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n oft-used maxim in U.S. health care is that patients ought to be treated more like consumers. Their feedback about medical services should be valued, and they should be given a chance to express their concerns.

But with more patients speaking up — via hospital surveys and third-party rating websites — inevitable tensions are emerging. Negative comments sting. Doctors targeted by them get angry. And in some cases, the feedback from patients gets labeled something else entirely: defamation.

A steady drip of legal disputes over online reviews is putting those tensions on display. In Texas, a pair of freestanding emergency rooms recently filed a legal petition seeking to force Google to share the identities behind 22 screen names connected to negative comments about the providers’ services.

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In another closely watched lawsuit, a plastic surgeon in Cleveland is suing a patient over negative reviews she posted on RealSelf and other sites. The dispute is unusual in that it may actually proceed to trial (most get settled), potentially leading to an influential precedent.

Participants in the doctor rating business say those cases are flashpoints in an inevitable, if messy, transition to a more open marketplace. And while some providers are balking at unfavorable reviews, other hospitals are taking a counterintuitive approach to the problem — calling for more reviews, and posting them on the hospital’s own site. That effort aims in part to put negative ratings in context. It’s also a way to deliver a more straightforward message to physicians: If you don’t want negative comments, do your job better.

“The big impact [of reviews] is on the people being measured, not so much on the consumer,” said Dr. Thomas Lee, chief medical officer for the patient survey company Press Ganey. “It makes people raise their game.”

University of Utah was the first hospital to begin posting unedited patient comments online in late 2012. Since then, dozens of hospitals have followed suit, including Cleveland Clinic, Duke, Geisinger of Pennsylvania, and Brigham and Women’s Hospital in Boston.

Some critics of publicly airing patient comments argue that they put doctors in an untenable position. Due to federal privacy laws, doctors cannot respond in a way that would compromise patient confidentiality, leaving them with limited ability to rebut complaints. Physicians are also uniquely vulnerable to public criticism, given the deliberateness most people take in choosing where to get health care.

So, many providers, including the University of Utah, give physicians an opportunity to review their comments — and to appeal to an internal committee to get them tossed out if a doctor can show a comment is particularly unfair or untruthful.

In some ways, hospitals’ decision to post more reviews is an act of self-preservation amid a dawning reality: Their doctors were already getting publicly rated on third-party sites like Healthgrades, Vitals, RateMDs and others. In many cases, such sites only feature a handful of comments on a given doctor. If one or two are negative, it’s easy for doctors to feel they are being presented unfairly.

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Although third-party sites themselves are shielded from liability, the individual commenters are not. Libel lawsuits remain rare. More common are threatening letters from doctors and their attorneys seeking to pressure commenters into removing or retracting their statements. Last year, Aaron Schur, senior director of litigation at Yelp, testified before Congress that the company regularly receives supboenas from plaintiffs involved in an array industries who want to get Yelp users’ personal information to press their legal claims.

In testifying for greater protections for consumers, Schur cited a letter from one Yelp user who said he removed his comment — even though he maintained its truthfulness — after a dentist sued him for $100,000.

Though effective in some instances, such tactics are often expensive and risky, especially if they lead to litigation. Dr. Jeffrey Segal said there are more effective ways to respond. Instead of fighting negative comments, he said, providers ought to solicit more of them.

“I call it the denominator problem,” said Segal, chief executive of eMerit, which helps doctors collect and post reviews from patients. He said doctors who feel their reputation is being harmed by a few negative comments can combat the problem by opening the floodgates to all commenters.

It’s a tack that a wide variety of businesses — from hair salons to laundromats — have taken in the online era of “reputation management”: hiring firms to help solicit good reviews or respond to consumers who leave negative ones. As the health profession belatedly embraces online reviews, a number of firms have sprouted up specializing in just this kind of digital spruce-up.

Segal said his company does not screen patient comments or advise that only positive reviews be posted. He said that would quickly undermine their credibility, causing consumers to pass them off as marketing puffery.

Segal, who also founded Medical Justice, a firm that helps doctors deter frivolous malpractice suits, is among many doctors who have done an about-face on the value of patient comments. He said he initially thought they offered limited value in improving quality, while giving disgruntled patients a chance to take potshots.

Then he started to look into it more deeply. Examining data from insurance carriers on specific procedures, he found a high correlation between the outcomes data and what patients were saying about the doctors online. “I went from being opposed to it, to figuring out how to do it better,” Segal said of online reviews.

He acknowledged lawsuits will continue. But he cautions doctors not to file the kind of frivolous claims he spent so much energy trying to protect them from. “Litigation is probably something that should be used sparingly, infrequently, and with full eyes open,” Segal said. “There probably are occasional circumstances where it probably is [warranted], particularly if your practice is clearly damaged. But those are the exception. They’re not the rule.”

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  • The tone of the response to all of us patients by a member of the medical profession has told us how they feel about us: negatively. Anything we bring up is brushed off. This is the same attitude that we’re saying happens when problems come along.

    I suggest that since we are not going to change the mindset/attitude of the medical personnel involved, we double our efforts to constantly put out there this attitude, to broadcast widely and loudly how we are treated, to record it, and to make sure we keep those things in our notes so that it is documented. Constant putting it out there to show the attitude to us, while we are paying for this service, should be done so all are aware of problems when mistakes are made on behalf of the medical community, those in administration.

    • It’s interesting that you mention attitude in your comment. Let’s review what transpired so far, shall we?

      Doctor posts a comment about anonymous online reviews being on-sided and inherently unfair due to federal privacy laws which limit/prevent a direct response (unlike any other business that gets reviews).

      Responses from commenters describe anecdotes about how horribly they or those they know have been harmed, and that there is an organized conspiracy that involves both doctors and the courts to suppress patients’ rights to legitimate recourse.

      Doctor responds asking for supporting evidence for these claims beyond anecdotes. Evidence is presented, and upon review, refuted. Doctor offers contrary evidence supporting point of view in an effort to continue the conversation regarding online review sites–the original topic of the article.

      Vic N responds with overly broad conclusion that, once again, doctors show their true colors in their negative attitude toward patients, and that it’s more proof positive of the righteousness of his cause.

      To be clear, I don’t have a negative attitude toward patients; I have a negative attitude toward website commenters that cannot seem to follow an argument, stay on topic, and generally participate in logical discourse. You obviously have an ax to grind, and you’re unwilling to listen to reason because you are on a crusade against doctors and the medical system in general, regardless of contrary evidence or differing opinions. Good luck with that attitude.

  • Joel, you are accurate. As a member of two national patient advocacy groups and a board member in one, I have learned about the wall of silence and how doctors will shun other doctors who break the code of silence. We have several physicians in our groups who have been harmed by bad doctors and also with bad devices. Once harmed they understand and become advocates. Confidentiality laws, tort reform laws, and other acts to prevent accountability hurt medicine. Dr. John James, NASA scientist, who became a patient advocate after his son died of medical harm determined and published in Patient Safety that an estimated 440,000 people die in this country from medical error each year. If the aviation operated the way medicine does, aviation would be killing a similar number. Fortunately, in aviation, there are national credentialing standards and no confidentiality in aircraft accident investigations. Pilots die when things are not done properly so there is full transparency in aviation. Unfortunately, as JAMA has published, negative surgical outcomes are more profitable for surgeons and hospitals. Mass producing using concurrent and ghost surgeries with unsupervised residents produces high revenue and patient devastation and death. The incentives are perverse. Doctors walk out of the operating room wealthier regardless of patient outcome. Perhaps if airline pilots had parachutes and ejection seats, they would be less concerned about safety. Thanks Joel.

    • “Dr. John James, NASA scientist, who became a patient advocate after his son died of medical harm determined and published in Patient Safety that an estimated 440,000 people die in this country from medical error each year.”

      Here’s a classic example of misunderstanding the basics of statistics and what preventable errors are. John James (a PhD, not a medical doctor) finds 38 deaths in a handful of hospital systems and extrapolates them across the US hospital population to come up with roughly 200,000 deaths per year. For reasons he does not fully explain, he then doubles that number to get to his “>400,000” conclusion. Again, not all bad outcomes are due to error, and not all are preventable. For more discussion on the subject, I would refer you here: https://www.kevinmd.com/blog/2013/10/adverse-events-preventable.html

      and here:
      http://qualitysafety.bmj.com/content/25/5/320

      To convince people of your concerns, you and Joel need better data, and stronger studies. Otherwise, you’re just promoting falsehoods and scaremongering.

  • Mr Richalds, you assert that patients can receive a hearing and justice before a jury. You state that the case referenced by Patient 32 was a frivolous case and this is why it was dismissed. You are badly mistaken. The case was remanded to trial by the Eighth District Court so the merits could be examined by jury. The Cleveland Clinic appealed to the Ohio Supreme Court influenced by Clinic money and by the amicus parties each of which gave money to the Justices. The OSC dismissed the case by expanding the Statute of Repose. Thus the merits of the case, including massive fraud and destruction of documents, were never heard by a jury. The issue of Statute of Repose has now been heard in 12 State Supreme Courts. It has been overturned in ten of those states. Only Ohio and Georgia affirmed the Statute of Repose.
    The case in Federal Court for false billing because the surgeon was never present was dismissed because the Court ruled the patient did not have standing. They determined that the OR Log and the Audit report showing the surgeon never present was not first hand knowledge as required by the Whistle Blower statute. The court actually stated the patient had to be awake during his surgery to have first hand knowledge and actually witness the Surgeon sign the reimbursement form sent to the government.
    Frivolous? Justice? This is wall of Tort Reform harmed patients must jump over to even have the merits of a case heard.

    • You continue to bring up information that was not available in the original link you posted, and then claim that my conclusions were wrong because I didn’t account for additional “facts” (allegations) you present about the case. I have no way of verifying what you’re saying, but it’s not particularly relevant at this point. This patient is getting his day in court, regardless of whether an actual jury is present. He has not been deprived of access to the courts just because you don’t like the outcome because you choose to believe all of the allegations are factual. In any case, it’s obvious you have a personal ax to grind here, and it has very little to do with online reviews. So, I’ll leave you to whatever it is you do, but don’t hurt your back moving those goalposts around. Good luck.

  • @ Vic,

    It’s funny how now this has become a discussion about the perfection (or rather inperfection) of doctor’s and the medical system. You’re arguing against a straw man—I never claimed the system was perfect. My original comment was that online review sites were categorically unfair. But, someone writes an article about physicians, and every crank with an axe to grind because they’ve been personally wronged by “horrible doctors” comes out of the woodwork to tell their sad story, or to act the part of the heroic whistleblower. Spare me.

    • Well its amazing the amount of power doctors have over us and refuse to give it up. How about recording the encounters AND the ability to see what is in the notes, ALL of them? Doctors rail against losing any power in any way they have. So unfair? No, its the only spot that we have against a system that is rigged against us. Now that the shoe is on the other foot and doctors are stuck in our position, its incredible the amount of lawsuits, threats, intimidation, contracts, that are used to stop it.
      Btw, calling us “cranks” says everything. We simply have a different viewpoint, different group. Yet articles on our prejudice come up, not doctors.

    • @ Vin N,

      Well, it seems like you’ve got one note to play, and you’re going to play it no matter what! FWIW, some doctors allow for recording of their visits with patients, and you are always entitled to your medical records, by law. Now, I’m sure you’ll respond with some personal anecdote about how you weren’t allowed to record something, or someone had a hard time getting their medical records, and I’m sure it will all be very compelling, but prove nothing. But, if you really want to know what it’s like to deal with “lawsuits, threats, intimidation, …” try being a doctor for a minute. The amount of frivolous lawsuits, complaints, and grievances physicians (the vast majority of whom are just trying to do right by their patients) have to deal with from attorneys, insurers, hospitals, and yes, sometimes even their own patients dwarf the perceived persecution you feel. Add to that now the threat of one-sided negative (and potentially libelous) online reviews, and you can see why physicians are burning out and leaving the profession in droves. But, I guess that’s good news for you, though–since you like recording so much, I’m sure you’re looking forward to the day when you’ll have to Skype with your nearest doctor who’s 250 miles away. Good luck, and record all you like then!

  • Tip of the Iceberg? Why is my family on the tip if it is so rare?

    Patient of mine lost his arm from a simple arm fracture not compound. He developed pain and fever. Saw the orthopedic doc that set it. Sent him home with pain meds. Hurt worse so he went to ER, then surgery, then amputation with septic infection. We went to a lawyer who told him he did not have a case. I asked who the lawyer was. Informed him he was the lawyer that defended the hospital and most of the docs in town from malpractice suits. Suggested he see another lawyer. He did, they sued. Doctor and Lawyer for failing to disclose a conflict of interest.

    My father’s 3 packs a day caught up with him. My step mother said she was overwhelmed and exhausted caring for him. Told her to tell the oncologist she wanted Hospice. She did and his response was ‘he would refer to Hospice when HE wanted to.” I made a few calls and was told in confidence that his oncologist doesn’t believe in Hospice care. He wants his patients in his office or in the hospital so he can bill for his time. Hospice is paperwork without compensation. My step mother felt helpless with his response. Totally overwhelmed and about to have a breakdown or wind up in the hospital herself. I told her to simply call one of the doctors names I gave her and see if he would accept my Dad as a patient. He will call Dads doctor and tell him about the change of physican. Her response was she didn’t think she was allowed to do that. “You just can’t FIRE your doctor can you?”. She had to get Dads consent to do that but that was all their was to it. She got a new doctor and she and Dad got Hospice. How many families and his patients were harmed before then. And AFTER then. If we only had reviews back then. There is a special place reserved in HELL for him.

    Mother-in-Law. Had a severe stroke, rehab, and went home. They spent a small fortune maintaining her at home and about a year later had another stroke. Had a G-tube but lots of problems managing it. She would throw up and aspirate in the hospital. Left with very specific orders about her G Tube feedings. Sitting upright in chair (not rolled up in bed), Very slow drip like. Continue sitting for 1 hours after G tube feeding. Created logistical problems for the nursing staff as she was incontinent and started developing decubi from sitting up so much and often soiled. We get a call she threw up the feeding and was sent to the hospital. We went to the nursing home to get some things and asked what happened. Told she threw up IN bed. (The tube feeding bag was on an IV pole at bedside.) No chair. Asked why she was sent to the hospital as she was DNR. (we were told she arrested) The nurse flipped the chart to check and I got a glimpse of new diet orders but couldn’t read what they said. It was a one liner rather than the paragraph of diet orders she came to the home with. They responded they called her husband who was told she was having trouble breathing and he said to send her to the hospital which they did. Three days later, she died of respiratory failure and aspiration pneumonia. I talked to my wife, (her daughter). She talked to her two siblings and they agreed that they didn’t really want to investigate or know if that change in diet orders was responsible for her death. They also decided not to inform their Dad because the same day she died, the doctor informed him that he had advanced lung cancer.

    Father-in-law. Did the radiation, chemo, the works. He has spent most of their assets on is wife’s care but he had Great Insurance between Medicare and his AT&T retirement medical. He did have an assisted living policy that had limited days. My wife was given POA for his finances. Rather than commute 1:15 minutes to get radiation and chemo.(there was a closer facility but his doctor steered him to HIS facility and he complied. So he wound up living with us (15 minutes away) and primary caregivers. We asked the oncologist what his prognosis was as we needed to manage his financial resources and specifically the cap on the days for the assisted living policy. He declined saying her father has not asked him that question so in his medical opinion her father wasn’t prepared to hear it from him OR us. Maybe Bull Manure. Maybe has a point. Still, he refused to give his POA for finances any guidance about using that resource. So we had to do it the hard way.

    We asked her Dad for permission to access and review all his medical records and got it in writing. Handed it to the doctor. He was really pissed and defensive. (When people ask for records, lawyers tend to follow) He wanted to charge us $20 a page for copies. We declined copies and asked to review his records under supervision. No more than one hour. He resisted. We insisted or we would get a lawyer to exercise our legal rights to the records, file a complaint with the licensure board, and he could pay our lawyer $300 and hour for the insult. I got the pathology report of his cancer and a little research on the internet said he was 8 months into a average life expectancy of 12 months with a 2% chance of surviving 2 years from diagnosis. (His was advanced lung cancer when he was diagnosed.) So we had a simple answer whether or not to use the assisted living policy. He would likely not live to exhaust the policy limit.

    Tip of the Iceberg? I have experienced malfeasance in all three of our parents and in laws final illnesses. I suppose it could be a freakish occurrence but the average Joe or Jane would have NO CLUE in those instances. Only because of my training and experience in health care were we able to identify that there WAS a problem and took action to correct it.

    Malfeasance in our health care system is a common occurrence. One of the first realities I was taught in grad school was that “Money dictates practice” It was affirmed over and over again in my 40+ years of practice. How many in-services did I attend in my workplace that was basically, CYA with documentation. Never write an opinion, Keep to the facts within your profession only, Talk to no one about anything. Basically, there WILL BE A COVER UP. Otherwise, you will be fired and never work in healthcare again. If it was such a rare occurrence, why would they need to threaten and intimidate their staff?

    In my career, I have made 2 hotline calls after trying to go through channels in two nursing homes. Twice I was fired and escorted out the door. One took 5 minutes, the other within 24 hours. which is against the law. One wound up in a wrongful death lawsuit which cost me days of work without pay for depositions and testimony. It cost the Administrator and Director of Nursing their job, license, a plead to criminal misdemeanor charges, and a very large civil judgment against them personally. The nursing home had to pay as well not to mention the headlines in the local paper followed by a low census.

    Frankly, I don’t know how the average Joe or Jane can navigate our health care system without a well informed advocate by their side to guide them successfully through the systems.

  • One statement I would disagree with is ” given the deliberateness most people take in choosing where to get health care.” In my 40+ years working in health care, it is my believe that MOST people go where they are referred to by their primary physician. They are lucky if the primary care physician gives them a choice where they might like to go that would be appropriate for their medical care. Nursing homes are selected by the family and NOT the patient. The most often used criteria seems to be proximity to the children of the most involved children or care givers. The average Joe or Jane doesn’t have a clue how to go about picking a hospital or specialist. They depend on others in the health care system to do that which can be a mistake. The local hospital in more rural areas are owned and operated by a major hospital. They call them “feeder hospitals” . Same way with “Urgent Care Centers” designed to feed seriously ill patients to their hospital.

    I plan to do a quick, unscientific survey of my own and ask people how they would go about picking a specialist physician and see what they say. I will wager that on line reviews of specialists are not mentioned.

    I like the idea of the hospitals where these physicians’ practice are inviting reviews of their physicians with clinical privileges. I like the idea that there is a mechanism for a negative review by the hospital to determine if a review should be removed or not. Many hospitals are motivated by Money and would paper over negative reviews and the ‘committee’ would be composed of PR, Legal, and Admin staff and not physician peers. ALL should be posted and if there was a review and determination of unfairness or untruthfulness, that the committee would respond to that review stating their findings while still respecting the privacy laws. For example, Some doctors can be real arrogant and insensitive jerks but are still excellent physicians. Lousy beside manner but can stitch coronary arteries a millimeter apart with such precision that will never be matched by a robot. Which would YOU rather have inside your chest? A charmer or a stitcher?

    Everyone wants to believe THEY have the best doctor in town. Well not every doctor can be the top doc. But if they have a successful outcome, they tell everyone, he/she was the ‘best”.
    All delusion.

    Doctors are only human. Just like their patients. They fall into one of three categories. The Good, The Bad, and The Ugly. Ask any doctor, nurse, therapists, nurses aid, if they can place every one of their patients seen today in one of those categories without any hesitation or indecision.

    I think there is more good than harm in an approach like this. The physicians need some protections. The consumer some protections from legal actions and threats. The rest of us will benefit and constructive feedback to doctors can only make them better doctors.

  • Commenters here that describe online rating sites as the only option patients have to expose “rogue” doctors are spouting nonsense. There is a pathway for everyone to have their grievances resolved if they feel they have been wronged—the courts. Both sides get to present their case, and a jury decides the verdict. The results are made public. There are countless frivolous lawsuits, but at least physicians can present their side of the story and defend themselves. No such protections exist for these review sites. Quite the opposite in fact.

    This article glosses over the primary reason why online physician review sites are ridiculous—HIPAA privacy laws prevent the physician from directly addressing the claims posted on them. Even acknowledging that the commenter is a patient constitutes a violation of federal law! If you complain online that your landscaper did a terrible job, at least he can respond by telling the public that your grass is brown at least in part because you never watered it. Physicians cannot present their side, making these review sites categorically unfair and prone to inaccuracy.

    • Dr Richalds fails to note that patients are blocked from bringing grievances to the court with legislatively imposed medmal tort reform with financial caps and statutes of limitations. In states with medmal tort reform, it is nearly impossible to get the merits of a case before a jury. All of the failures noted in this Modern Healthcare article (http://bit.ly/1joSc1U) never were allowed to be judged by a jury. Clinic appealed the When the Eight District Court remanded this case back to trial, this doctor and the Cleveland Clinic appealed this decision to the Ohio Supreme Court (http://www.cleveland.com/healthfit/index.ssf/2015/12/ohio_supreme_court_to_decide_f.html) Of course they did! The Ohio Medical Assoc, The Ohio Osteopathic Assoc, and the Academy of Medicine of Cleveland and N.Ohio not only wrote amicus briefs to support the Clinic, they contributed to the election campaigns of the Justices. And the Attorney defending the Clinic in this case, hosted and co-chaired fund-raising events for the Justices. And of course, the Cleveland Clinic also gave money to the Justices. The League of Women Voters in Ohio wrote that Justices Kennedy and French ruled 93% in favor of their contributors. Unfortunately, one injured patient seeking to bring the merits of case before a jury does not stand a chance. I disagree with Dr. Richalds that “patients can present their case, a jury decides the verdict.” This is not the case for patients in tort reform states.

    • Dr. Chim Richalds does a good job of highlighting the self-serving naivete of the medical profession, for instance the idea that there is a pathway for everyone to have their grievances resolved – the courts. In fact, only one in some thousands of patients with verifiable injuries can get a lawyer. The court system is available to almost no patients.

      Also, doctors communicate with other doctors about injured patients, labeling them as cranks with frivolous grievances, which prevents injured patients from getting care for treatable injuries. Patients have no ability to respond to that. The only thing they can do is warn other patients, but risk management is very good at terrifying them into silence by rattling the sabers of defamation suits.

      There almost never is any record of harm caused to patients. Even when they go to their primary care physicians for help, those physicians do not write down what the patient says about how they got injured. Characteristically, they also do not do an exam that could find the injuries, so deep is their belief that the complaint must be frivolous. Health care professionals could not be more deluded about the world they create for their patients, like imagining that there is a pathway for everyone to have their grievances resolved. That degree of self-serving naivete really is inexcusable.

    • Joel, your comment is heavy on the conspiracy theories, but light on facts. I’m sure you have some evidence beyond anecdotes to support your wild claims, right? To review: the medical profession is conspiring against patients to silence them, the legal profession doesn’t want the business from these patients who have “verifiable injuries,” and only internet reviews can save us all from the vast conspiracy? Got it. I look forward to your investigation and the evidence you’ll undoubtedly provide for this massive cover-up, but you’ll forgive me for not holding my breath.

    • You won’t have to hold your breath. For starters there is this:
      “Despite the overwhelmingly large number of people who die from hospital-acquired infections each year, there are virtually no instances of successful litigation against doctors or hospitals.” Pamela Nolan, Unclean Hands: Holding Hospitals Responsible for Hospital-Acquired Infections, 34 Colum. J.L. & Soc. Probs. 133, 136 (2000).

      One of the reasons cited in the article is that injured patients cannot get lawyers.

      There also is this:
      Harvard researcher Dr. David Studdert, in a 1999 study of 14,700 medical charts, found that of the patients whose charts revealed legitimate negligent injury, 97% did not sue.

      But Studdert studied only grievances of which a record has been made. According to the United States Department of Health and Human Services (and others to which I can point if you want) only 2% of adverse events are reported accurately by health care professionals. 93% do not appear in the record at all. What Studdert is saying is that of the 2% of patients whose injuries are accurately reported in medical charts, 3% get lawyers. 3% of 2% is .0006%. That matches my experience with this. Of the patients with legitimate grievances, only .0006% get legal representation. That is one in some thousands.

      Med Mal Lawyers look for victims with legitimate injuries caused by treatment who have lost large incomes that now need to be replaced, who are articulate in answering hostile questions, who are attractive and charismatic enough to be liked by the jury, whose injuries are visible and not too difficult to understand – like a lost arm or a wheel chair or breathing from oxygen tanks – and who have young children who can sit in court where the jury can see they will need a means of support for years to come. That is a rare patient.

      But my experience is that no number of studies and no numbers of patients recounting their experience with this can pierce the beliefs of people in medicine. What I am saying is not “heavy on the conspiracy theories, but light on facts.” I can make this argument heavy on facts and studies. I don’t indulge in theories. I recite the experiences of the thousands of injured patients who called me asking for help, and my own experiences, and my family’s experiences. I can recite some of that for you if you need. And list more journal articles. This is a small chat box, but do you want me to keep going?

    • “Med Mal Lawyers look for victims with legitimate injuries caused by treatment who have lost large incomes…That is a rare patient.”

      Yes, that’s why we have such a dearth of malpractice cases in the U.S. Malpractice attorneys are just too darn picky!🙄 This whole paragraph indicates you haven’t a clue as to what you’re talking about. Both of your citations are almost 20 years old, and from law/ethics journals. Forgive me if I don’t find them compelling in their conclusions or timeliness.

      But, thankfully, you have Yelp to bring justice to the thousands of patients that have been irrefutably harmed. I do find it ironic that you tacitly promote a platform that only allows one side to air their grievances while mandating that physicians stay silent. How convenient for furthering your conspiracy theories.

    • Newer citations abound. Here is one from ProPublica in 2014:
      “Those who don’t earn big paychecks – including children, the elderly and stay-at-home-moms – are the least likely to find an attorney, studies show.

      “A 2013 Emory University School of Law study found that 95 percent of patients who seek an attorney for harm suffered during medical treatment will be shut out of the legal system, primarily for economic reasons. Most attorneys would not accept a case – even one they might win – if the damages likely were less than $250,000.”

      “You’re basically saying for someone who doesn’t earn a lot of money, ‘It’s OK for a hospital to harm them,’” Ciccotelli said.

      I provide data, studies and experience and you respond with ridicule. Like I said before, no amount of data, patient experiences or studies can pierce the self-serving beliefs of health care professionals. That’s why much of my research is old. There was no point in keeping the argument current for health care professionals. Nothing can pierce the self-serving myths clung to in medicine. It is a fools game to try. We must work outside of medicine to protect patients from the nonsense within it that we cannot change. Reviews filed by patients are a weak attempt to do that. It is a start, but it cannot uncover an ICU that falsely reports causes of death in order to cover up a MRSA epidemic (a real case covered by the CDC). It cannot uncover the inept surgeon who ruins one life after another in a hospital where no one will stop him (a real case revealed to me by a member of the board of directors of the hospital). What is needed is a better aggregator of such information to digest it for the patient community and warn patients of such problems. Yelp style surveys are a weak start, but at least they get the conversation started. Physicians are paranoid about their reputations. Actors, artists, chefs and many others learn that there is life after negative reviews. If a restaurant keeps making customers sick, customers can talk about it without getting sued. If a hospital keeps doing that, risk management crushes most patients who attempt to speak. But some get through. I didn’t get through. I got sued.

    • @ Patient 32,

      The first link to the Modern Healthcare article you posted says nothing about patients and any legal claims they may or may not have brought against the facility and/or physicians. You have no basis for your claim that none of the occurrences “were allowed to be judged by a jury.”

      The second link is a classic example of a frivolous lawsuit. A patient sues over having complications from prostate cancer surgery–complications which are part of any basic informed consent discussion. The plaintiff also apparently makes allegations about the surgeon not being present during the surgery, for which he provides no sustainable proof (according to the text). So, when the hospital and physician use the legal means at their disposal to get a frivolous lawsuit thrown out, you see it as an example of a failure of the legal system? Not only did this plaintiff get his day in court, he got multiple days in court. Just because it wasn’t immediately a jury trial doesn’t make it a failure of the system. It’s ridiculous to suggest that just because a patient files suit mean they should be entitled to a jury trial, no questions asked.

      But, just to be clear, because of your perceived grievances with the legal system, you would suggest that one-sided, unverifiable online reviews are the answer? I can’t say that that makes a lot of sense.

    • @ Joel

      That which is ridiculous is deserving of ridicule. For example, the ProPublica piece you cite is particularly interesting as it presents a classically frivolous claim masquerading as a patient that has been unduly “harmed” by the medical system. It’s a good example of how lay people and even attorneys often confuse harm and negligence. Infection and bowel injury are known and readily disclosed potential complications after donor nephrectomy surgery. Furthermore, according to the article, the complication was identified and treated successfully. Just because a patient has a bad outcome or suffers a complication from treatment (“harm”), it does not mean that negligence occurred (breach of duty), which is the basis of tort claims. A threshold where no one ever has a bad outcome from medical care is unrealistic (nor does it mean an error occurred, let alone negligence), and it certainly is not in keeping with what is required to bring a meritorious tort claim. In other words, maybe this patient couldn’t get an attorney to take his case because he didn’t suffer any breach in duty on the part of his physicians or the hospital.

    • So, if staff surgeon agrees as noted on informed consent to do surgery, and then is never present for surgery performed by residents, then Patient has no case, right. Surgeons attestation is blank, op note written in third person by resident, surgeon not present for surgical time out because he is running multiple operating rooms all good with you! OR log and audit report indicate staff surgeon never present. All progress notes during entire hospitalization written by 2nd year resident- none co-signed. You still good with this? Op note Reports blood loss of 150cc but Patient given 6500cc colloids and crystalloids during surgery with HCT drop of 12%. Nothing wrong here, right? And this case never made it to a jury and is considered frivolous by Dr Richards—until it him of his wife.

    • @ Patient 32,

      None of the allegations you describe are in the article you linked to, so I don’t know what you’re talking about. I do, however, know how tort cases work, and a plaintiff can allege whatever they want—it doesn’t make it true.

      Your original comment was that “…patients are blocked from bringing grievances to the court…”. In this example, this patient is getting ample time in court, and getting rebuffed at every turn. The reason this happens is not because of dinners and donations to judges (yes, it’s all a grand conspiracy and everyone is in on it!), but because of a lack of evidence to support the plaintiff’s allegations.

      Btw, the next time you pull out additional details or information in a discussion that the other party is not privy to in an attempt to move the goalposts, reconsider. It makes you look amateurish, and makes it obvious why you might be struggling proving your case (both online and in court?)—you don’t know how to have a logical discussion. You good with that?

    • Joel is dead right on the money. I’ve seen intimidation, hiding things, blacklisting by other doctors, gaslighting by doctors, denial of care, things that would not happen without cognitive dissonance. The same kinds of things displayed by Dr. Richards. All the tactics in the book used by the powerful lawyers are there. How else can you deny Christopher Duntsch? There are more like him that the medical profession misses. How about the medical school dean that the school dean that they knew had problems and did nothing about? https://www.fiercehealthcare.com/practices/usc-blind-eye-medical-school-dean-carmen-puliafito-s-alcohol-use. If you are so sure, then allow the FOIA laws to go on medical boards, medical administrations, allow representation of regular people (patient boards) on there. Why does risk management exist? What about getting rid of gag orders? If you are not afraid that the medical community are such angels, then why not allow patients a foot at the table and also allow recording of them? I’m sure the facts will prove what we have been saying all along.

    • The essential point is one for which you present no evidence – countless frivolous lawsuits. I present multiple sources agreeing that it is a rare patient who can get a lawyer. No one who exams it finds countless frivolous lawsuits. They find that almost no injured patients are able to get a lawyer. Seven state supreme courts have overturned tort reform saying it only is about keeping injured patients out of court. They did not find countless frivolous lawsuits. I have given you plenty of studies pointing out this central point. You have provided none, zero. Only ridicule, which is the half brick one throws when one has no information to support a point. Show me some studies that find that there are lots of frivolous lawsuits, rather than countless injured patients who cannot get access to the courts.

    • @ Joel,

      Regarding lawsuits without merit, I would suggest you review this for starters: http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/practice-management/medical-malpractice-costs-continue-climb

      Some highlights include:
      “In 2010, 63.7% of closed claims against physicians were dropped, withdrawn, or dismissed without any payment. Each of these claims costs an average of $26,851 to defend, accounting for more than one-third of the total annual defense expenses.”

      Of those cases that went to trial, 80% (the 8% in the article is a typo) were found in favor of the defendant (i.e. the physician and/or hospital). When the majority of suits are dropped before trial, and the vast majority of cases that are brought to trial are losers for the plaintiff, it’s hard to conclude anything other than these cases are without merit.

    • That is such old information, and it does not address the merits of the cases. It addresses only the difficulty of prevailing. You are making an unfounded leap to suggest that it shows the cases are frivolous.

      But that aside, where is anything that suggests that all patients can get hearings in the courts. I have provided multiple sources saying that, of the patients with verifiable injuries, only a very small minority can get lawyers. After that, if you really want to delve into the subject of how many of those are frivolous, I would suggest we do so in a different forum. I will wipe the floor with you. I am discussing and you are fighting. You haven’t an honest leg to stand on. I have many. But this forum isn’t the easiest in which to show that. So for now, please, show me a study that says that most injured patients can get lawyers. I have shown you multiple ones verifying the opposite. Start with that now and if you cannot do that simple thing, then stop wasting everyone’s time.

    • @ Joel,

      You said “[s]how me some studies that find that there are lots of frivolous lawsuits…” I did, but now you are claiming it’s “old information.” As it turns out, you’re right. Based on data that runs through 2013, the percentage of cases that get tossed before trial and that lose at trial is even higher: https://www.ama-assn.org/about-us/medical-liability-policy-research

      Specifically:
      “Most claims (65.3 percent) were dropped, dismissed or withdrawn, and 24.4 percent were settled. In contrast, relatively few claims (7.6 percent) were decided by trial verdict, and the vast majority of those (91.9 percent) were won by the defendant. In fact, less than 1 percent of claims resulted in plaintiff verdicts…”

      You say it’s a leap to conclude that the cases that got dropped/dismissed or simply lost in court were without merit? Yes, of course. All of those cases are air-tight for the plaintiff, but they’re getting tossed because of…what? Bad lawyering? Whatever you say.

      “So for now, please, show me a study that says that most injured patients can get lawyers. I have shown you multiple ones verifying the opposite.”

      False. I’ve provided you with data to support my case (as above), but you move the goalposts and declare victory. All the studies you provide are really just opinion pieces based on just one 2013 “study” from Emory University, and it’s not as solid as you think. The author surveyed over 23,000 attorneys, and got a total of 464 responses back. That’s right–the response rate on a survey study was about 2%! The author of the paper simply glosses over this suggesting that many of the emails may have gotten stuck in spam folders. What a joke! So, after ensuring a methodology that will solicit responses from only the most motivated respondents (i.e. there was absolutely no attempt at randomization), the attorneys self-report that they are turning away 95% of claims that are, of course, absolute winners, if only they could just get them into court! (Obviously, this runs completely contrary to the actual claims data I present above that shows that most malpractice cases are duds. I guess it must be that the most meritorious cases must be among the 95% that the attorney are “forced” to decline. What an amazing coincidence!) So, to summarize, a non-randomized, poorly-responded-to survey of malpractice attorneys essentially concludes that the caps on non-economic damages are limiting their ability to obtain “justice” for the silent multitude of potential plaintiffs that they simply couldn’t help because…well, there just isn’t enough money it it for them. What a surprise! It’s hard to take the moral high ground when your best piece of evidence is a thinly-veiled appeal to repeal non-economic damage caps in order to line the pockets of the malpractice attorneys.

      It seems that all those “honest” legs you had to stand on have been knocked out from under you with just the gentlest of nudges. Mop the floor with me, indeed.

  • My Cleveland Clinic surgeon, foreign trained, and represented false credentials including an Iowa Medical License for which he did not meet the minimum requirements, exaggerated volume experience, exaggerated positive patient outcomes, membership in FACS, AMA, credentialing, privileging to use the da Vinci, Urology Board Certification from his “home country”, American Board Urology Board “eligible” and more. He received compensation and had a conflict of interest with Intuitive Surgical, manufacturer of the defective and harmful da Vinci robot. Perhaps most egregious, he was performing concurrent surgeries beginning at the same time without informing patients that unsupervised residents would be doing their surgeries. For putting comments such as this on blogs, he has initiated a SLAPP suit to silence me. Too many people have been harmed by this man. I am one of many harmed patients trying to expose the fraud, harm, and life long disabilities inflicted upon his patients.

  • Sometimes these rating sites are all a patient has to warn the public when a practitioner does not follow best practices and harms a patient, but the practitioner and their affiliated hospital intimidate and threaten the patient.

    It happened to me. A simple acknowledgement of responsibility and an apology would have eliminated every negative review I’ve written.

  • Patient rating websites are dangerous because the patient is not really able to evaluate a provider’s competence or knowledge. If they ask a question, the provider has a choice: the long answer or the short answer. If that gues is wrong then the patient is either going to complain “I was just brushed off with a short answer” or if a long explanation is given ” boy, did he rave on about that matter… he must not be very busy or thinks me a fool”. Nobody wins. .. other than the website promoters who are often linked to insurance companies promoting “we know everything, trust us”.

    • I disagree. Medical Boards, CMS, Joint Commission and other Accrediting Orgs protect rogue doctors. Tort reform with confidentiality laws, compensation caps, and unreasonable statutes of limitations and repose prevent patients from obtaining accountability or exposing rogue doctors. There are stories of this everyday. When doctors commit fraud with “ghost surgery” and represent false credentials, other potential patients must be informed. Doctor rating sites are one of the few places harmed patients can inform others. Casey Ross points out patient ratings are generally accurate. Doctors can sue for defamation if they are not. Harmed patients have no recourse.

    • and I can verify EVERY word of Patient 32’s comments. Along with the security who harassed me on public property for telling others about the doctor I had AND how the admin did. They would photograph me but hide when they did it. The cops came out twice in response to THEIR calls and went in and told them to LEAVE ME ALONE. This is the tip of the ice berg. So you want to give me that line of garbage again? I’m not the only one who has been blacklisted and gaslighted from the medical profession/admin to protect the gravy train of profit.

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