The Emotionally Labile Client; Duties – When A Client Threatens Violence

Elon Law Review
2012, Spring
By: Jeffrey Segal, MD, JD, FACS, et al.and Michael Sacopulos, JD

What happens when a client – a defendant – threatens violence? The pressure of litigation can push a defendant over the edge. Even professionals, who are calm under pressure, lose their cool. Once an attorney believes his client might embrace violence as a means to an end, what obligations, if any, are triggered? And is the attorney liable for his client’s violence?

Imagine this scenario: A seasoned medical malpractice plaintiff’s attorney accepts a client presenting with a marginal professional liability case. This attorney generally screens cases carefully. This case is attractive because he calculates significant damages. His enthusiasm is tempered by paltry evidence of a breach of standard of care or causation. On balance, it’s a weak case. The plaintiff’s expert has shaky credentials, but is ready make the case for liability.

The defendant is a talented doctor, but emotionally volatile. He reacts to the summons with rage; smoke erupting from his ears. He cannot believe anyone would have the nerve to sue him. The case against him starts percolating through the legal system. The defendant’s rage builds.

The plaintiff’s attorney picks up on this volatility. He believes a jury might punish the doctor for his demeanor. His weak case just got stronger – a lot stronger.

The doctor defendant sends his defense attorney an email. He cannot believe his evolving litigation. Words such as “travesty, nightmare, horror, and injustice” are sprinkled throughout. He suggests that if he had a gun (which he does not) he might even kill the plaintiff’s attorney. The defense attorney is concerned, but does not believe anyone is in imminent danger. Yet.

A few months later, the plaintiff’s expert is deposed. The defendant takes his seat at the table, listening in silence for three hours. As the expert leaves, the defendant directs a verbal rant at the expert. The defendant then pushes him. No one is injured. But the expert is shaken up.

The defense attorney continues to have nagging doubts about the defendant’s emotional state. He questions the safety of the plaintiff’s attorney and/or expert. The defense attorney urges his client see a psychiatrist. This request falls on deaf ears.

Complete article – and legal analysis – continues in Elon Law Review, Spring, 2012. pp55-70.

Managing Your Online Reputation

Journal of Medical Practice Management
2012, May/June
By: Jeffrey Segal, MD, JD, FACS

The world has changed. Patients, now euphemistically called consumers, head to the Internet before choosing their doctor. In 2012 there are over 80 doctor rating sites inviting patients to post their experiences. These posts, in aggregate, do have an effect on business. Managing one’s reputation (particularly a doctor’s online presence) has never been more critical.

The problems associated with doctor review sites are well documented. First, most posts are anonymous, so it is impossible to determine whether the post was authored by a real patient, or someone posing as a patient. Who would pose as a patient? Someone with an axe to grind. A disgruntled employee. A competitor. An ex-spouse. Even an online reputation management company promising to “fix” a problem for a fee – a problem that company created as an excuse for your business.

Next, if there’s a wisdom of the crowds, there’s no crowd. The average review site has 0-3 reviews for any given doctor. The average doctor sees anywhere between 1,000-2,500 patients a year. This is a big gap. In general, the sampling on sites is not representative of a doctor’s practice.

In the U.S., the antidote to offensive speech in the U.S. is more speech. But, doctors cannot post the medical record on a web site to correct a misleading account. Doctors are foreclosed from responding because of HIPAA and state privacy laws.

Good medicine is not always popular. Patients sometimes request antibiotics for viral syndromes. They may ask for more pain medication than the doctor believes is necessary. The list of unrequited patient expectations is long. An unhappy patient with a mouse and broadband connection can create significant reputational damage.

The Internet is also a double edged sword. The Internet can promote one’s practice. Doctor reviews are weighted heavily by the major search engines. Doctors who invite their patients to post reviews – and have many reviews – can control the “real estate” on page one of organic searches. More on that shortly.

A Bad Review. What Now?

It’s impossible to have perfect scores forever. A bad review is inevitable. First, don’t over-react. Read that again. Give it perspective.

You can’t make everyone happy. The public at large knows that. A simple opinion about customer service is not defamatory. If patients want to write about poor bedside manner, a gruff front office, rotten parking, or long wait times in the waiting room – let them. That is fair game. And often it is the only way to get reasonable feedback on what your patients perceive, and how to fix problems.

Here’s a documented review about the Ritz Carlton. The Ritz Carlton provides excellent service and has a stellar reputation. And everyone knows that.

This hotel is a genuine piece of crap! I have stayed at some bad hotels and while this is not the worst I have ever seen it is pretty bad! This has to be the worst Ritz-Carlton in existence. I would suggest burning this hotel down before staying at it. The rooms suck, there is no gym or pool. …. The wall paper was falling off the walls in my room and my friends were staying in a room where they received a breakfast menu from housekeeping that had the pages stuck together by chewed bubble gum!…This place is horrible, I would suggest one of the trendy boutique hotels in Old Montreal! 1

Ouch.

If your rating is, in general, positive, there is often little reason for concern. Many believe that a collection of excellent ratings punctuated by a couple of bad ratings is perceived as being more credible than uniformly good ratings. In other words, a couple of negative ratings (among many positive ratings) may actually have the unintended consequence of increasing the positive perception of positive ratings.

Next, if the review is entirely unfair or inappropriate, determine if it violates the site’s Terms of Use. Many sites have formulated rules constraining how reviewers should behave. For example, on many sites, (1) reference to drugs or alcohol; or (2) abusive, objectionable, inflammatory language is prohibited. If the posting violates the Terms of Use, you can submit a respectful letter to the site, drawing their attention to the language of the post. They are not obligated to take it down, but might be persuaded to honor their Terms of Use policy. Civil discourse in a respectful tone is more likely to be effective than inflammatory threats. Some sites will respond to a persuasive tome. Others will not. Each site is different.

If you have an idea who wrote the post, it might be productive to reach out to that patient. Recently, a dentist was graded an “F” by an ex-patient. The poster alleged the dentist “over-diagnosed” the number of cavities; the implication being the dentist was only concerned about money. This ex-patient went to another dentist – who might have added gasoline to the then nascent fire. The original dentist looked at the chart to make sure he had not made any diagnostic mistakes. He had not.

The dentist wrote the patient. Selected excerpts follow:

A patient brought to my attention a review you recently wrote. We really want all of our patients to have a positive experience with our office and it’s clear you were not satisfied. I respect everyone’s right to voice their opinion. But, your review stung.

I reviewed your chart and saw that we diagnosed four cavities and recommended treatment. From the review, I see you went for a second opinion and that dentist disagreed with my diagnosis. No healthcare practitioner gets it right 100% of the time and I am no exception. That said, I used your review as an opportunity to double check the record to see if I missed anything. I also had the record reviewed (confidentially) by 2 peers. Each agreed with my diagnosis.

It was never my intention to disappoint you and for that please accept my apology. Given the information above, I would appreciate it if you would amend or remove the review you posted. It’s ultimately your decision and please receive this as just a request. I would be happy to speak with you directly about this. And if there is something I can do to reverse your initial impression of our office, I would welcome the chance to do so.

The patient responded positively to this overture – and did indeed update the “grade” to an “A.”

Pro-Actively Managing One’s Online Reputation:

A negative review has impact is it’s the only review on a site. But, an isolated negative review mixed within a sea of positive ratings is diluted. The literature suggests most patients are happy with their doctors. Tehrani, et al.2 published an article summarizing findings of validated online patient satisfaction surveys. They concluded the great majority of patients reporting their satisfaction online are highly satisfied with their outpatient medical care. The overall patient satisfaction rating was 9.28 on a scale from 1-10. Of the 14,984 ratings, 10,510 (70.1%) were 10s and another 2,291 (15.3%) were 9s. By deputizing one’s patients to post reviews, honest feedback is obtained, customer service issues can be remedied, and the inevitable negative review will generate less anxiety.

Coaxing one’s patients to post feedback is a challenge. There are over 80 doctor review sites. No matter how well intended, patients often forget about the request when they get home. Or, if they post, they may post to sites that have zero impact on your online reputation. One service that addresses this dynamic is e-Merit3. There, patients are provided an e-Tablet device (such as an iPad) in the office to anonymously provide feedback via survey. With patients’ permission, their comments can be uploaded to various doctor rating sites. The response rate is dramatically better than relying on patients remembering to participate when they leave your office. Further, the system can identify customer service challenges, ideally solvable, before they mushroom into visible reputational problems.

Other solutions touted by reputation management service providers include: (a) creating webpages with “competing” positive content to drive negative content to deeper pages on search engine results4; and (b) “bread and butter search engine optimization5.

What Not To Do?

Suing a website or patient for defamation should rarely, if ever, be pursued. There are exceptions, of course. In December, 2011, an Arizona jury awarded a $12 million judgment to two doctors after a local jazz singer posted critical Internet reviews of their practice and aired multiple complaints to the state Medical Board. 6 But, most doctors who sue alleging online defamation do not win.

Websites, for the most part, are immune from the tort of defamation. Section 230 of the Communication Decency Act, a federal law, provides review sites a safe harbor to display posts. To prevail in a suit for defamation, one must sue the actual poster. That poses more challenges. The vast majority of posts are anonymous. One would obtain a “John Doe” subpoena to identify the IP address of the source of the post. That entails significant work, a healthy amount of cash, and a lawsuit – alleging defamation – that is likely to prevail on the merits. This qualifier, “likely to prevail on the merits” is daunting. To prevail in such a lawsuit, the doctor must prove that the poster uploaded a false statement which damaged his reputation. Statements of opinion do not count. And truth is a defense to a charge of defamation. If a patient states “The doctor communicated poorly and did not seem to care about me one iota” – that is treated as opinion, and not actionable. If a patient states that Dr. X is not even Board certified, and he is indeed board certified, that does qualify as a false statement, and is arguably actionable. Most online rants are catalogued as “opinion.”

While a given review might qualify as legal defamation, a doctor should resist the reflex to sue. A lawsuit will convert an obscure item on a Google search into page one news. That is, a lawsuit might have the unintended consequence of publicizing the post even more than before. Further, the legal process moves slowly and is unpredictable. There are times when a lawsuit is the only tool left to achieve a reasonable long-term result; but, it should be the exception, and not the rule.

Other Details:

Rounding out odds and ends:

  1. Don’t pay patients (or provide discounts) for reviews. If you do, the patient must clearly disclose that he received material consideration for the review. This rule was memorialized in the Federal Trade Commission’s “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”
  2. Be careful about responding to reviews. Some mistakenly believe if a patient has posted, he has waived any expectation of privacy. That is not true. You are still bound by HIPAA and state privacy laws not to disclose any protected health information. That said, many posts are anonymous and related to customer service. Sometimes, it is possible to respond without violating privacy standards.

Summary:

Online reviews do impact a doctor’s business – for better and for worse. In general, more reviews are better. Most reviews are either positive or constructive. An isolated negative review generally has limited impact, as long as it is diluted by a sea of positive reviews. If a significant number of reviews are negative, attention should be paid to analyze the content of such criticism, and whether it can be remedied. It often can.

References:

1 Virtual Tourist. The Ritz Carlton Montreal. http://www.virtualtourist.com/hotels/North_America/Canada/Province_of_Quebec/Montreal-906413/Hotels_and_Accommodations-Montreal-The_Ritz_Carlton_Montreal-BR-1.html (accessed January 16, 2012).

2 Tehrani A, Feldman S, Camacho F, Balkrishnan R. Patient satisfaction with outpatient medical care in the United States. Health Outcomes Research in Medicine. November 2011. 2: e197-202.

3 www.emerit.biz (accessed January 16, 2012).

4 www.reputation.com (accessed January 16, 2012).

5 http://reputationmanagementx.com (accessed January 16, 2012).

6 Arizona Republic. Scottsdale doctors awarded $12 million in defamation case. http://www.azcentral.com/community/scottsdale/articles/2011/12/16/20111216scottsdale-doctors-win-lawsuit.html (accessed January 16, 2012).

Reprinted with Permission from The Journal of Medical Practice Management May/June 2012, Copyright 2012, Greenbranch Publishing, (800) 933-3711; www.mpmnetwork.com


A note from Medical Justice Services, Inc…

There are many third-party marketing vendors that help doctors navigate these waters safely. A word of caution – not all of these third-parties are HIPAA-compliant, so when investigating, ask the right questions. One physician-based online reputation management service, eMerit, has our endorsement. To learn more about their take on doctor reputation management, visit eMerit.biz.

When Doctors Sue Patients – Defamation Is Devastating, but a Lawsuit Could Make It Worse

manage negative patient reviews 1
We are a group of physicians that have been working with the Medical Justice eMerit team for the past 9 years. They have helped us obtain many more reviews from our patients by streamlining the process and making it much more convenient for our patients. They have also helped us in the process of flagging and getting fictitious reviews removed. Throughout our experience with them, they have been highly effective, honest, timely, talented and professional. If you are looking for a service to help manage your reviews, we highly recommend them.
Elliott23232323
Elliott23232323
14:44 17 Jan 24
The competence and responsiveness of the Medical Justice / eMerit team is remarkable. We have been super impressed with Robin and Josh, and their entire team. We ran a "test" with them and we've been more than happy to give them more business. They are now our go-to group. Thanks again, Team Medical Justice!
Christopher Scully
Christopher Scully
13:54 15 Dec 23
I have been a client for many years and have appreciated Medical Justice's expertise and numerous perks including internet defamation prevention. The team was readily responsive to my needs and helped to remove an unwarranted negative online post. It's difficult enough to practice medicine, much less maintain one's professional online reputation. I highly recommend Medical Justice for any medical professional.
Sohail Delfani, MD
Sohail Delfani, MD
17:05 25 Oct 23
Very enjoyable experience
Brittan Willimon
Brittan Willimon
21:13 09 Jan 23
Totally worth it! I had an issue with a very large insurance company threatening to remove me from their network. Contacted Medical Justice right away. Within lass then a week, Dr. Segal had crafted a magnificent 60-page appeal! Insurance company kept me in network, which saved me a lot of hassle and headache. Worth every penny!
Barbara Wood
Barbara Wood
18:01 13 Dec 22
I have used emerit for 10 years and have been extremely pleased with their service. highly recommend to all medical professionals especially plastic surgeons. very responsive CEO and staff. thanks!!!
Neil Zemmel
Neil Zemmel
13:56 13 Apr 22
When hiring someone professionally fortheir advice, the most important aspectfor me is their time that they give me todiscuss what I need to get the job done.Dr. Segal was always available whenever Ineeded to speak. He is extremelyknowledgeable, patient and kind. He hasthe unique perspective of the legalprofession from a doctors point of view.This is priceless in terms of understandinga Doctor's concerns.
Endodontic Group
Endodontic Group
00:38 31 Jan 22
I would say Medical-Dental Justice is a Level I Trauma Center for the legal matters of health practitioners. Your matters are handled STAT and in a professional and assuring manner. In a legal sense, they set you up with tools for preventive care, assist when there is an injury and handle the legal traumas. Rest assured that the legal injury will be minimized or they will rehab the situation a bring you back to legal health. No physician or dentist should be without this service...period.
Edward Kirsh
Edward Kirsh
21:17 30 Jan 22
I highly recommend Dr. Segal for all doctors who would like to have a bullet proof practice and avoid unnecessary litigation and threat by patients. He is always available and punctuate with time. We have a very busy practice in northern California and Dr. Segal has been a unbelievable asset and success to run it smoothly. You won't regret his service.
Sani Aesthetics, M.D.
Sani Aesthetics, M.D.
01:17 28 Jan 22
Medical Justice is always responsive and gets to solutions. We especially appreciate Josh P and his relentless drive to help us satisfy our customers. Their knowledge of the digital landscape brings us closer to prospective patients.
What's NEXT
What's NEXT
15:06 16 Nov 21
Jeff and his colleague Josh were both very prompt and knowledgeable in helping me resolve an issue with Instagram. Recommended to any healthcare provider needing help online with social media.
Spencer Hawkins
Spencer Hawkins
16:37 12 Sep 21
Dr. Jeffrey Segal and Medical Justice are amazing! They helped me deal with a frivolous and false board complaint to my license quickly and professionally. I was impressed with the amount of attention and copious amounts of time they committed to resolving my case. Dr. Segal also helped greatly in advising me how to protect my practice and avoid similar issues moving forward. I'm fortunate to have found their services! While I hope to not have to deal with more frivolous complaints in the future, I feel better knowing that Dr Segal and Medical Justice are there to help me navigate through what may come.
Lisa Wagner
Lisa Wagner
18:06 16 Aug 21
Dr. Jeff Segal is great at what he does! As a physician and lawyer he understands clearly the difficulty of practicing in this day and age. Having both backgrounds is his biggest strength in the medico-legal arena. He gives sound logical advice and is very responsive. I am glad that I trusted him with my issue which he solved by doing background research into the issue from other specialists. He approached the problem like a physician in a very methodical and detail -oriented way. I'm so happy to have found him! I highly recommend!!!
Nicole Basa MD
Nicole Basa MD
02:14 10 Aug 21
Medical Justice is the GO TOO for any medical provider.
Curt Litton
Curt Litton
00:35 29 Jul 21
Medical Justice exceeded my expectations on delivery of professional services. Top notch professionals, only the Best, and advisors on every medico-legal area of health care, especially Dentistry, with the Great, Vince Monticello, DDS, MBA, JD, on-board. By far a great investment. I enjoy doing business with Jeff and his Outstanding Team!
Rob Eye
Rob Eye
16:16 27 Jul 21
I’ve now been a subscriber and client of medical justice for over a year. Dr. and attorney Jeff Segal has been helpful on several occasions. He has guided me through both potential patient issues as well as recent HR pandemic concerns. He along with the Medical Justice team have given me reassuring legal advice that allows me to proceed with confidence through these difficult times. This is one of my best investments in business and personally.
Walter Tom
Walter Tom
16:06 25 Jul 21
I cannot give enough thanks for Medical Justice’s existence! It is a company that fills such a highly needed niche’ in medicine – especially aesthetic medicine. And it was founded and continues to be led by a visionary, Dr. Jeff Segal. I admire his drive and envy his intelligence. He first completes a rigorous Neurosurgery Residency. That by itself deserves tremendous kudos from anyone in the medical universe. Yet, he eventually goes back to obtain his JD. Yet what he has done in blending those two degrees into an amazing entity, Medical Justice, is nothing short of phenomenal.I was an early adopter of Medical Justice, and all that it provided for me as a surgeon and a business owner, as I am in my 12th year (this year being 2021) of being a member of Medical Justice. Throughout those twelve years, I have leaned on their team in helping maintain a fair and hard-earned online reputation when unfairly attacked. Also, Dr. Segal has always been personally involved with assisting me in resolving conflicts with difficult and unreasonable patients. He has always been only a phone call away, and prompt with his response.What I have especially appreciated is in my discussions resolving these occasional issues with patients over many years, Jeff seems to possess a third therapist certification as a compassionate, empathetic peer that understands my hurt and frustration. He has a way through the phone to put his arm around me, making me feel he sympathizes with my hurt and frustration, and together we will get through whatever issue, and the sun will rise in the morning. He then produces what he promises, as he has threaded the needle to resolution more than once for me. He feels like the big brother I never had that is there for you with honest, realistic guidance to amicable conclusions, when called upon.I just hope I retire before him. I can’t image practicing my specialty without someone like him, as well as his amazing team that he has gathered, that has and continues to have my back. - Dr. Burke Robinson, Robinson Facial Plastic Surgery
Burke Robinson
Burke Robinson
19:17 14 Jul 21
Jeff Segal, MD, JD was a tremendous help to me when battling a frivolous and retaliatory complaint to the State Medical Board. Jeff and the Medical Justice team fought immediately and tirelessly to clear this absurd complaint. It was validating, vindicating, and made me have hope again to practice medicine. It renewed my faith in the justice system and made it a pleasure to practice medicine again. Skillful. No - Masterful. There is really nothing that can replace the knowledge of an MD/JD or DO/JD to defend physicians. They were absolutely in my corner. Additionally, Medical Justice found negative reviews that I was not aware of and helped me address those concerns. Well worth every penny!
Terri Bowland
Terri Bowland
16:32 14 Jul 21
I cannot recommend a more professional or effective and caring team to help in legal matters which are delicate and require a high level of care. Dr. Segal is one of the most intelligent, thoughtful, and efficient attorneys that I have had that pleasure of working with. He was always available and attentive and demonstrated genuine concern and compassion towards making sure that all matters were handled with the highest level of efficacy. I highly recommend Dr. Segal and his team to any physician or practice, they will not disappoint!
Kriti Mohan
Kriti Mohan
02:15 15 Mar 21
Dr. Segal is kind, professional, and a complete genius! I am so glad to have found him! I would recommend him hands down for anyone needing legal assistance!
Samantha Britt
Samantha Britt
19:57 28 Jan 21
I am an oculofacial plastic surgeon who has been a member of Medical Justice for well over 10 years. It is a pleasure for me to be able to recommend their services to others.We have utilized the Medical Justice consent forms for operative patients throughout this time. It gives me peace of mind to know that any expert witnesses who may be called to give testimony against me are from my specialty. It also gives notice to any potential plaintiff firms that I have not only my malpractice carrier but also Medical Justice working for me should any claims arise, and puts them on notice that any frivolous claims can be in turn be litigated by me against them and the plaintiff.Does this translate to less claims or better results if claims are brought? I can only say that in 30 years of practice I have had a handful of patients request records be sent to plaintiff attorneys, and none have become suits.I can and have offered my highest recommendation for this firm and their services. Their services and client support are outstanding, and are especially beneficial when that letter for your records comes in. To have them on your side is a comfort we can all use.
Alan Brackup
Alan Brackup
15:01 07 Dec 20
The Medical Justice team have a wealth of knowledge and experience in this space. I highly recommend them to medical professionals and practices of any size. They take a highly responsive, professional, practical and no nonsense approach which has proven to be highly effective.
GenXovite Pro
GenXovite Pro
15:42 23 Nov 20
As a physician, reputation is everything. This is why I’ve trusted Emerit for years! Their unmatched ability to handle my clinic’s online reputation has helped us earn more credibility therefor increasing our patient base. They also create custom surveys for patients along with weekly reports so we can provide better treatment. These little things give us the ability to address certain areas of the practice and fix them immediately. I would highly recommend that healthcare providers to at least consider Emerit when considering an online reputation partner. I know I’m glad we did … Robert Odell, MD, PhD, Neuropathy & Pain Centers of Las Vegas
Robert Odell
Robert Odell
17:06 13 Nov 20
I recommend Medical Justice and its founder Dr. Jeff Segal with great enthusiasm. As medicine evolves the private practitioner has become increasingly more isolated. I signed up with Medical Justice so that I would have a sound legal back up for clinical business decision making. My private consultation with Dr. Siegel, neurosurgeon and attorney was insightful. His team, medical justice has already supplied us with appropriate patient forms to help me to continue practicing medicine with confidence. They have already initiated our web presence reviewing with recommendations.Dr. Segal was also readily available for a specific case consultation, and I appreciate his counsel and direction. The peace of mind and collegiality is well worth the investment in Medical Justice.
Walter Tom (Dr Walter Tom)
Walter Tom (Dr Walter Tom)
18:56 05 Nov 20
Have had the help from Medical Justice for about a year now. They are very responsive and always available to answer questions and help with any practice issues I may have. The most satisfying aspect of their assistance is in obtaining and posting patient reviews on various sites. A big help in that
Jonathan Lebowitz
Jonathan Lebowitz
00:50 03 Nov 20
In this era of digital feedback and punishment through fraudulent reviews. I wouldn't leave home without them!!
David Pincus
David Pincus
15:15 02 Nov 20
After a complete nightmare of a frivolous suit in 2002, aided and abetted by the sheer avarice of a competing surgeon right across the street (stunningly, a $2.1 million award over a pea-sized suture granuloma; when it went to the state medical board they dismissed the case as “groundless”), I was advised to join Medical Justice.What a wonderful team! Everyone there has been immediately available for any questions or concerns that have come up over the years. Just having Medical Justice’s cover letter stating that one’s a member will be enough to stop a frivolous threat dead in its tracks — and that alone makes the eminently reasonable annual fee worthwhile many times over.Knowing that Medical Justice “has my back”, and knowing that because of these fabulous people, the worst and most profoundly mind-bending experience of my life would never be allowed to happen again has given me the peace of mind to continue and even enjoy and relish my career over these many years.I can’t say enough about Dr. Jeff Segal, Mike Odden, Wendy Cates and the rest of this amazing team! Joining Medical Justice absolutely will be one of the best decisions of your career. How about 10 stars!⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️
Holly Barbour
Holly Barbour
18:39 05 Mar 20
We have been MedicalJustice members for over nine years, and this is a service that has been priceless for us, and our facial plastic surgical practice. Ninety percent of our new patients cite the Internet as their source of referral, so for us, our internet reputation is priceless. Plus my kids see what's on the internet about our practice. MedicalJustice scours the internet for any online posts about your practice, good and bad. Even if you are able to do things exceedingly well, it is unlikely that you will be able to deliver impeccable care with exemplary bedside manner 100% of the time, have the perfect staff, and count zero competitors. And thus, unfortunately, being defamed on the Internet is an occupational hazard.I recommend MedicalJustice without reservation to any medical practice, since nearly all patients will google you before calling for an appointment. Everyone at MedicalJustrice from our advisor Shannon, to the CEO, Dr Jeff Segal, is knowledgeable, friendly, and genuinely glad to help physician practices like ours. I am grateful for all they have done to help our "mom and pop shop" thrive, and navigate unchartered waters on the internet. MedicalJustice has been outstanding for our practice in these situations :1)Reputation management. The American Academy of Facial Plastic and Reconstructive Surgery recommended MedicalJustice to all members in 2009, and after we got on-board, we were surprised to see more than a few negative internet reviews and comments about our practice. Frankly, I do not have the time nor desire to actively surveil the internet about our practice, but someone NEEDS to. If you don't read it, someone googling your practice will.2) Dealing with negative reviews in a safe and HiPAA compliant fashion. Some internet "specialists" recommend ignoring bad reviews, but for us, that philosophy is not cool. 12% of patients who request rhinoplasty have BDD, and as of August2018, there is no reliable method for ruling this out preoperatively. The small minority of unhappy postoperative patients may post on multiple sites, and have the longest and most painful words. MedicalJustice has helped us A LOT in this arena.3) Dealing with internet defamation.4) How to manage the disgruntled patient, and more importantly, the "difficult" scenario where you don't know what to do, and it's not malpractice.5) How to manage patients threatening to harm themselves or others.6) How to manage patients demanding a refund.7) Advice with patients threatening to sue.8) Advice with copyright infringement.9) Obtaining positive reviews from our patients with eMerit.If any physicians wish to reach out to us for any questions, it would be our pleasure. Thank you. Dr Joseph
Eric M. Joseph, M.D.
Eric M. Joseph, M.D.
19:17 09 Mar 19
Great doctor.My neck pain is gone. The doctor explained everything in detail. He was patient and respectful.
Sushil Basra
Sushil Basra
01:57 31 Jan 19
No medical professional should be without this service! I have been a long time member and will never give up my membership. I have never had such clear and concise solutions to common issues, education regarding what I need to do and how to be best prepared for common issues that arise. Whenever I have had a question, I get immediate responses that are clear, concise and of great value! Honestly - the first time you run into a difficult situation is not the time to realize you SHOULD HAVE had this service. You need to be aware, and appropriate- this service is absolutely the best resource you could want for you to meet your obligations, as well as be prepared for common issues. Not only has Dr Segal experienced both sides of many of these issues- he is brilliant, and condenses issues down - allowing you options that allow for the smoothest possible outcome for all involved. I honestly could not recommend it more!CR MD
Celia R
Celia R
18:35 12 Nov 18
A must-have for every physician. Their expertise in medical malpractice defense, and internet reputation management, is unparalleled.
Armond Levy
Armond Levy
01:27 07 Oct 18
HIPAA is complicated and always changing. That is why I recommend Medical Justice to all my clients. They are knowledgeable and trustworthy.
Jen Longtin
Jen Longtin
22:58 29 Sep 18
Impeccable service and reputation from the CEO on down. Helped me grow my practice by vastly improving the quality of my online presence. In addition, I am now insulated from the occasional anonymous and damaging online reviews. I see many additional new patients who have “googled” me and have read my numerous outstanding reviews. In addition they have helped protect me from frivolous law suits while readily providing expert legal advice. In this day and age, in my opinion, every physician needs Medical Justice standing behind them. Thank you, Medical Justice!
David K
David K
05:57 16 Sep 18
I have partnered with their organization while working in two separate companies and they have continued to provide outstanding support, superior service and communication and remain ever available. I would not practice medicine without their support.
Christina A
Christina A
15:16 13 Sep 18
We have been working with Medical Justice and Emerit for years. I would highly recommend them. They have been very responsive to all of our needs in our practice. They have guided us on how to get our patients to share their experiences online Dr. Segal has given us honest advice over the years and he has never steered us wrong. Highly, highly recommend Medical Justice!
Angela Parker
Angela Parker
20:25 12 Sep 18
Medical Justice is the real deal. They are professional, knowledgeable, timely, and their rates are beyond reasonable. Put all of that together and they have become an invaluable asset to our practice.
Jackie Foster
Jackie Foster
17:38 06 Sep 18
Our surgical practice joined Medical Justice and eMerit many years ago and it has been an invaluable resource and support. Jeff Segal, the founder, is a surgeon and an attorney who understands the challenges that physicians face today. They have been our advisors, mentors and dispensers of wisdom for any and every issue that we presented to them as well as in growing our practice. I can't imagine running our practice without them all of these years.
Bonnie Pontell
Bonnie Pontell
14:48 06 Sep 18
EXTREMELY beneficial. The ratings have done more for my Google search rankings than my website. Worth every penny. It is 2018--get on board with your online presence!
Scott Phillips
Scott Phillips
14:13 06 Sep 18
I have been a client of Medical Justice for many years. They provide a fantastic opportunity for Healthcare providers to defend against frivolous claims and to control their reviews using the eMerit platform.The service and the reviews have been extremely valuable to my practice, my social media presence and ratings as well as protection against some false claims over the years.They are always available, responsive and timely in their assistance. Dr. Segal offers a wealth of resources, insight and legal advice due to his vast experience in this venue.I highly recommend this service for anyone with a medical or dental practice.
Semira Bayati
Semira Bayati
16:27 05 Sep 18
Dental Justice has helped us manage challenging patients who are impossible to please. Let them show you that there is a better way than being frustrated.
Mitchel Friedman
Mitchel Friedman
14:53 04 Sep 18
Worked with Dr. Jeff Segal and his team for many years, I absolutely trust them when it comes to protecting our practice and team. I give my highest recommendation and I sincerely appreciate your thoughtful approach as leaders in the industry ( :
Rich Castellano
Rich Castellano
03:40 04 Sep 18
I have been a member since its' inception and can recommend the company without any reservations whatsoever. I benefited from their online review services, their involvent in preventing a frivilous malpractice threat, and their pro-active legal seminars. Thank you Dr. Segal for all your efforts.
Michael Prater
Michael Prater
21:55 02 Sep 18
It only took one reading for me to become a big fan of Leonard Berlin's.Who was Leonard Berlin?He's the radiologist who countersued a plaintiff who tried to make a fast buck by frivolously suing him. When I finally met him, I told him that I'd been following what he was doing.Berlin was the first MD I knew who fought back. When I read about Medical Justice, it was clear to me that in case I got sued frivolously, I, too, would be able to counterpunch.Raised by a pair of criminal lawyers in New Orleans (yes, really), I pretty much had a (legalistic) chip on my shoulder from childhood. Medical Justice welded it there. Instead of being a 98-pound weakling in the face of a pseudo-legal assault, it made me a Charles Atlas kinda guy.No fear after joining up. I was surprised at how reasonable the rates are.
Joseph Horton
Joseph Horton
19:00 02 Sep 18
I have used Dental Justice for the past several years and have always been happy with their service. They are professional and timely. Dr Segal has been great with his knowledge, advice, services and timely responses. I would highly recommend them to anyone in the dental or medical profession.
Shane Claiborne
Shane Claiborne
14:28 31 Aug 18
I have been using E Merit and Medical Justice’s services for the last nine years. I have found their helpful feedback to be of tremendous value to me and to my practice. I am extremely grateful to Jeff Segal and his entire team for their thoughtful and professional help. You will not be sorry if you give them a chance. I don’t know anyone who has not found them immensely helpful or who has stop using them once they have engaged their services.
Joseph Stern
Joseph Stern
01:43 30 Aug 18
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Florida Medical Magazine
By: Jeffrey Segal, MD, JD, FACS, et al.

Before we dive in, some fast advice. Suing a patient for defamation is challenging. It will likely propel you and your practice into the spotlight – and not in a good way. If you are a doctor who is considering suing a patient for defamation, schedule a consultation with our Founder and CEO, Jeff Segal, MD, JD. We can help you determine the best course of action for your circumstances. And for more content specific to doctors combating internet defamation, read: Defeating Internet Defamation: How Doctors are Crushing Lies Online.

Dog bites man never makes the newspaper. Man bites dog is news.

Doctors suing patients (and their families) is news.

Several cases are percolating through the legal system. In each, a doctor sued a patient (or patient’s relative) for online mischief. Doctors are starting to prevail in the legal system. Whether this is a useful strategy for all doctors will be discussed further down. First the details.

In Carlotti v. Petta,  Dr. Carlotti, a cosmetic surgeon,  successfully sued his former patient – receiving a jury verdict of $12 million in December 2011. In 2007, Albert Carlotti, performed a number of procedures on Ms. Petta, a singer, including a rhinoplasty.

To say Petta was unhappy would be an understatement. She launched a website which claimed, among other things, that Dr. Carlotti was not board-certified. Records showed he was board certified by the American Board of Oral and Maxillofacial Surgery.

She claimed Carlotti was being investigated by the Arizona Board of Medical Examiners. Carlotti did not have any disciplinary record with the Arizona Board.

Petta also allegedly obtained phone numbers for some of Caroltti’s patients, calling them, making the same allegations.

Petta’s actions took a toll on the practice. “I was dealing with somebody who had the intent of destroying us professionally, personally and on every level. I went from a very successful surgeon to pretty much out of business.” Carlotti considered relocating to another country. He was forced to sell his home. And he shed over 30 pounds due to stress.

As a last resort, Carlotti sued Petta for defamation. A jury listened to testimony over three weeks. They delivered an 8 figure verdict in one day. The case will likely be appealed. [Update: On January 15, 2015, the Arizona Court of Appeals vacated the lower court judgment noting “the evidence presented [did] not support such an excessive award of general damages.” The Court of Appeals mandated a new trial to address both liability and damages.]

In McKee v. Luarion, Dr. McKee, a neurologist, sued his patient’s son for online defamation. In April, 2010, McKee was reviewed on a doctor rating site.

“My father spent 2 days in ICU after a hemorrhagic stroke. He saw a speech therapist and physical therapist for evaluation. About 10 minutes after my father transferred from ICU to a ward room, Dr. David C. McKee walked into a family visit with my dad. He seemed upset that my father had been moved. Never having met my father or his family, Dr. McKee said, “When you weren’t in ICU, I had to spend time finding out if you transferred or died.” When we gaped at him, he said, “Well, 44% of hemorrhagic strokes die within 30 days. I guess this is the better option.” My father mentioned that he’d been seen by a physical therapist and speech therapist for evaluation. Dr. McKee said, “Therapists? You don’t need therapy.” He pulled my father to a sitting position and asked him to get out of bed and walk. When my father said his gown was just hanging from his neck without a back, Dr. McKee said, “That doesn’t matter.” My wife said, “It matters to us; let us go into the hall.” Five minutes later, Dr. McKee strode out of the room. He did not talk to my mother or me. When I mentioned Dr. McKee’s name to a friend who is a nurse, she said, “Dr. McKee is a real tool!””

The patient’s son sent letters to the hospital and assorted medical associations making the same claims. McKee sued the son in Minnesota court. The case was thrown out on summary judgment. Truth and opinion are two defenses to allegations of defamation. The judge concluded the review contained statements of opinion, true statements, and vague statements. Accordingly, the judge ruled against the doctor. McKee appealed his case.

January 23, 2012, the Minnesota Court of Appeals overruled the lower court, sending the case back to be heard by a jury. The court ruled that many of the statements were factual assertions – not opinions. And many of the statements were capable of harming the doctor’s reputation. For example, the following statements suggested the doctor was rude, insensitive, and morbid: the doctor had to “spend time finding out if [the patient was] transferred or died”; “44% of hemorrhagic strokes die within 30 days. …this is the better option”; and “[It] doesn’t matter” that the patient’s gown did not cover his backside. So, the case lives on.

In the past, some doctors have tried to sue various doctor review sites. But, such sites are immune from most litigation. They are protected by Section 230 of the Communication Decency Act. Section 230 is a federal law which makes it impossible to sue a web based platform for defamation. That said, if a doctor can identify the actual author of a defamatory post, he can sue that person. In the cases above, the doctor was able to easily identify the author. More often, it can be challenging – as most posts are uploaded anonymously.

Even anonymous posts can be tagged to a specific person. Patients often leave digital footprints. Their post emanates from a specific Internet Protocol address. Many online sites and/or Internet Service Providers keep date stamped records tying an Internet Protocol address to online activity. Doctors can file “John Doe” lawsuits making the case for defamation. If they can demonstrate they have a prima facie case asserting defamation, they can file a subpoena to track down the Internet Protocol address – getting closer to determining the identity of the poster.

So, is it a good idea to sue a patient for defamation? In most cases, the answer is no.

First, proving defamation is not easy. To prevail, you must prove that the defendant made a false statement to another person; and the statement harmed one’s reputation. If the statement was true, you will lose. If the statement was an opinion, you will lose. If the patient writes she does not like your bedside manner and you communicate poorly, that will likely be construed as opinion. And opinion is fair game. For a deeper explanation here, consult our follow-up article about doctors tackling online defamation.

What type of statement might be considered defamatory? One which is easily proven to be false. For example, “Dr. X is not board certified” – when he is. Or “Dr. X charged $15,000 for the surgery” when the documented price was $3,500.

Next, litigation can be capricious and expensive. Even if you win a judgment, the defendant might have no assets. A Pyrrhic victory.

Most importantly, suing a patient brings attention to the nasty post. If that post could only be located on a Google search buried on page 3, suing the patient is the most effective way to move the post to page 1 – an undesirable outcome. In other words, suing for defamation might increase the damage caused by the post.

This phenomenon is known as the Streisand effect. In 2003, Barbara Streisand attempted to suppress photographs of her residence appearing online. She sued a photographer, Kenneth Adelman, and Pictopia.com for $50 million hoping to have an aerial picture of her mansion removed from a publicly available collection of 12,000 California coastline photographs. The photographer said he took shots of beachfront property to document coastal erosion. Before Streisand filed her lawsuit, “Image 3850” was downloaded from Adelman’s website less than ten times (2 of those times were from Streisand’s attorneys). After the lawsuit was filed, more than 420,000 people visited the site the following month. Streisand did not prevail.

The best way to prevent damage from isolated online posts is by accumulating real reviews from confirmed patients. This will dilute whatever effect the negative post has. The public understands you cannot make everyone happy 100% of the time. Even the Ritz Carlton gets an occasional bad review. If you only have great reviews, the public will likely discount the authenticity of such reviews. If there’s an occasional bad review, the public will perceive all reviews as authentic.

Don’t be afraid to invite your patients to give you feedback. The literature suggests most patients are happy with their doctors. Tehrani, et al.[1] recently published an article summarizing findings of validated online patient satisfaction surveys. They concluded the great majority of patients reporting their satisfaction online are highly satisfied with their outpatient medical care. The overall patient satisfaction rating was 9.28 on a scale from 1-10. Of the ~15,000 ratings captured, 10,510 (70%) were 10s and another 2,291 (15%) were 9s.

Suing a patient makes news. Pre-emptively asking your patients for online feedback is not remotely newsworthy. But, that strategy is more likely to help you control your online reputation. Request a complimentary consultation. We are equipped to neutralize patient disputes and help you protect your reputation. And for more content specific to doctors combating internet defamation, read: Defeating Internet Defamation: How Doctors are Crushing Lies Online.

Jeffrey Segal, M.D., J.D., is founder and CEO of Medical Justice. Medical Justice is a physician based organization focused on keeping doctors from being sued for frivolous reasons. In addition, Medical Justice helps doctors control their online reputation.

 

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Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.