Saturday, April 23, 2011

A new twist to medical (lack of) ethics

I was angered - but not surprised - to read about the latest tactic by some in the medical profession to restrict their patients' ability to comment on how they were treated. Time magazine reports:

Around 3,000 doctors in the US use the services of a company called Medical Justice which, for just $1,200 a year, will protect its customers from medical malpractice suits. Oh, and make sure that patients sign away their review copyright to their doctors in the middle of all the other paperwork they have to fill in, allowing doctors to then go to review sites and demand the bad reviews be taken down because they're in breach of copyright.

According to Medical Justice, what they're doing is not only protecting the doctors from unfair bad press - "Some sites say, we don't know if you're telling truth, and we don't know if they're telling the truth -- it's the Internet, so deal with it," Medical Justice spokesman Shane Stadler is quoted as saying. It's actually less onerous than what the company previously did, which was to issue contracts to patients forbidding them to post any reviews online.

There's more at the link.

I could hardly believe what I was reading; so I looked up the Web site of Medical Justice to learn more. Sure enough, they're quite unapologetic about their approach. Here's some of what they say about 'Physician Internet Libel and Web Defamation', interspersed with my reaction to it (i.e. what I think they really mean) in italics.

We crafted a solution that balances the rights and expectations of patients with the concerns of doctors. Mutual Agreements do not create a choice between healthcare and one's right to free speech (as some have erroneously claimed). Far from it. We recognize that medical errors can and do occur. There are existing processes and viable venues where patients can report bad experiences with physicians. For example, other doctors, lawyers, friends, state licensing boards, civil court and more.

You're free to write about your experiences - but only where we're willing to let you, or where we can't stop you. That doesn't include unregulated public fora.

The most recent iteration of the Mutual Agreement encourages patients to provide valid feedback. Patients are free to post online. In the rare event the feedback is not constructive, doctors have a tool to address fictional or slanderous posts.

If we don't like what you say in public about our doctors, we'll silence you.

. . .

Current solution: Mutual Agreements address the emergence of now over 40 generally anonymous physician rating sites. Patients are free to post online. Further, Medical Justice can recommend which sites have adopted our minimum standards to increase credibility. The Agreements provide an actionable tool to address fictional or slanderous posts In return, patients are granted additional privacy protections by the doctor above and beyond those mandated by law.

We've arranged to have some Web sites censor patient communications, so that we have some control over what you say about our doctors.

. . .

Patients remain entirely free to communicate about their treatment with friends, family, other health professionals, hospitals, licensing boards, attorneys, civil court, and more. There are multiple venues for communicating and/or venting, and these venues are more effective in addressing issue accountability. The Agreement provides additional privacy protections to the patient. Online posts are not forbidden.

Online posts are not forbidden, provided they're positive about our doctors. Anything else, fuggetabahtit!

Commentary is even promoted; particularly on sites that meet minimum standards for credibility. That's right. This has been a moving target, but the marketplace has responded with meaningful and substantive options. Medical Justice has been instrumental in prompting the marketplace to create these options. Since Spring, 2009, a number of consumer health sites have actively approached Medical Justice asking for guidance on how to work with both doctors and patients. These sites have already implemented or are implementing such standards.

Sites that we control, or which share our approach, are OK, because we can monitor and control what they publish. Any other sites are suspect by definition, and we don't want you posting there.

. . .

Ongoing Goal: We are not, in principle, against physician ratings. We are actively working with a number of rating companies. Patients want good information. Honest - and useful - ratings will require a sophisticated understanding of outcomes research, risk stratification, etc. In other words, it's not a simple task. In 2010, we are still struggling to compare apples to apples, like mortality and infection rates for institutions, much less individual practitioners. That said, subjective impressions by patients can be measured and reported. And such information can be used - by doctors - to improve performance -and by patients- to make decisions. This information must be placed in context. But, that does not diminish its potential utility.

We'll determine what rating system is used, and in what context, so that we can control how our doctors are rated in public. Don't like our rating system? Too bad.

Future Solution: Medical Justice is partnering with a number of ratings company to get ratings done right. Doctors are interested in constructive feedback. They want to promote patient safety. In general, they want to improve the experience for the patient.

We'll make sure that as many medical rating systems as possible conform to our requirements, so that genuinely independent, objective ratings of medical institutions and personnel are as hard as possible for health care consumers to obtain.

Our mission is to promote a transformational healthcare system where patients can make informed decisions using the Internet as one means. But, not all sites on the Internet are equal. Medical Justice is identifying sites that are balanced and credible so as to help doctors and patients know where to turn.

Believe what we tell you. Of course you can trust us! And don't you dare contradict us!

Again, more at the link.

I'm pleased to see I'm not alone in my negative reactions to Medical Justice's efforts and policies. A Web site called Doctored Reviews has been set up as a joint effort of the Santa Clara University High Tech Law Institute and The Samuelson Law, Technology & Public Policy Clinic at the University of California Berkeley School of Law. Doctored Reviews has this to say:

This site is designed to help patients, doctors, and websites understand the problems created by Medical Justice, a company trying to restrict online patient reviews, and to offer some ways that let patients freely talk about their healthcare experiences.

Medical Justice sells contracts to doctors - we call them "anti-review contracts" - that either expressly prohibit patients’ online reviews or permit patients to post online reviews so long as doctors can remove them whenever they want. In exchange for these restrictions, the contracts promise patients purportedly greater privacy. However, this privacy promise is illusory, and the restrictions these contracts impose on online reviews are a bad deal for patients - and everyone else.

Medical Justice’s efforts may be a sign of things to come. Imagine if other companies used similar contracts. Before you get a haircut, before you buy a six-pack of soda at the local grocery store or before you order a meal at a restaurant, imagine you were required to keep quiet and never post your opinion online about the product or service you purchased. Sound ridiculous? It does to us, and we think it’s no less ridiculous when doctors demand this of their patients.

More at the link. Interesting and recommended reading.

As a first step, I'd like to encourage my readers to check any contracts and/or agreements they have already signed, or may be asked to sign in future, with medical personnel or offices or institutions. If there's a 'confidentiality clause', or 'copyright assignment' section, I'd cross it out and initial the alteration. If you find you've already signed such a waiver, I'd write to the doctor or office or institution concerned, formally withdrawing your consent to it and notifying them that henceforth you claim copyright in any communication you may make to anyone about their services.

It used to be said that lawyers were the sharks of the legal world. Now it looks like some medical practitioners are taking lessons from them!


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