
Doctors and dentists tell patients, "all your review are belong to us" - chanks
http://arstechnica.com/tech-policy/news/2011/05/all-your-reviews-are-belong-to-us-medical-justice-vs-patient-free-speech.ars
======
gfunk911
Regarding the argument that doctors aren't lawyers, and they were just
listening to so called experts:

There was a popular article last week discussing how doctors were ignoring
evidence and logic because so-called experts in their fields hadn't instructed
them what to do yet. They refused to think for themselves.

The idea that a doctor only used this form because an expert told them to, and
didn't think about it for even a minute, does not fill me with confidence. Why
would this thought process be confined to one area?

Link: <http://www.cancer-healing.com/blaylock_brother.php>

~~~
Alex3917
"Why would this thought process be confined to one area?"

It's obviously not, you can find any number of books on Amazon about how the
standard of care in virtually every area of medicine is horrifically awful.
The one thing these books have in common is that virtually none of them are
selling more than 10,000 copies, and of course number of physicians that
actually read and take the time to read these books and understand them is
only a small fraction of that. The vast majority of doctors can't even name a
single recent finding in their own field, let alone the most important ones.

~~~
pygy_
Another day, another relevant and polite
post(<http://news.ycombinator.com/item?id=2582372>) randomly [killed].
phren0logy wrote:

\----

>Alex3917: The vast majority of doctors can't even name a single recent
finding in their own field, let alone the most important ones.

I guess what you are saying is that it's important to support one's opinion
with peer-reviewed research, rather than being overly reliant on personal
experience. A noble goal. I'm assuming that because this is important to you,
you have done the same. Could you please cite your sources for the above
statement? Or is this an extremely clever way of proving the point that
perhaps physicians really are justified in worrying about unfounded negative
opinions on the internet?

\-----

~~~
pygy_
BTW, if the issue of arbirarilly killed posts worries you, please upvote this
submission: <http://news.ycombinator.com/item?id=2583101> (Ask pg: What's up
with the randomly [dead] comments?)

------
jrockway
These "copyright rights" violations are becoming egregious. I recently had to
sign an addendum to my apartment lease stipulating that the management company
owned my "copyright" and could broadcast, on the Internet, all security
footage of me in the building.

What action should I take to get this clause removed? I don't care if they
share the tapes with the police when they have a warrant. I do care if they
end up on the Internet. I want to walk to my apartment, not have my life
broadcast to strangers.

~~~
kmfrk
It's quite possible that they could use the footage to help find assailants or
other criminals, where the footage of you might pose a violation of the law.

What I'm saying is that there's not necessarily any shady motive behind it.
The problem is - and has always been - how to determine this.

~~~
jemfinch
Model releases are not necessary for the use of recordings as evidence.

~~~
ChuckMcM
But they [releases] are required to sell the video to 'clip show' producers
(exemplars "Caught on Tape", "Outrageous Videos", Etc). One of the complaints
in the 'stupid person falls in the fountain' case was that the security camera
footage did not include a release.

------
michaelpinto
The funny thing is that this will lead to many more anonymous reviews — which
will be much more nasty than folks who sign their actual name to a comment. So
negative reviews will always outweigh any positive feedback. What's sad is
that you can take negative feedback and use it to improve your practice (if
you care about those things)...

------
dfranke
As a consumer, the way deal with this stuff is to cross out the objectionable
provisions, sign, and hand it back without a word. Walk out if they put up a
fuss, but they usually won't.

~~~
nhangen
Just make sure to initial next to those changes.

------
robdd1
There should be an open way for patients to give public feedback. HIPAA makes
it impossible for a Doctor to defend herself from a BS review.

For EXAMPLE:

Patient X: This Doctor is terrible, I had a broken leg and he told me to get
the hell out of the hospital and walk it off.

Doctor Y: This Patient has been to the ER 30 times over the past 2 months,
every time he asks for narcotics for broken bones that NEVER show up on
X-rays.

Patient X's Lawyer: You are now being sued for a HIPAA violation.

------
bugsy
It seems the obvious thing to do would be to have a site that collects the
names and addresses of the doctors and dentists who are so incompetent that
they fear reviews.

~~~
cosgroveb
I'm not a Doctor but I seem to think if I were at least competent with a good
bedside manner that the best play would be to encourage patient reviews. You
are always going to get a few bad apples, but people appreciate transparency
and I bet that would translate to more/better reviews.

I could be completely wrong though. You would probably want to A/B test it ;)

~~~
hugh3
It's difficult to know. It only takes one complete horror story to drive a lot
of patients away, and the person telling the horror story may not necessarily
know what he's talking about.

At least when I read hotel reviews on tripadvisor I know enough to tell when
the one-star reviews are based on real complaints ("Cockroaches all over the
room") or excessively picky customers ("Desk clerk rolled his eyes the third
time I requested to be shifted to a room with a better view").

But if I read "Doctor Smith botched my surgery, and I lost both my legs" I'm
at a loss. Did Doctor Smith really botch the surgery? Or did Doctor Smith's
heroic and brilliant surgical intervention _just_ manage save the life of a
patient who otherwise would have died? I don't know, and the patient really
doesn't know either.

If I knew more about medicine I'd probably have a more realistic example than
that, but the fact is that some patients always wind up with outcomes from
their medical treatment which are worse than they expected, and they're
usually pretty ignorant about to what extent the blame lies with "crappy
doctor" vs "crappy luck".

~~~
ericd
Good point - a doctor who performs only layup procedures is probably going to
have a much better track record in their reviews than someone who tackles the
challenging ones all the time.

Normalizing reviews is extremely hard, so it's a bit worrying to think about
what online reviews might do to doctors' willingness to take on challenging
cases.

------
ben1040
Here's a few examples of these forms I found from googling:

<http://lagunaskincenter.com/RegistrationForms.aspx>

 _I agree to the mutual privacy agreement and authorize the office to retain
full copyrights to any communication or online posts related to my treatment
and services._

<http://www.academylaser.com/user/PatientSignInForms.pdf>

This doctor demands a five year gag order on all his patients!

<http://www.rejuvalife.md/forms/patientreg09.pdf>

This doctor seems to imply he would try to find loopholes in HIPAA to use your
records for marketing if not for you agreeing to keep quiet on Yelp.

~~~
colinprince
So the question becomes:

Are all Dr. Y's reviews positive because Dr. Y is a great doctor, or because
Dr. Y removed the negative reviews?

With ownership of the commentary comes the power to remove it.

~~~
Natsu
There's a simple algorithm for that: don't trust "perfect" people or
companies. There are two ways to appear perfect: suppress all bad information
and actually be perfect. One of these is much easier, and therefore a lot more
likely, than the other.

------
latj
Well, I didnt sign any contract with this guy. I guess I'll head over to yelp
now. :> I cant speak for his abilities as a dentist but having to sign
something like this is good enough reason to find a different dentist.

~~~
derwiki
Yelp's ToS forbids writing a review based on someone else's experience -- to
allow that would enable and encourage an echo chamber effect of one person's
bad experience. There's a lot of mis-information floating around about what
would cause a Yelp review to disappear, but a ToS violation like that is a
perfectly valid reason. (disclaimer: I used to work at Yelp)

~~~
kenjackson
Just call the dentist and ask or have the form faxed. Then you have first hand
experience.

~~~
andrewpi
The article mentioned that the patient wasn't allowed to take the form out of
the office.

------
nathanwdavis
Angie's List (I work for AL) recently did an informational video to inform
customers on the topic. [http://magazine.angieslist.com/videos/is-your-doctor-
asking-...](http://magazine.angieslist.com/videos/is-your-doctor-asking-you-
to-sign-away-your-free-s.aspx)

Hopefully more people will become educated on the matter and refuse to be a
patient of such physicians and dentists.

~~~
ChattyKathy
MedicalJustice is an EXTREMELY slimy organization. Not only do they sell these
damn contracts but they also take "extra legal" measures against doctors who
testify on behalf of a patient in a medical malpractice trial.
(<http://blog.medicaljustice.com/?p=2048>) AND they post positive reviews for
doctors across the US. (<http://www.ratemds.com/social/?q=node/49926>) At
least four of the doctor who have received reviews from them are themselves
members of Medical Justice.

Its like they're saying, "Don't rate your doctors, let us do it for you!"

------
TomOfTTB
People seem to be missing the most cogent point here...

"The agreement is based on a template supplied by an organization called
Medical Justice, and similar agreements have been popping up in doctors'
offices across the country. As we dug into the story, we began to wonder if
Medical Justice was taking advantage of medical professionals' lack of
sophistication about the law. Doctors and dentists are understandably worried
about damage to their reputations from negative reviews, and medical privacy
laws do make it tricky for them to respond when their work is unfairly
maligned. Although Dr. Cirka declined repeated requests for an interview, his
emailed statements (and the statements of his staff) suggest he doesn't
understand the terms of the agreement he asks his patients to sign."

Doctors aren't lawyers. Most just want to stay in business and do their job
without getting sued. That's where organizations like Medical Justice come in.
Attacking the individual Doctors on an issue like this does no good. Because
they weren't the people who thought up the chain of logic that led to the
creation of this form. So they can't argue the pros and cons of its existence.
Meaning they might agree with every counter point you present but still stick
with the agreement because they are "trusting experts"

If Ars or anyone else wants to really make a difference in this arena they
need to engage those "experts" and take the accusations to that organization
(they clearly tried to do this, my issue is with their attack on the doctor)

The problem with the author calling-out an individual doctor is it makes a
case for the agreement. By singling out one doctor and attacking him for an
industry practice it says "patients can be irrational online" which will make
doctors fear the online world more (and hence give more credence to
organizations that claim the best way to deal with patients is to censor them)

~~~
jemfinch
No, doctors aren't lawyers. But they are humans, and thus they're responsible
for their own actions, even if they've been misled by so-called experts. They
bear responsibility for refusing medical treatment to clients who refuse to
sign ridiculous "mutual privacy agreements".

I reasonably expect that highly educated doctors should have enough skepticism
and worldliness to recognize that there exist people who will try to take
advantage of them, much like "Medical Justice" has done here. Demanding that
patients sign away their rights to public expression of their opinions is
_prima facie_ ridiculous and should trigger the bullshit meter of any doctor
I'd consider trusting my treatment to. If doctors' bullshit meters don't
trigger there, I shudder to think what pharmaceutical companies and free
lunches could sneak by them.

~~~
hugh3
Think about the constraints that doctors operate under. They're bound by
doctor-patient confidentiality, and certainly aren't allowed to tell the whole
world what they think of _you_. So they might well think it's reasonable that
you're not allowed to tell the world what you think of them, either.

Legally enforceable? Damned if I know.

~~~
phillmv
There's a word for people like that: pricks.

They're running a business at the end of the day, especially with so many of
them arguing against public healthcare options.

~~~
tspiteri
But if you say something nasty about them, I don't think they can even defend
themselves because they cannot say anything about your health story, so it is
a bit more complex than just running a business.

~~~
Klinky
Saying that doctors are the only ones bound by privacy concerns is incorrect.

A lot of businesses cannot bad mouth customers or defend themselves in public
due to how badly it looks to hash out all the details between the parties. If
you check out WebHostingTalk.com you will see that sometimes hosting providers
and dissatisfied customers will get into multiple page slugfests over who was
in the wrong. This just makes the hosting company look unprofessional.

Let's say someone wrote a negative review about a cell phone store: "They
wouldn't give me a cell phone! They're a horrible company!". The cell phone
store isn't going to reply back(in a public space) "You couldn't get a cell
phone because your credit was terrible & when we ran your card for a deposit
it came back as declined!". It makes them look bad for airing the customers
dirty laundry in public. A generic response & a request for the customer to
contact them on the issue is the best they can do in that situation.

These review websites sometime have a feature where the business can become
"verified" which allows them to respond back to these posts with at least
something generic like "Dr. X has attempted to communicate with Customer Y" or
something generic like "I am sorry to hear of your problems, please contact us
@ xxx-xxx-xxxx so we can help resolve this matter". This is probably the most
any business can do as far as communicating details about a certain customer
without looking bad.

------
yaks_hairbrush
I wonder if (non-tenured) college professors will undertake a similar
endeavor, given the visibility of ratemyprofessor.com

------
SkimThat
TL;DR - An Ars Technica reporter was about to sign an agreement with a new
dentist when he noticed that the contract forbade posting any reviews of the
dentist online. An organization called Medical Justice is supplying
boilerplate agreements to doctors and dentists to put in contracts with new
patients like the one previously mentioned in order to help control negative
reviews. Doctors, however, may not fully understand what those agreements
actually entail. They’re mostly focused on fraudulent negative reviews by non-
patients, which privacy laws make difficult to eradicate, but the agreements
could have a chilling effect on legitimate patient reviews. Doctors, however
can respond by making general comments about their practices, accepting that
there will be a few negative reviews, and dealing with complaints made by
patients.

------
callmeed
The "product" is $625/year or included with some larger membership.

<https://www.medicaljustice.com/web-defamation-purch1.aspx>

The fake patient quote on the page is so bad it's almost funny ...

------
Egregore
The article says that the agreement will not work in court, but even if it
will, why can't somebody (your relative) who know the situation and have not
signed the agreement post a bad review?

------
learc83
What is the doctor giving you in return? From my understanding it's not an
valid contract unless both sides get some kind of consideration (such as money
or a discount for service).

------
SoftwareMaven
The internets don't provide much information for doctors to go off of. Lots of
people who want to sell them mutual privacy agreements, lawyers that say "you
should do it!", but nothing with any real facts about them.

Maybe EFF could do some SEO efforts to get on google's front page talking
about what they really mean to balance everybody trying to sell them.

------
Vivtek
The real question is how much each doctor or dentist pays Medical Justice for
the privilege of being lied to.

------
chalst
AMS News wrote about this in 2008: <http://www.ama-
assn.org/amednews/2008/06/09/bica0609.htm> criticising an earlier invocation
of Medical Justice's "vaccine against libel".

------
logjam
My prior comment posted about another link describing doctors behaving like
this remains pertinent:

"I'm a doc. I have no idea of the legality of such "contracts", but it doesn't
matter - such a practice is completely unethical.

"Nor is it going to help a physician when a patient makes a complaint to your
medical licensing board.

"If you're doing your job as a physician you aren't a "provider" to
"consumers" - you are hopefully a professional working in the best interests
of a patient or population of patients regardless of your own personal
interests - this horseshit obviously has nothing whatsoever to do with that
goal."

~~~
Goladus
Very pertinent. The last also makes me think, though, that the sites
encouraging people to post random doctor reviews online to sell ads are the
biggest culprits.

I don't want my doctor focused on winning internet popularity contests. Most
people are not qualified to critique for the general public much more than
manner, environment, and particularly egregious mistreatment.

Choosing a doctor can be difficult and it's a problem worth solving, but I
don't think online review sites are the best way to do it. (That doesn't make
unreasonable terms and conditions any less unreasonable, though).

~~~
stretchwithme
Random reviews are encouraged? So these sites are encouraging people to post
reviews on anyone, regardless of whether they'e actually received a service
from them? Or do you mean something else when you say random?

~~~
Goladus
Sorry, poor choice of words. By random I mean someone whose opinion is
informed only by their impression of the care received, which was specific to
them.

Sites like www.ratemds.com are encouraging patients to review their doctors
like they would review a restaurant or hair salon on Yelp. A collection of
customer reviews of a restaurant can be very useful in two ways. First, the
main point of a going to a restaurant is the customer experience, which is
more or less the same for everyone. If a lot of people are leaving a
restaurant happy enough to write a favorable review on yelp, that's pretty a
good indicator that you may enjoy the experience as well. Furthermore, many
customers are well-qualified to critique the details of the service. The food,
environment, atmosphere, busy times, and various other features can be
described. For something like a hotel or a hair salon, those feature
descriptions will probably be more important. You can look for mismatches
between what's advertised and what the customers are saying

Doctors are different from restaurants in a critical way. The point of going
to a doctor isn't to feel good about the experience (although hopefully you
will) the point of going to a doctor is to get good, personalized, medical
care. Ratemds draws focus to the incidental features which are useful but not
especially critical (staff, punctuality) and on very vague evaluations of the
doctors ("helpfulness" and "knowledgeable"). For the most part, the patients
don't do an especially good job of rating the actual medical care.

In terms of surveying patients, all I really want to know is how many are
dramatically unsatisfied. Occasionally I hear major complaints about
caregivers from multiple people (extremely rude, very painful, etc.). That's
about the extent to which I trust the average patient to inform my decision
about what doctor is right for me, although I will admit standard Dental care
(cleanings, fillings) is more reviewable than internal medicine.

~~~
stretchwithme
I don't think people rate solely by how pleasant the experience was. The
actual results do matter. Did this lead to the problem being solved or being
better managed? Patients do care about such things.

There has been a great deal of focus on the delivery of procedures in health
care and not so much on actual cures. Compensation is entirely based on
procedures. A doctor may be rated on how a procedure was performed, but only a
patient can decide if the result was good.

Perhaps a system that quantified a patient's health before and after an
experience is a good way to go or over time is the way to go. If a doctor is
able to keep his patients healthier, he's a good doctor. But that's pretty
difficult to do with "random" ratings. Which is probably why word of mouth is
probably more trusted. And doctors haven't figured out how to stop it.

~~~
stretchwithme
Would it make sense to separate diagnosis from treatment? If the doctor
diagnosing problems had incentives for maintaining health and keeping costs
low, the doctors performing procedures could focus on delivering services
instead of selling them.

I could also see that approach making sense in things like automobile repair.

------
rorrr
Here are the places where you can review this particular dentist:

<http://www.yelp.com/biz/ken-cirka-dmd-philadelphia-2>

[http://www.facebook.com/pages/Dr-Ken-Cirka-
DMD/142418484400?...](http://www.facebook.com/pages/Dr-Ken-Cirka-
DMD/142418484400?sk=app_6261817190)

[http://philadelphia.doctoroogle.com/reviews/viewdentist.cfm/...](http://philadelphia.doctoroogle.com/reviews/viewdentist.cfm/pageID/8/dentistID/76856/philadelphia_dentist/dr_ken_cirka)

[http://www.bbb.org/washington-dc-eastern-pa/business-
reviews...](http://www.bbb.org/washington-dc-eastern-pa/business-
reviews/dentistry-cosmetic/dr-ken-cirka-dmd-in-philadelphia-pa-205551181/)

