Up with Zagat! Down with Patient Waivers!

I recently discussed the collaboration between Wellpoint and Zagat for rating physicians and concluded that the benefits of web-based rating systems outweigh the risks. Since writing that post I have come upon (a) a very informative report about physician-rating websites by Ruth Given and (b) a seven year old physician protection enterprise called "Medical Justice."

Ruth Given's survey of 40 physician-rating sites indicates that they are not ready for prime time in statistical validity. Medical Justice raises the spectre of malicious anonymous comments from disgruntled patients, competitors, ex-spouses and former employees ruining a physician's practice. It offers (for a not insignificant fee) a "mutual privacy contract" under which patients agree not to use the Internet sites and "are granted additional privacy protections by the doctor above and beyond those mandated by law."

I empathize with physicians' concern about being slandered. Several decades ago a patient of mine who suffered from a serious psychiatric ailment went to a series of emergency rooms all around Boston complaining about me. I received some polite and some not-so-polite inquiries about what I was up to and why I was treating my patient so badly. When that phase of the ailment lifted the ER visits stopped and the treatment continued successfully. Anonymous Internet slander would be much worse - at least I had the opportunity to continue working with my patient.

But the idea of asking new patients to sign a contract eschewing physician-rating sites and sweetening the deal with "additional privacy protections" is unseemly. Meaningful privacy protections are fundamental moral obligations - they're not chits to use as enticements for patients to sign a contract. If a physician greeted me by asking me to sign such a contract I'd be out of the office in an instant and badmouthing the physician shortly thereafter.

Still, the potential harm from anonymous slander is real. Medical Justice warns its potential customers about Section 230 of the "Communications Decency Act," which gives strong endorsement to free speech on the web:

The Congress finds the following:

(1) The rapidly developing array of Internet and other interactive computer services available to individual Americans represent an extraordinary advance in the availability of educational and informational resources to our citizens.
(2) These services offer users a great degree of control over the information that they receive, as well as the potential for even greater control in the future as technology develops.
(3) The Internet and other interactive computer services offer a forum for a true diversity of political discourse, unique opportunities for cultural development, and myriad avenues for intellectual activity.
(4) The Internet and other interactive computer services have flourished, to the benefit of all Americans, with a minimum of government regulation.
(5) Increasingly Americans are relying on interactive media for a variety of political, educational, cultural, and entertainment services.

It is the policy of the United States—

(1) to promote the continued development of the Internet and other interactive computer services and other interactive media;
(2) to preserve the vibrant and competitive free market that presently exists for the Internet and other interactive computer services, unfettered by Federal or State regulation...

[therefore:]

No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider...

If we wait until statistically reliable well validated rating systems are developed before going ahead we'll still be waiting long after the cows have come home. There is definitely a danger to physicians from maliciously intended anonymous postings. But that danger is outweighed by the potential for the web to provide patients with a better level of guidance about the humanistic dimensions of how we physicians comport ourselves than is currently available. And asking patients to forswear the web will sully the medical profession without deterring maliciously intended behavior.