Medical 'gag orders' for patients

Podcasts > May 2009 > Patient 'gag orders'

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Patient 'gag orders'

Posted: 5/4/2009 12:01:01 AM By Listen! | 16 comments | Transcript

Patients commonly share opinions of doctors on online review sites like AngiesList.com. The reviews help to keep doctors honest and on their toes, according to patients. But a handful of doctors call the ratings unfair and they’re fighting back by requiring patients to sign contracts that bar them from commenting on their care. Patients say these contracts – usually known as “Mutual Privacy Agreements” – violate free-speech rights. Hear from all sides about a topic that’s generating buzz nationwide.

reported by Daniel Simmons, Paul Pogue and Mason King | produced by Jeremy Stacy

Read Angie's List Magazine's special report, "Company tries to stifle online reviews with patient gag orders," to learn more about these contracts.

Comments

	Ed
	These podcasts are great but please allow us to download and time shift them. I listen to podcasts at the gym, while doing household chores, etc. It's great to be able to listen to them on MY schedule.
	5/5/2009 9:41:11 AM

	Carole Jenkins
	Many doctors are afraid that they won't be able to get away with shoddy practices if patients comment openly on websites. I think it is a great idea for us to be able to comment. I happen to have a doctor whom I love, but I remember once, a long time ago, I had a specialist that was told I was allergic to adhesive tape, and he used it anyway, and never even apologized for the pain and suffering he caused me!
	5/5/2009 12:10:56 PM

	Neil McWilliams
	As a pediatrician, I meet with folks that have incredibly varied expectations. My goals are to always practice evidence-based medicine, trying to empathetically alleviate parents' worries through education when I perceive that my advice or treatment does not match their expectations. I sleep well at night, because I do try hard to please, realizing that some people leave the office upset with me. I think that doctors fret about the general public's tendency to be uncritical of public information, to believe statements that really are perception, that are not grounded in fact. I suspect that these muzzle contracts are not legally defensible, but they might intimidate someone from sounding off in a public forum, to the detriment of the doctor. I wouldn't mind a feedback system that graded professional demeanor - bedside manner, if you will. The first few dings would really hurt if you care, but if numbers mount and the overwhelming percentage are positive, the dings would lose their sting. Perhaps a system could be devised that would not post any comments until a statistically significant number had been collected. In terms of judging the quality of the medical care, not the doctor-patient interaction or office ambience issues, the public does not have the knowledge to judge. But some public score card based on practice review by knowledgeable professionals would be useful. Doctors, like all individuals, like good grades and will change behavior to attain them. I suspect such professional review would be very expensive and time consuming, so I don't expect to see it on the horizon. Just my thoughts.
	5/5/2009 2:19:41 PM

	John Scope
	It would probably be OK for a doctor to use a patient gag order if patients had a true free market with plenty of alternative choices of a doctor in the speciality the patient needs, i.e. could walk down the street and get another doctor, which would take away the leverage of those doctors. The problem is patients have to limit their choice for their medical situation to the list of doctors in their geographic area covered by their insurance company and who practice at the hospital the patients wants to go to.
	5/5/2009 3:00:48 PM

	Ed Silha
	If Angie's List management is proactive in acquiring reviews on doctors so that the ratings are not skewed by disgruntled patients (who are more likely to post complaints than a satisfied patient is likely to post a positive review) the listing could be reliable. There are many people that are satisfied with their family doctors or specialists but would be unlikely to go through the effort to post a review. Also, the only people that will be contributing are members which significantly limits the sample size.
	5/5/2009 3:00:52 PM

	Barbara
	When I enter a doctor's office, I am not merely a patient, but a consumer as well. My cash is being used to pay for his/her service. It is my right to evaluate a doctor's performance as it is to comment on my plumber, hair stylist or moving firm. I am hiring them. If anything, it is more essential for us to assess a doctor's performance for incompetence or excellence as his/her actions will directly effect our state of health, whereas we will not suffer serious health problems if a plumber fails to stop a running toilet.
	5/5/2009 3:12:53 PM

	Suzanne Gerard
	I believe that a doctor has the same right to privacy as any other purveyor of a service, i.e. the appliance repairman, the dog's vet, the carpenter, etc. If the service provided is less than the quality one has the right to expect for the fee, one should be free to say so! I would not hire a repairman who asked me to sign a gag order agreement nor would I go to a doctor who asked it. Just for the record, I have a wonderful doctor who is always late and I make allowances because when he gets to me, I get what I pay for and then some!
	5/5/2009 3:31:04 PM

	Jeannie Vawter
	Look, I don't think it should be posted. This is why. My dad was hospitalized a year ago. What my brother saw as "shoddy care" and them trying to get as much money as they can. Was in my opinion great care and he is alive at home today because of it. Now if a doctor has a medical error, that is straightforward but quite often it's a personality conflict or someone fighting the system. You want to post it, make sure it's something that should be posted. I go to a doctor that my sister-in-law wouldn't because I like his directness. She doesn't. Is that worth a post? It's different than someone walking through red paint.
	5/5/2009 3:34:42 PM

	Paxton
	I have worked years in a large pharmacy - I would hear people gripe about a doc and then the next person praise the same doc. It's not really fair to judge someone 'publicly' when so often the 'raters' are not at their best - otherwise they would not have been to a doc. It's also not fair to rate someone without that person having any recourse. What are you rating, the entire event? Receptionists? NAs, PAs - there are way too many variables at this time. It should be fine tuned before this is implemented.
	5/5/2009 5:48:06 PM

	sam
	Rating physicians is very different from plumbers, contractors, etc. Physicians are bound by privacy laws (HIPAA) and would never be able to defend themselves on any public site without the permission of the rater. False information could never be contested and could potentially be damaging to a physicians career. I agree with Paxton that there are also too many variables to the patient experience and that there should be further fine tuning of the system. Rating of healthcare should be regulated so that it is fair for the patient as well as the physicians, nurses, hospitals, etc. that strive so hard to provide compassionate, knowledgeable, and timely care.
	5/6/2009 12:09:11 AM

	BADragon
	If a doctor asked me to sign a gag order I would leave - and I would take all my medical records with me. Not going back there - nope!
	5/6/2009 1:16:00 AM

	Rosie
	Doctors are not above the law. These are people's lives here. If the quality of care is bad then I would want to know. Just like when the quality of care is good. You don't hear doctors complaining that we are allowed to give good reviews. Just not bad ones. Doctors or anyone do not have the right to trample on my constitutional rights. People are smart and they are not thrown off by one bad review especially if there are many good ones. However, if there are many bad ones then people should be made aware. Also, if there are some bad doctors in your profession why would you not want people to know. What is it that you are first taught? "First do no harm."
	5/6/2009 11:26:45 AM

	Rockys Lady
	I agree with the no gag order. I have had two very bad experiences — one with dentist who is trying to fraud me and another where the doctor did not investigate a problem with my husband while in the hospital and he expired. Without an autopsy nothing could be proven, which I wasn't concerned with at the time of being in shock that he was fine and an hour later he was deceased. Doctors have too much freedom to do as they please and the law always covers them!
	5/6/2009 11:39:03 AM

	Myron Persoff
	I am a plastic surgeon and do not participate in any insurance programs as my practice is entirely cosmetic. Like most doctors, I am extremely concerned that my patients get the best possible care and results, which they usually do. However, life is unfair and sometimes things do not go as well as planned. In such cases, I work even harder to get the best results despite adverse circumstances. Like most other doctors, I work harder on the problem patients. It would be an "insult to injury" to also be blamed publicly with no recourse. I can understand getting a poor rating for saying unkind things or thoughtless behavior, but not for doing one's best in a bad circumstance. BUT, I don't think that a gag order would solve anything.
	5/6/2009 2:37:16 PM

	Barbara
	Word of mouth is one of the best ways to select a physician, and most states also have professional ratings thru their state boards of health - I agree that individuals in a state of anger may not rate a physician fairly, but it may be helpful to cite specific and to the best of their ability, unbiased reasons for such a rating. There is the first amendment, ya know!
	5/6/2009 4:48:55 PM

	Steve T
	Doctor's ratings are a great thing. Everything on the internet has to be taken with a grain of salt, and sure, some ratings will be unfairly bad. Welcome to the real world. Unfortunately many many doctors treat all of their patients like idiots. A rating system is desperately needed and very helpful.
	5/15/2009 1:16:43 PM

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Patient 'gag orders'