“Don’t see this doctor, he’s dangerous; “This guy learned all his medicine from TV on Grey’s Anatomy and ER.” And there’s more, even the occasional compliment.
There are now hundreds of sites, mostly anonymous, that rate health care professionals, and 43 million url’s unfurled by Google with the search terms “doctor ratings.” Welcome to the world of the Internet. As Dr. Jeffrey Segal observes in Physician News Digest, “…where the paradigm argues that plumbers, roofers, contractors… are fair game,” why not docs and other health providers? Is medicine a spectator sport when results depend not only on the condition-say advanced cancer vs. a cold-or whether the patient takes his meds or keeps his appointments-but only partly on “quality of care,” whatever that is. The plumber only asks that you pay his bill for unplugging the toilet. But medical care is often delivered by a team of doctors and other professionals, and outcomes of serious, conditions, often unknowable, are usually determined over long periods of time. In the case of a plumber,you either have hot water or cold. If you’re a smoker, drinker, diet binger, and weigh 300 pounds, or resume weight lifting three weeks after spinal surgery, it isn’t usually the doctor’s fault if you have more problems than expected.
Why are postings bad? Because of anonymity, anyone passing as a patient, anyone with a grudge,even a competitor, can let loose with a post and more posts. And there’s no one to stop her. Physicians are forbidden by law to respond to factually incorrect claims. As Dr. Segal points out, the usual way to respond to offensive speech is with more speech. Yet thanks to our friend HIPAA (the Health Insurance Portability and Accountability Act of 1996) and state privacy laws, doctors are foreclosed from this option. “A physician cannot even acknowledge that a poster is his patient.” Of course, doctors can ask patients to sign waivers but these only apply to the person signing them, not his family or friends. Others claim these waivers have a chilling effect on doctor patient relationships, and are nothing but glorified gag orders denying patients’ First Amendment rights.
Internet postings, gossip, or writings of any kind represent a growing problem for us all since they are cloaked in anonymity, the Great Protector, not only of posters but of web site accountability.For the latter, we have Section 230 of the Communication Decency Act.The best place to learn more about privacy and postings is, of course, on the Internet itself, the Great Mother of Knowledge and Opinion, invaluable and true much of the time; wrong, misleading, or dangerous the rest of the time.