Patient gag orders: Our doctors weigh in

Mar 5, 2009 2:30 PM

Yesterday we reported on news that some physicians are starting to ask patients to sign waivers that say they will not post negative comments on rating Web sites. We asked for your thoughts, and you said it was a bad idea. Our doctors here on staff agreed:

"I often counsel friends and family that if a doctor tries to talk you out of getting a second opinion or acts in a defensive or arrogant manner, it is time to get a new doctor. Similarly, if a doctor tries to get you to sign such a waiver you should run the other way. Patient centered care requires that physicians put the patient first – long waits, gruff demeanor, being treated like a statistic rather than a person, etc. are all unacceptable. While we all have bad days, I find it hard to believe that a doctor with multiple negative reviews has just been unlucky enough to be judged on those occasional bad days. Doctors should be encouraging and soliciting feedback from their patients so that they can continuously improve." —Beth Nash, M.D., a board-certified internist (on staff here at ConsumerReportsHealth.org)

"First amendment issues notwithstanding, I think that both ethically and legally this type of contract calls into question the issue of inappropriate duress. Patients are vulnerable at the time that they see a physician and are more likely to sign agreements such as this in order to get care when they are ill. Physicians should not exploit that vulnerability with contracts governing behavior." —Orly Avitzur, M.D., medical adviser

"First of all, signed agreements or waivers between doctor and patient rarely hold up in court (i.e. operative consent forms). Almost always the patient is in (or is conceived of as being in) a compromised position. And second, no matter how damaging a disgruntled patient’s remarks may be, in the current atmosphere and the advanced state of IT, there is no way that such action can be prevented or excluded (barring profanity or obviously psychotic verbiage). Damaged parties can, of course, resort to liability suits when remarks are slanderous or untruths can be proven." —Marvin M. Lipman, M.D., chief medical adviser

"Physicians asking their patients to sign these documents should review the professional codes of behavior they have agreed to. Our government agreed to give doctors and other health professions a monopoly through the licensing systems in this country in return for their commitment to a code of professional behavior. Every one of these professional codes dating back to Hippocrates emphasizes the importance of putting the patient’s interest ahead of the physician's interest when it comes to providing care. Real professionals have an obligation to do everything possible to understand and undo any damage they have done to a patient. They should be encouraging honest feedback and accountability not suppressing it." —John Santa, M.D., M.P.H., director, Consumer Reports Health Ratings Center

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