will probably look better, may even look worse, but it won't be eliminated. But some patients somehow expect that scars can just be erased. So how does the doctor protect himself against the prima donna who expects absolute perfection and writes a bad review because she went in with unreasonable expectations, didn't listen to the doctor, and then wasn't happy with a fine result? He can't. -- Susan
	3/31/2009 5:13:17 PM
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	Cassie
	I completely support Angie’s List collecting reports about doctors. I have been misdiagnosed and mistreated by a number of doctors over the past 35 years. I would report them if I weren’t such a coward. I am seriously ill and need regular and comprehensive medical treatment. I fear retribution. Doctors have literally laughed in my face when I reported symptoms, then days, months or a year to two later, the symptoms turned out to be an early-warning of very serious, life-threatening condition. One doctor ignored my middle-of-the-night pain for seven years until I developed gangrene and had to have emergency surgery. He’s dead now so he can’t hurt anyone else. Another doctor missed a broken ankle and sent me home in a cab with a loose ace bandage--no cast, no crutches, no cane. The poor cab driver had to help me into the house while I hopped on one foot. My husband went out and rented some crutches for me. Two weeks later, I still could not bend my ankle. At a follow-up appointment with a different doctor, another x-ray was taken and showed the break. Because I was not diagnosed and treated correctly, it took EIGHT MONTHS for my ankle to heal. More than once, I have been prescribed something while in the hospital that I am not supposed to take. If the nurse had not told me what medications she was giving me, I could have been permanently injured or died. I have had countless similar experiences. There is also the personality and bias issue. Some doctors are shockingly arrogant. Other doctors are so prejudiced about the appearance of their patient that they just pretend to provide appropriate medical care. In many cases if you are old, fat, ugly or poor you have no chance. Potential patients need to know about these things. I believe that malpractice is actually underreported. Both the patient and the doctor knows the doctor screwed up but without enough of the right kind of evidence and money for an attorney, most people have no recourse. I also believe that most people would be understanding and forgiving if the doctor showed a little humility and told them that he was sorry and had tried his best. I believe the “gag orders” should be illegal. Just because someone is a patient, does not mean they give up their rights at the doctor’s door. Maybe if negative reports are consistent, the doctor should try to change. After all, doctors constantly demand that their patients change. I am in an uncomfortable state right now. I need doctors but I can’t trust them anymore. Good doctors have nothing to fear from a patient’s fair and honest report. Thank you.
	3/31/2009 5:12:09 PM
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	Bo
	doctors practice a trade just like carpenters. They are subject to criticism on Angie's list as are all other tradesmen. Go Angie's List.
	3/31/2009 5:09:38 PM
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	Sue
	Thank you for the warning about medical gag rule contracts.
	3/31/2009 5:08:26 PM
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	B.J.
	Physicians should not be able to use "Gag agreements" to shield themselves from legitimat criticism and expressions of thier professional ability. I have practiced medicine for 38 years an was always able to discuss and resolve patients questions and complaints. Many physicians do not spend sufficient time develping their professional rapportr with their clients. B. J., M.D.
	3/31/2009 5:07:56 PM
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	Carol
	There are numerous scientific papers written explaining how and why humans make errors. No human is exempt from error. From the most brilliant and highly trained on down to the least knowledgeable of us,we make mistakes. Since both doctors and patients are prone to error, we need a better solution than law suits. Mediation works better and costs less. The emotional and financial stress is counterproductive to both doctors and patients. The Medical Review Boards are biased in favor of medical professionals. Patient Advocates work hard to overcome this bias for their clients. Malpractice insurance is insanely expensive. It is driving good medical professionals out of business and escalating medical expenses to those they serve. A better solution is a Mediation Board consisting of both medical doctors and patient advocates. Perhaps legal scholars should be included from the court system. The majority of complaints consist of miscommunication and misunderstanding. Very few malpractice cases truly involve real malpractice. This mediation should be a court requirement before a lawsuit. Mediation would resolve the majority of disagreements amiably and certainly at less cost in money and stress. Mediation protects all sides from defamation and extraordinary expense. Sincerely, Carol
	3/31/2009 5:07:09 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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	L.
	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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	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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	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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	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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	Tim
	Yet another example of Profit Care coming before Patient Care.
	3/23/2009 2:18:41 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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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	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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