Balancing Shared Interests of Patients and Doctors

This week, the national media continued its coverage of our services to protect physicians from Internet defamation. Several of these stories used the attention-grabbing headline of “gag order.” This statement could not be farther from the truth.

Mutual privacy agreements do not create a choice between healthcare and one’s right to free speech (as some have erroneously claimed). 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.

We are not only doctors. We are patients and want to be able to choose the best healthcare professionals available so we receive the highest quality care. We agree that viable, actionable and statistically significant feedback is beneficial to patients and doctors alike. Unfortunately, most current rating sites fail at these criteria. We are diligently working to develop such a mechanism, utilizing the Internet, as an integral part of our long-term solution.

What are the facts?

Who we are: We are Medical Justice, an organization that is focused on serious proposals for reforming the entire healthcare system, not just for physicians, but also payers, and patients. These proposals, as well as discussions of our core offering, have been published in a number of peer-reviewed journals and presented at scientific, legal, and policy conferences.

How we’re involved with the issue of online defamation: Medical Justice has developed a mutual privacy template. When first seen, patients are asked to sign an agreement of mutual privacy. Patients agree not to post about their doctor on the Web without the doctor’s permission. Patients are free to discuss their care with other doctors, family, friends, licensing boards, attorneys, and any number of institutions. In exchange, physicians grant additional privacy protections to patients above and beyond those mandated by law.

How are physicians affected: On rating sites, patients, or people posing as patients- such as disgruntled employees, ex-spouses, or competitors – can damage a hard-earned reputation. And a doctor has no recourse. As an arcane nuance of cyberlaw, the web sites are immune from any accountability. (Section 230 of the Communication Decency Act). These sites have generally taken the position they will not monitor or police any content.

Secondly, in the U.S. the antidote to offensive speech is generally more speech. However, under U.S. and state law, physicians are foreclosed from posting a medical record to correct any factual inconsistencies. As it should be. Both patients and doctors place a higher premium on privacy.

The benefit to patients: Mutual privacy agreements are designed to address the emergence of now over 40 generally anonymous physician rating sites. “Mutual privacy” means that patients are granted additional privacy protections by the doctor above and beyond those mandated by law.

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. It is true a few patients do value a need to vent anonymously online. But the vast majority of patients feel otherwise.

Medical Justice is not, in principle, against physician ratings:

Patients want good information. But, facts matter. 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 2009, we are still struggling to compare apples to apples, like mortality and infection rates for institutions, much less individual practitioners.

If any site is willing to back the quality of their information (postings), they should post a conspicuous banner stating “Users can rely on the quality of the posted information to make important health decisions.” As healthcare consumers, we look forward to the day that we have statistical, actionable information delivered with transparency. We will send a note of praise to any entity that reaches that milestone first. But, the current flock of anonymous consumer rating sites are nowhere near that goal.

We know that outcome measurement of clinicians and institutions is a reachable goal:

This is what Medical Justice is working on at present. We are exploring partnering with a ratings company (such as Drscore.com) to get ratings done right. While we may disagree with DrScore on some issues, we find common ground on others; specifically that doctors are interested in constructive feedback, and if the information is made public, it be based on statistical analysis and not just anecdote. DrScore is the one site pushing a scientifically validated survey methodology.

Our mission is to promote a transformational healthcare system where patients can make informed decisions using the Internet as one means. Patients rely on the Internet information highway for this now – potentially to their detriment. This will change…