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Stifling Online Reviews With Patient ‘Gag Orders’ (Part I)

8/16/2010

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“She is difficult and rigid. She’s easily offended by questions, and is often late. She is moody, controlling and the coldest fish known to womankind.”

“From the very first meeting, she gives a lot of time and does not rush. She is very up to date with your records. She’s very good about making referrals, and her staff is wonderful.”

Do you think it’s valuable to hear diverse opinions such as these, taken from two reports on AngiesList.com about the same Boston-area doctor? Do you think patients have a right to speak about their experiences — good, bad or otherwise — to whomever they like? Or do you think doctors have a right to privacy that overrules patients’ rights to free speech?

These questions have taken center stage since the emergence of so-called medical “gag orders,” now in use by a small group of doctors in a range of specialties across the country. The one-page contracts have been added to the stack of paperwork their patients sign before care begins. “You agree to refrain from directly or indirectly publishing or airing commentary” about the doctor or your medical care, the contract reads.

And if you do? The doctor may sue for damages, although there’s no evidence such a suit has been filed yet.

The contracts came about thanks to a Greensboro, N.C., company called Medical Justice Corp. The company incorporated in 2001, founded by neurosurgeon Dr. Jeffrey Segal, who remains its chief executive officer. Recently, the company launched a subsidiary for dentists called Dental Justice. Segal serves on the board.

Interviews with former patients and colleagues of Segal’s show a range of opinions about him as a neurosurgeon. Two of them — Glenn Cass and Mark Bachelor — highlight how doctors can leave profoundly different impressions on the patients they treat. Cass and Bachelor agree on one thing about Segal: he doesn’t lack confidence.

To Cass, the confidence was reassuring when Segal was treating his late wife, Caroline, after she had a stroke in 1999. “I’d recommend him to anyone,” says the 78-year-old retired teacher and former neighbor of Segal’s. When Segal and his family moved from Terre Haute, Ind., to North Carolina in 2000, he says, “I hated to see them leave.”

But Bachelor found the doctor’s attitude off-putting. “He likes himself a lot,” he says. “His best friend is a mirror.”

Segal treated him for a broken neck after the 57-year-old contractor fell head first off a horse at his home in Hutsonville, Ill., also in 1999. Bachelor says post-surgical complications required two corrective surgeries to avoid what would have been a permanent disability — and prompted him to sue the surgeon for medical malpractice in 2001. He says he eventually dropped the case because of insufficient evidence to prove malpractice at trial.

Medical Justice originally formed to help protect doctors against what Segal calls frivolous malpractice lawsuits, citing his own experience being sued by Bachelor. The company pre-emptively threatens to countersue expert witnesses scheduled to testify in malpractice cases against its members — who reportedly pay between $350 and $1,990 per year depending on their specialty and state — and offers legal support up to $100,000 in the countersuits.

It wasn’t until 2007 that the company started offering members the “gag order” contracts. Segal did not return calls seeking comment from Angie’s List Magazine, but he reportedly defends the contracts as essential to protect a physician’s good name and prevent an unfair character assassination.

“Jeff has very cleverly thought of a way to allow the doctor to protect his reputation,” says Hawaii plastic surgeon Dr. Larry Schlesinger, a longtime Medical Justice member and one of approximately 1,000 doctors nationwide who reportedly use the contracts. He maintains he’s never had a patient question them.

Dr. Nick Slenkovich, a plastic surgeon and Angie’s List member in the Denver area, explains why he uses the contracts: “It’s fear. Fear that you would be unfairly characterized, even by an unscrupulous competitor.”

Elsewhere, though, the contracts have prompted a blast of criticism. Lawyers call them legally dubious. Patient advocates call them offensive. And some doctors — the group the contracts are intended to protect — call them paranoid.

“Even the best doctors can make mistakes or have a bad day when they come off as a jerk,” says Dr. Heidi Littman, a pediatrician in suburban Cleveland. “Their patients should be able to bitch about it to whoever they want.” 
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    Bruce A. Cadkin, MBA President                          BAC Medical Marketing

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