Doctors Sue Patients for Online Complaints

Carl Bialik writes "'Several Web sites have sprung up that encourage patients to post anonymous reviews of doctors and dentists. Some frustrated patients have even created entire Web sites to criticize specific physicians. The Wall Street Journal Online is reporting that some doctors are, in turn, defending their reputation by suing the online critics."

Comments

Just the facts, maam

[BWJones]

Awww, they should toughen up. Spending time posting on Slashdot should help out with that as no interesting or informative post here goes without some sort of pain.

Seriously though, if the patients are reporting on their experience, then that is not slander. Just stick to the facts and they should be fine. However, when you start crossing the line into statements that cannot be substantiated, then that is dangerous water. It is of course important to have resources like Slashdot where comments past a certain date cannot be modified. They become a part of the historical record that documents both protection for and against issues of speech.

Re:Just the facts, maam

[Zeinfeld]

The main problem is that the sites had names like drsmithfraud.com not medicalreviews.com. If someone has a site with a name like that it is probably not a dis-interested review, it is more like publishing a hit piece on the subject.

On the other hand the doctors involved are interestingly similar. They are all promoting elective surgery for cosmetic or quality of life reasons, one at least is a heavily advertised brand that does frequent infomercials. These are not your usual doctors.

Folk who bring libel suits often have something to hide. Robert Maxwell successfully supressed criticism of his theft-in-progress of the Mirror group pension fund using libel writs. Only after he committed suicide did the massive fraud come out. Jeffry Archer got away with millions until he was found out and jailed for perjury. The US libel laws are not quite as idiotic but a successful defendant can't get costs of the plaintif and so the SLAPP potential of libel suits is much higher.

Re:Just the facts, maam

[Frank T. Lofaro Jr.]

Is Farmers the company that ran an ad for home insurance showing a house with flames pouring out all the windows and then they made the flames go in reverse and said that they get you back to the way you were?

That ad disturbed me - no amount of money will replace people, pets or even memories of a house, or undo the terror one would feel if one's house caught fire.

First Amendment versus Sanctioned Legal Monopoly?

[dada21]

Doctors are already a protected class of citizens, who have enormous power over the average person. They've got sanctioned monopoly powers, have a huge amount of leeway in treatment quality, and generally don't come close to the quality of service that they did a generation ago.

It is in everyone person's right to criticize bad service, and the threat of libel lawsuits should not be as powerful. When you have a State-sanctioned power to treat others, it shouldn't stop you from giving your best, especially in life or death situations.

I have a great doctor who has been retired for probably 15 years. He's old school and treats me and my family with respect and friendliness. He's available 24/7 by phone (home, office, cell, pager) and he's called me back at bizarre times when I've had problems. All my friends are blown away by the stories I have of his service.

I've been to other doctors and wish I had the time to complain. Dirty exam rooms, gossiping about other patients, staff that works more like DMV workers than health professionals.

I guess these people should just shut up and take what the State spoonfeeds them. Just wait until we have Nationalized Healthcare if you really want to see things get worse.

The American Dental Associations is no better.

First Amendment restrictions on our Federal and State governments should be re-visited. "No law" means no law. Especially when a doctor is free to blog their side of the story. I'm not sure why it is in anyone's power to curb the speech of others on a private or public forum.

Doctors smockters

[hackstraw]

I'm always late to a doctor's "appointment". Why should I have to wait for them after I already made an appointment?

Also, fact is that there is little difference between a doctor and someone that makes up mnemonic rhymes to monty python songs for 4 years and a doctor. Granted, there are decent doctors out there, but I've never been too impressed with your average doctor.

I welcome websites and/or other means of communication to bring doctors to our level. To me they are basically a non-technical auto mechanic that works on people instead of cars.

Re:Doctors smockters

[swillden]

My wife schedules each patient a reasonable amount of time for the problem that they're calling to see her about. On occasion, some of those problems turn out to be more complex and urgent than they expressed over the phone.

On occasion? Well, your wife is a much more considerate doctor than any I've ever seen, then. Every doctor I've ever been to is always running late unless I'm one of the first appointments of the day (which is what I try to arrange, actually).

The cause is obvious, and related to what you said, but you didn't take it far enough. You say your wife tries to schedule a "reasonable" amount of time. Since it's obviously impossible to estimate the amount of time each patient visit will take with 100% accuracy, the best she can do is to pick times that average out to be correct, that is, to schedule appointments so that roughly 50% of the patients require less than the allotted time and roughly 50% require more.

The first problem is, that does not work. Without getting into the math, it's very simple to prove with basic queueing theory that, assuming a normal distribution of error, she'll be behind schedule more than 50% of the time. The only way to ensure that, most of the time, patients *don't* have to wait is to systematically overestimate the time required per-patient.

The second problem is that if a doctor were to systematically overestimate patient treatment times, and schedule accordingly, statistics guarantee that the doctor will have a fair amount of down time between patients, most of the time. It's those bits of down time that provide the slack needed to catch up when even the overly generous estimate turns out to be inadequate.

Now, I think that would be the considerate way to run the business. Estimate in 15-minute increments, schedule in 20-minute increments, and plan on having time to read a journal for a few minutes after each appointment. But I've never yet met a doctor who does this. Why? Money. Downtime between patients means fewer patients in a day and that means a lower income.

Going back to the theory, if the doctor's goal is to optimize his/her time and income, not the patients' time and convenience, then the best thing to do is to ensure that there is never any slack. The doctor can still schedule "reasonable" times, but should make sure to schedule a few patients in very quick succession early in the day, so that the waiting room is never empty. It's to the doctor's benefit to be running behind schedule, because that way there's never any dead time. A little mathematics could probably even work out the minimum number of patients that should be waiting, on average, to guarantee a given (low) probability of dead time.

This is what happens in every case I've seen. They don't actually do it by scheduling three patients at five-minute intervals for 15-minute appointments first thing in the morning, but instead they systematically underestimate the appointment durations, then throw in the occasional empty block later in the day to prevent the backlog from getting too deep. The net effect is the same... they're perpetually behind and therefore perpetually busy, at the expense of their patients, who almost always have a long wait.

I think the best solution is a combination of slightly more conservative estimates in scheduling (accepting that it will mean a little dead time and a couple less patients per day) and communication. Determine a target maximum waiting time and if you get far enough behind to begin approaching it, start notifying patients that they should arrive a few minutes later for their appointments, and even ask each of them if they would prefer to reschedule for another day, which will open up a block of time to absorb the delay.

What about the other way around?

[alan_dershowitz]

It wasn't that long ago that there was a big stink over a doctor-run web site that blacklisted malpractice plaintiffs so that doctors could deny them future coverage, regardless of who won the case. Google cached link I guess it's not so funny when someone does it to them.

Re:What about the other way around?

[Randseed]

That depends on what the malpractice claim was for. Or, more accurately, whether it had any merit in the first place.

Most malpractice claims are dubious at best. When you come into the office and say you're on an MAO inhibitor and the doctor gives you demerol for pain, then that is an example of a legitimate malpractice claim. (The interaction is lethal.) The problem is that a lot of these cases are based on, to put it bluntly, bullshit, like the assertion that if someone is allergic to sulfa drugs then were administered a drug containing sulfur, the doctor is at fault for any sequelae that occur as a result of that. (For those who didn't read carefully, sulfur != sulfa. Depends on a lot of things.)

People who sue for bullshit like that, regardless of whether they know it's bullshit or not, should expect people to not take care of them. The idea that we should have a national registry of doctors to chronicle such claims but at the same time should not be able to have a national registry of people who file the claims is hypocritical and makes no sense.

There's a malpractice attorney in my town who has filed so many bullshit lawsuits and badgered people to settling out of court or pulling tear-jerking bullshit on the stand that none of the doctors here will take care of her. She has to go to a county hospital to get care for her kids. The last time she came in I was there. The attendings and residents were drawing straws. Literally.

Illegal?

[Daveznet]

I didnt know there was anyhting illegal about posting on ones experience. If a patient does not post false information and made up facts about the person and it is all just their opinion then these Doctors have a moot argument.

Re:Why is this surprising?!

[Ingolfke]

Your point is taken, but libel is not and never was protected speech. The fact that the doctor sued under libel indicates that the claims were false or misrepresented. If the were in fact true, the doctor would gain nothing by bringing the case other than proving the claims were indeed true.

Buy insurance before you criticize anyone publicly

[bigtallmofo]

For an average of $300 per year, just about anyone can get Umbrella Liability Insurance. Such insurance shields you from many things including slander and libel claims.

That way, the evil corporation or incompetent doctor that wants to shut you up with a frivilous lawsuit will really be suing your multi-billion dollar insurance company. $1 Million worth of coverage is typically around $300 per year. Multi-million policies are frequently available for not much more.

Balance opinion with truth

[kid_oliva]

The reason the doctors' are suing is this: true, you do have free speech, but you have to be responsible with it. If you slander (I guess in this case it would be libel) someone, they have the right to sue you. You would need to have disclaimers galour on the web-sites and all sorts of legal rhetoric to protect your backside. Case in point is the site bestbuysux.org. He has been sued a couple of times and has had to reorganize content and post disclaimers.

As long as you act responsiblly and have your backside covered you're good. If you make you make everything look legit but it is really just a flame page because you don't like someone's bedside manner; well, someone with their career on the line may just come after you.

Only Libel if false

[RedACE7500]

It's only libel if what the person is saying about the doctors is false.

... in order to recover damages a public person (as a celebrity or politician) who alleges libel (as by a newspaper) has to prove that "the statement was made with 'actual malice' -- that is, with knowledge that it was false or with reckless disregard of whether it was false or not" ...

The defendant may plead and establish the truth of the statements as a defense.

Your Career

[unidyneVII]

This is just unfair. Look at it this way: what if it were your career? If you work a service job, what if managers from companies worldwide in your industry started manager forums to talk about your performance and possibilies for hiring. Its way too unreliable. If you work a professional job at a desk-- same deal. And if you're a manager, what if clients all started forum-ing about your business? Plus, is there any check for truth in comments? Perhaps I'm just a malignant troublemaker and decide one afternoon that it would be fun to ruin the career of a respectable practicing doctor. Is phone calling and talking too slow? The old heard-from-my-friend-he's-bad [or good] seems fine to me. Phone calling and gossip are tried and trued methods.

Book Review

[CultFigure]

Can someone please explain to me how this is any different than someone posting a bad review for a book on, say Amazon.com? Or is it that Amazon does in fact receive subpeonas to remove those reviews that can be categorized as libel or slanderous and we, the public, don't hear about it?

Re:Book Review

[techno-vampire]

A friend of mine has a book out. Somebody who doesn't like him posted a nasty review there, full of personal attacks. He saw it and complained to Amazon. Within 24 hours, the review was removed. Yes, you can complain about a bad review, but what they do about it probably depends on what your objections are.

Respond in kind?

[peacefinder]

It's bound to come up, so let me head this question off at the pass:

Q: Why don't the physicians post their side of the story and let the public decide who is more correct?

A: The docs cannot simply post their side of the story on a patient's blog in response to the complaints. HIPAA's privacy provisions generally prevent physicians and their staff from doing so.

In the court of public opinion, only patients have a voice. It's little wonder that some docs might choose to reply via the official court system, because they have no other recourse.

Re:Why is this surprising?!

[angle_slam]

How the hell does tripe like this get modded insightful? Yes, there were free speech zones, but that was for two specific events, the nomination conventions. And that was done to lessen the chances of confrontations that could lead to violence. There are many protests of the current administration and they aren't being shut down by any fascist society that you imagine to be in existence.

Re:Why is this surprising?!

[ptbarnett]

Pretty much every time he goes out to a public event, the Secret Service sets up free speech zones.

This practice was apparently pioneered by the Clinton administration, after he was embarrassed on a number of occassions by protestors.

I'm not saying that it's a defensible practice. I'm just pointing out that the precedent was set before (the junior) Bush was elected.

I got contacted by an author based on a review

[Anonymous Coward]

I wrote an Amazon.com book review for a programming book that was less than flattering. I posted the review under my real name.

The author of the book Googled me, found my email address and then contact me to complain. I found that a little strange.

Re:How Else Can You Decide Which Doctor to Choose

[Karma_fucker_sucker]

I have a family member in medical. And they come home sometimes complaining about a Doc's incompetence. I said, "I know you and I can check up on another doc with you. What's the average Joe supposed to do?"
Answer: "They're fucked."

I think it's really shitty that the average person can't go and check ratings of healthcare workers and institutions. Believe me, a lot of shit isn't reported. A lot of incompetence is hidden. And unless the AMA starts weeding docs better, the only recourse the average Joe has is to gamble with his health and sue if need be.

Re:Buy insurance before you criticize anyone publi

[HBI]

Generally negligence is excluded. This means that if you consciously or unconsciously lied, they can deny coverage.

Simplified, negligence is when you do something wrong. Gross negligence is *knowingly* doing something wrong.

Umbrella liability is not a license to be an asshole. It's frankly not worth it in my view. It makes you a target since you now have deep pockets. First thing a lawyer is going to want to know is the policy limits on the target of a lawsuit. If he/she hears about an umbrella policy, they'll be gunning for the whole amount.

Re:You should also see www.taubmansucks.com

[networkBoy]

They had a fan site for a local shopping mall. The mall developers tried to shut them down (for some inexplicable reason), so as part of defending themselves they registered several "sucks" domains including http://www.taubmansucks.com/ (Taubman is the name of the developer).

The guy was trying to defend himself for a long time and started to get dug into a hole, but eventually he found pro-bono representation and ultimately they won. Maybe there's some useful ideas for you in there.

Yup. I've done lots of research about gripe sites because of that C&D.

On a side note someone at farmers reads /. my hits from them are higher than normal :)
-nB

Re:First Amendment versus Sanctioned Legal Monopol

[nightsweat]

Heck, if it's simple, I can go to a pharmacist and get something for a headcold. I want a doctor who'll catch that cancer one visit earlier or run that extra test to rule out a possibly fatal disease, or know that there's a better drug for me than the one he used to prescribe.

The best possible option is to get a middle-late career doctor who also teaches and works at a good medical school/research hospital. They have to keep up with the latest and greatest and have the experience to evaluate the material.