Medical Experts Riled as Doctors Try to Censor Their Patients

Doctors across the country are forcing their patients to sign waivers giving up their right to post comments and reviews about them online, a move experts say is unethical and should be prohibited.

Consumer-oriented Web sites like RateMDs and Vitals.com give Web users a chance to recommend and review physicians and hospitals nationwide. But some doctors now are telling their patients to censor themselves — or find another physician.

"This is just the guild trying to protect itself from accountability to those it serves. That's not professional behavior — this is self-interested behavior," said Laurence McCullough, professor of medical ethics at Baylor College of Medicine.

"And as a rule, when a doctor acts primarily out of self-interest, it's ethically suspect."

Among the groups spearheading the move is a company called Medical Justice, which says it is helping protect doctors from online libel, which it says is an "emerging threat" within the medical profession.

Dr. Jeffrey Segal, a former neurosurgeon who founded Medical Justice to help doctors fight off lawsuits, said he robustly supports the sites in theory, but in practice they aren't properly monitored and can do irreparable harm to a doctor's reputation — especially when people pretending to be former patients write phony reviews.

"It was not only patients posting information, but people posing as patients," Segal said, including "disgruntled employees, ex-spouses and competitors."

Segal and other medical experts say that while the ratings sites may have good intentions, little of the information they impart is of use, as the most important indicators of clinical care can only be judged by experts. The rest, they say, is just "random discussion."

"I think the real problem is that the info may not be all that useful," said Dr. Wendy Mariner, a law professor and director of the Patients' Rights Program at Boston University. "Patients may be able to evaluate whether a physician is responsive, courteous, on time, provides useful info to the patient," she said, but they cannot judge the most important issues concerning medical care.

But Mariner said the waivers create "an adversarial relationship" between doctors and patients, and could possibly limit options for patients seeking care. "If this kind of thing gains any traction, medical licensing boards will, and I think should, prohibit it," she told FOXNews.com.

Even without action from medical boards, Mariner said patients should be wary of doctors who ask them to muzzle themselves.

"What patient would want to go to a physician that asks for a waiver? It's a big red flag signaling that the physician is afraid of being evaluated," she said.

Under the terms of the agreements, patients promise they "will not denigrate, defame, disparage or cast aspersions upon" their doctors or post comments to any Web pages by name or anonymously, according to one contract obtained by Florida Health News.

Legal experts say private practices are permitted to ask this of their patients, and they do not violate any free speech laws.

But what happens when patients refuse to sign?

Segal said "there may be some" doctors who would refuse treatment to a patient who wouldn't sign the agreement, but that in an emergency those worries would go out the window.

"I don't think anyone will refuse lifesaving treatment because of this," he said. "Any time there's an urgent or emergency situation, you've got to take care of the patient. End of story."

Physicians are required to provide emergency treatment under the Emergency Medical Treatment and Active Labor Act, Dr. McCullough said. The American Medical Association allows doctors to choose their patients, but AMA principles of medical ethics say that even private physicians lose that freedom in case of emergencies.

Yet medical experts say they are concerned that if a patient refuses to sign the waiver, he may have no other place to turn.

The Coalition for Patients' Rights, which works to widen the range of options open to patients, said it is wary of any mechanism that would limit information patients have while choosing their doctors.

"We are certainly in support of patients having the widest access to accurate information, be that from magazine articles and Internet sites," said Maureen Shekleton, a registered nurse and member of CPR.

Many medical groups, including the CPR, have no official position on the waivers as the practice is not yet widespread.

Around 300 physicians in Florida reportedly require the waivers, and Segal would not divulge how many of the 2,000 physician members of Medical Justice use them. He said most patients are "perfectly comfortable" with signing.

Judging by the growing popularity of health ratings sites — there are now more than 40 major Web pages dedicated to assessing doctors — not everyone will be so comfortable.

Consumer sites are worried that the waivers could have a chilling effect on free expression and deny patients a vital resource for finding the best care.

"These kinds of agreements stifle the consumer's right to free speech" said Angie Hicks, founder of Angie's List, a consumer ratings site with a growing health section. "They would prevent even patients who are happy with their health care providers from recommending them."

But Segal and others say they are trying to find an ideal balance where both doctors and patients have a "seat at the table," and they hope to see more reliable online resources develop in coming years that can incorporate both the professional and layman's judgment.

For Mariner, asking patients to give away their right to voice an opinion is not a step toward that ideal balance. "It's self-defeating and it won't last," she said.