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Doctors and dentists tell patients, "all your review are belong to us" (arstechnica.com)
187 points by chanks on May 24, 2011 | hide | past | web | favorite | 76 comments



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


"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.


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?

-----


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?)


I work in healthcare IT; specifically I am the IT Security Officer and HIPAA Security Officer for a health system. In that role I deal with technology, operations and compliance issues frequently. It has been my experience that most physicians care about learning more, but are overwhelmed with the expectations around changing regulations, adopting technology and new demands outside of medical knowledge being placed on them.

Healthcare is in an odd state right now. Technology is being adopted rapidly, regulations are being passed that change how medicine is practiced, patients are getting more involved in their care and the clinical staff is expected to be involved with this while continuing to improve patient care. Eventually all of this change will be for the better, but not everyone handles change well.


Most doctors don't give a damn. They just follow exact rigid procedure. If someone dies they can exonerate themselves in front of any medical review board that bothers to investigate. They can then send the patient off to the morgue and go play golf on the weekend. Happens all the time.

If a doctor reads a medical study, takes a risk, and the patient dies anyway then the medical review board will ask them to explain themselves and why they didn't follow procedure.


>narrator: "Most doctors don't give a damn. They just follow exact rigid procedure. If someone dies they can exonerate themselves in front of any medical review board that bothers to investigate. They can then send the patient off to the morgue and go play golf on the weekend. Happens all the time."

Physicians are required to provide treatment within the standard of care. I'm not sure if that's the "exact rigid procedure" that you are referring to, but I would note that this requirement is imposed by the legal system.

Also, it really makes me sad to hear that you think that doctors don't care about their patients that die. I am a physician, and I can tell you (anecdotally) that doctors I have known who lose patients don't take it lightly. I'm sure there are exceptions, but I would ask you to back up such a broad and accusatory statement with some evidence.


Do you remember the names of the last three people who died under your care?


Yes.

What's a "bad day at work" like for you?


"Most doctors don't give a damn" if someone dies?

Perhaps you had a bad experience with a physician, but please don't generalize that to the entire profession. That's a ridiculous, inflammatory starting position.


Yea he was a bit crass there but the point is that patients die all the time and doctors will keep doing what they do. But being sued for malpractice is one of the most destructive things that can happen to a doctor's private practice and they will go to great lengths to avoid that.


It is wonderful that someone does. If doctors were as squeamish about death as I am, nobody would try to practice life-saving medicine at all and outcomes would be far worse.


It turns out that clinical treatment and medical research are two distinct activities, and patients appreciating not getting the one they did not expect.


Have you ever cared for someone who is chronically unwell, in pain, depressed? Take all the complexities of that relationship. Think about the days when you want to kill each other. Think about all the emotional ups and downs. Now have 10 relationships like this each day, every day.

You don't know anything about being a doctor.


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.


You could attempt to direct a bunch of publicity towards the fact that the management company wants to broadcast the security footage on the Internet:

* 'Anonymously' put up a bunch of papers around your apartment complex to direct residents' attention to those terms in the lease contract.

* Notify the local media about it.

* Discuss the idea that someone could use it to determine when you are/aren't home in order to rob/assault you.

* If you want to fight dirty you could bring up the 'protect the children' angle and talk about online predators watching your children.


> 'Anonymously' put up a bunch of papers around your apartment complex to direct residents' attention to those terms in the lease contract.

Kind of hard, when they have security cameras.


See that anonymously is in quotes. This probably means to use a pseudonym like "A Concerned Resident" on the letter.


No rule against putting up fliers, though.


Haha. I once received a threatening phone call from the son of my landlord for posting a flier (protesting an illegal mid-lease rent increase) in the lobby of the apartment building where I lived, or as he called it, "his place of business."


What came of that?


Most likely they "broadcast" the footage over the internet to a security company. There may be issues involving consent to record in your state that your apartment owners are trying to make sure they don't get in trouble over. If you are concerned over where the video ends up or what safeguards are in place to protect your privacy talk to the owners.


Have you asked for clarification on the terms of the addendum?

I'm guessing the situation is that networkable cameras have been installed and that they're being accessed remotely by management or a security company they hired.

I'm also actually surprised they even bothered to notify you and have the addendum. It'd be nice if they just said that or offered that as an immediate explanation. But they probably just got boilerplate text designed to be as broad as possible. Nothing necessarily sinister but lazy/cheap.


  > Nothing necessarily sinister but lazy/cheap.
This attitude really irks me sometimes. Once you've signed off on that overly broad language, do you think that the management company wouldn't take full advantage of it if there was a way for them to profit off of it?

Lazy/cheap is no excuse for attempting to pool as much power in your corner as possible 'just in case.' Once you've gained all of that power 'just for defensive purposes' there is nothing to stop you from using it offensively.


It's ok to be evil, as long as it's just because it was too darn much work to be good.


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.


They are required to give up security footage to law enforcement anyway during an investigation.

How is this copyright clause even helpful in that case? I'm guess it's not.


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


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.


If your lease was not up for renewal, you probably could have gotten out of your lease by refusing to sign it. Refusing to sign it and taking your business elsewhere is one of the best ways to let them know that you won't stand for this type of thing. And then spread the word to anyone that will listen about why you don't recommend doing business with that establishment.


Refusing to sign it and taking your business elsewhere is one of the best ways to let them know that you won't stand for this type of thing.

Although this is probably the best way to let them know, unfortunately real world constraints often mean that there are a very small percentage of people who are in a position to truly have a choice between not renewing their lease (in this example) and renewing it. Therefore, a company who is only being affected by those people who don't like their policy and have a choice to follow through will likely receive very little feedback. This is why, I feel, although on paper it works, in real life unfortunately one must insist on other ways to get our point across, including the ones mentioned in replies to the OP.


...which brings this subthread back on topic to the growing practice of vendors attaching gag clauses to service contracts.


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)...


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.


Just make sure to initial next to those changes.


It works with rental car agreements, too!


This sounds like a pretty good tactic.


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.


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.


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 ;)


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".


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.


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.


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.


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.


With regard to http://lagunaskincenter.com/RegistrationForms.aspx...

Since the office owns the full copyright to any communications posted online by the patient, if the patient were to post libelous content, would the doctor then sue his office for libel?


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.


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)


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


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


I emailed his office directly to ask about the policy yesterday. I'm making my own experience. yay!


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-...

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


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!"


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)


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.


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.


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.


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.


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.


TomOfTTB's point is not that what the doctor's did is justified. It's that if we want to deal the situation, we're barking up the wrong tree.


At the same time, I think it is fair to say that anyone (doctor or otherwise) should attempt to understand any legal agreement they enter into.

If doctors are asking patients to enter into a contract with them, they should have a good understanding of exactly what it says.


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


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.


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 ...


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?


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).


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.


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


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".


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."


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).


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?


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.


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.


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.





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