Gag orders on patients

[digitalising]

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http://consumerist.com/5164211/going-to-the-doc-be-sure-you-dont-sign-a-gag-order#c

http://www.washingtonpost.com/wp-dyn/content/article/2009/03/03/AR2009030303035.html?hpid=sec-health

There's a similar thread in Gen. Residency issues, but just wanted to see what the medical student community thought.

 

[themudphud]

Just some doctors fighting back against some of the occasional B.S. that comes up in practice. My personal feeling is, work hard, care about your patients, do a good job and take responsibility for your work. I've found that most docs who do that don't run into too many problems.

But then again, I've been largely sheltered at academic institutions so I can't comment on how it is on the outside.

 

[MassTransport]

I think what patients expect doctors to do and what doctors think is reasonable to do don't match up a lot of times, and if the expectation isn't fulfilled, the patient will oftentimes come away with a negative impression. Healthcare is emotional work, and it can polarize opinions. I get the impression that whether or not a doctor is perceived as good or not depends significantly on whether or not the patient figures he's been 'cured', and that's oftentimes not possible.

 

[LossForWords]

Didn't the ACGME do a study on patient satisfaction surveys recently? I recall that they found out that patients satisfaction ratings on the level of treatment they received were only 50/50 correlated with the actual medical appropriateness of the treatments they received. That's the same as random chance.

 

[cpants]

I think it's pretty stupid. Just thicken your skin. If you provide excellent service and show respect and caring for your patients, a few negative comments won't put a dent in your business. Even if it does, what right do we have to restrict patient speech?

 

[digitalising]

Unfortunately, physicians don't have the right to respond to comments made against them without HIPAA violations being thrown around.

And a few comments can easily become a few dozen on the Internet. The only people who post comments online are the ones who are either extremely satisfied or extremely dissatisfied, and the latter are more vehement, whether their concerns are justified or not.

 

[cpants]

It doesn't matter that physicians aren't able to respond. There is no response necessary. Just practice good medicine, and the problem takes care of itself. The idea of trying to restrict a patient's speech with an in-office waiver is absurd, and probably unconstitutional. These docs should try to reduce complaints by improving their practice, rather than trying to stifle speech.

 

[digitalising]

It doesn't matter that physicians aren't able to respond. There is no response necessary. Just practice good medicine, and the problem takes care of itself. The idea of trying to restrict a patient's speech with an in-office waiver is absurd, and probably unconstitutional. These docs should try to reduce complaints by improving their practice, rather than trying to stifle speech.

Doctors are not the government, and thus the First Amendment would not apply. There is no constitutional right to health care in the United States and thus asking a patient to sign the waiver is not an infringement upon their guaranteed rights. They have the option to go elsewhere.

 

[cpants]

Doctors are not the government, and thus the First Amendment would not apply. There is no constitutional right to health care in the United States and thus asking a patient to sign the waiver is not an infringement upon their guaranteed rights. They have the option to go elsewhere.

While I agree with you that healthcare is not a constitutional right, that really has little bearing on the discussion. I guess your point was that doctors could refuse to treat patients who refuse to give up their free speech rights. While that is technically true, I don't really see how that would be productive, especially if the point of the waiver is to keep business, not lose it. You are right that patients have the right to go elsewhere, and I'm sure a lot of them would if you asked them to sign a waiver like this. I know I would.

You can't expect patients, without knowing what's going to happen in your office, to give up all future rights to criticize your performance. Regardless of whether or not you agree with that, I don't know how you would expect to enforce the waiver. The internet is pretty anonymous. Are these doctors actually going to waste the time and money to subpoena websites and ISP's for user information? Assuming they even can obtain this information, do they expect to collect monetary awards from patients for complaining online? That should be real good for business...

The whole thing is a stupid idea. We as physicians should welcome criticism.

 

[digitalising]

While I agree with you that healthcare is not a constitutional right, that really has little bearing on the discussion. I guess your point was that doctors could refuse to treat patients who refuse to give up their free speech rights. While that is technically true, I don't really see how that would be productive, especially if the point of the waiver is to keep business, not lose it. You are right that patients have the right to go elsewhere, and I'm sure a lot of them would if you asked them to sign a waiver like this. I know I would.

You can't expect patients, without knowing what's going to happen in your office, to give up all future rights to criticize your performance. Regardless of whether or not you agree with that, I don't know how you would expect to enforce the waiver. The internet is pretty anonymous. Are these doctors actually going to waste the time and money to subpoena websites and ISP's for user information? Assuming they even can obtain this information, do they expect to collect monetary awards from patients for complaining online? That should be real good for business...

The whole thing is a stupid idea. We as physicians should welcome criticism.

While I agree with the welcoming criticism thing, why isn't the patient speaking to the physician about his or her concerns regarding treatment? It's difficult to learn much from an anonymous comment left on a website when you have no mechanism of getting follow-up.

My major issue is that when people don't get what they want, they get angry, and these people are the ones who are most likely to go onto ratings websites and write subjectively about their experience. Those who have good experiences are less likely to take the time to say so online. Think about it - if you were treated poorly at a restaurant, for example, wouldn't you be more likely to talk about that experience than if you received standard or good service?

If I have a patient who wants antibiotics for something that isn't bacterial, as many do, I'm not going to give it to them. If they've come into my office with their minds made up that they need this drug, me providing correct service is not likely to change their minds, whether or not I attempt to explain my reasoning. These are the patients that I'm worried about going online and saying that I didn't care about their problems when I did and just disagreed with their self-diagnosis. If I accidentally stab someone in the eye with a butterfly while trying to draw blood, then yes, probably I should be reported, but if I provide the correct medical treatment or correct advice which contradicts what a patient's erroneous beliefs, then we've got what I'm concerned about.

 

[cpants]

Maybe a more positive strategy for you would be to encourage all of your patients to rate your performance online, even give them a card or an email with the URL. That way the few bad apples will be drowned out by all of the people grateful for your healing.

Whether you like it or not, some patients will write negative things about you, and you will never know who they are. Heck it could be your ex-wife writing things about you. However, the waiver strategy will only cause annoyance and further dissatisfaction from your patients. Waiver or no waiver, there is no way to stop people from posting whatever the hell they want on the internet. So get over it, and don't read your reviews online.

 

[TMP-SMX]

Could turn into a ratemyprofessor-type fiasco. Of course it is along the same lines as being sued. You need good beside manner and rapport with patients. Even if you screw up, patients understand if they think you care about them and show some empathy. If you aren't going to prescribe antibiotics you need to explain why and make it personal. They have little viral packs they are giving out now to people with colds that explain why giving antibiotics is a bad idea for viral illness.

 

[Regnvejr]

There's a similar thread in Gen. Residency issues, but just wanted to see what the medical student community thought.

Rotten idea, and I doubt it would hold up in court.

Yes, we all have patients that are less than satisfied, but its not like we end up with no patients. The trick is to be able to actually communicate with your patients and have them understand why you do things. You are the professional, but that doesn't mean that you can decide what is best for them. That's what those ethics classes were for; empowered patients are satisfied patients, even if you don't help them that much.

The general measure of satisfaction is not so much how good a physician you are, but more about whether you are able to have the patient understand that you care.

Now, if they don't respect their patients, then they really shouldn't be in medicine to begin with (or at least not in that field of medicine). If a physician don't care, then the "pre-nuptual" won't help much anyway.

 

[Dirt]

I am not going to lie, when I saw this thread title I though "Now that is taking an order for restraints too far."