Doctors force patients to sign gag orders forbidding online reviews

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107 Responses to “Doctors force patients to sign gag orders forbidding online reviews”

  1. Anonymous says:

    Reassurance therapy has guided them well. All we have to do is keep them coming back.

    We have no recourse having believed the lie.

  2. wolfiesma says:

    But its not just stupid people that act like idiots in the doctor’s office. Smart people seem like the much bigger pain in the ass, bringing that same know-it-all attitude to the doctor-patient relationship that they take to many of their other relationships. (Na-na-na-na-I-can’t-hear-you-I-know-just-as-much-as-you-blah-blah-blah-blah.) I think its often the more educated patients making unreasonable demands, reveling in their own unchecked entitlement, and taking an adversarial role with their doctors and nurses. I saw this attitude among many of my peers in the birthing not birther! community, and it made me feel really embarassed for my whole generation. Oh well.

  3. aeon says:

    Takuan @ #75.

    Ouch. That was nasty & below the belt.

    Oh! You meant batteries from single-use irrigation devices and discarded, unused items from surgical packs otherwise destined for landfill. That’s OK then… :-)

  4. 6453893 says:

    I can’t imagine why anyone, let alone a doctor, would think this was a good idea. Honestly, it makes you look like you have no confidence in your own abilities and/or care more about your reputation than doing your job. I don’t want to put my money, my confidence or my life in the hands of someone who is worried about online reviews before I even walk through the door.

  5. Anonymous says:

    A simple counter-website for this would be a site that has a list of all practices and doctors that have this waiver.

    If your doctor asks you to sign in, you advise him/her that they are being reported to XYZ website for using said form, you will explain that anyone can visit this site and will see the doctors name and office if they search for it and you a then leave their office.

  6. Anonymous says:

    I’m a physician, so feel free to discount my statements accordingly. One of the sad processes that happens in my (very needy) community is that docs go to great lengths to shed any patient who’s going to be a hassle to work with. My group (of pediatricians) take the opposite tack; we rarely ever fire patients, since we believe that even children with obnoxious parents deserve good care.

    So when you look at online ratings, remember that a lot of what you see reflects the population of patients the doctor sees – if he/she only accepts well-insured patients and fires them if they no-show one appointment, most of the reviews will be written by well-functioning, basically content people. Docs who work with more difficult patients will have a higher level of discontent, even if they give good care.

    Of the handful of patients who have blown up at me in my career, the most common cause was pointing out the connection between their smoking and the child’s illness.

  7. Jeff says:

    I love it, doctors useing lawyers in this way–a A partnership made in Hell. Sign the papper and then do what you want. If the doctor wants to sue you he/she will have to pay a lawyer to do so, and that’s probabalby not going to happen if what you have said is true.

  8. Faustus says:

    @#25

    It’s not about having confidence in your abilities, medicine isn’t a field where if you’re amazingly talented and conscientious then no bad things happen.

    No matter how good your care some of your patients will die/have bad drug reactions/their conditions will get worse/ the drugs don’t work/ they just make it worse.

    A lot of patients (the majority) don’t understand how their treatment is supposed to work or the many ways in which it might not work, these people write bad reviews for doctors if their treatment goes wrong irrelevant of whether it was the doctors fault.

    To illustrate how reviewing doctors is a nonsense and harmful to not only the doctors but patients who trust those reviews here are two scenarios:

    1). A patient goes in to see his doctor with the flu, he is feeling terrible and he really needs something to help him. The doctor is very understanding and immediately prescribes a course of antibiotics, the doctor says these pills will make you feel better. The patient goes home, after a few days his flu gets better and he writes a glowing review of the doctor who cured him online. Needless to say this doctor gets many more patients, unfortunately he is a terrible doctor, he prescribes unneccesarily and fosters antibiotic immunity. Rates of MRSA infection in the community increase, people die because of this.

    2). A patient goes in to see the doctor, he has had aches and pains, a stiff neck, an intermittent cough, aching hips, tiredness and headaches for years and nothing has been able to help, he’s had MRIs, CTs and Xrays, he’s seen neuro specialists, general surgeons, endocrine specialists and orthopaedic specialists. Noone can think of a diagnosis. After some research on the internet he stumbles across a page on lupus. He presents his research to his doctor and demands treatment. Unfortunately the doctor doesn’t agree with his diagnosis, previous tests the patient has undergone have actually been for lupus. The patient insists and gets very angry, the doctor continues to refuse and the patient storms out. Needless to say he writes a terrible review, unfortunately this is a very good doctor, patients of this doctor see the review and are discouraged from visiting him. Some of their conditions are serious but they are now afraid of their doctor and suffer needless pain. The doctors practice withers and he eventually has to quit and become an estate agent.

    In conclusion if you support online reviewing of doctors you want more MRSA and more estate agents. *may be slightly facetious*

    To declare my interest I’m a medical student in the UK.

  9. Takuan says:

    well, I meant kidneys and other good stuff all the rest of us have to hang around the dumpster for, but OK.

    Hey tell me, have you ever once given into temptation and just when they wheel the patient in, pretended to be taking hits off the gas mask and looking a little loopy?

  10. Digital Artz says:

    One can sign this stupid (unconstitutional?) paper
    then still write evil against the Medical Doctor
    with a nom de plume ,conversely the Dr. can also
    write how great she or he is with a nom de plume.

  11. merreborn says:

    The ability of consumers to communicate their experiences with service providers to other consumers is essential to a properly functioning capitalist market.

  12. TEKNA2007 says:

    From the medicaljustice.com site:

    “Mutual privacy” means that patients are granted additional privacy protections by the doctor above and beyond those mandated by law.

    Did anyone see what exactly the patient is supposed to be getting? HIPAA pretty much already locks down what the doctor is allowed to release. Unless this agreement gives me final editorial control over all information sent to the insurance company (and I can be *very* creative) I don’t see a lot of mutuality here.

  13. Takuan says:

    how about a system wherein physicians take care never to treat the hopeless and thereby retain perfect reputations for cure?

  14. sleze says:

    To those who are for the reviews in their current form, how would a doctor legally defend inaccurate reviews about himself online?

    Complaining Patient: The doctor didn’t inform me that drug X would cause nausea.
    Defending Doctor: I didn’t inform you because you had undiagnosed genital herpes and that reaction only occurs with genital herpes.

    If he gives any details, he is violating doctor patient priviledge. So basically, they are unable to rebut any criticism. As I have said on other websites, I am totally for doctor reviews BUT it is more complicated than reviewing a camera or a plumber.

  15. zuzu says:

    If you want to have your appendix removed by Ryan Seacrest, go right ahead, but I’ll take the ill-tempered, snaggle-toothed, old crank who knows what he’s doing.

    So how would you rate your doctor, then? :)

    Step back for a minute and picture yourself working in a job where your “customers” generally don’t understand the service they are purchasing so you can’t always give them what they want.

    Web site designer?
    Car mechanic?
    Plumber?
    Architect?

    …just about anything you pay someone to do because you don’t know how to do it yourself. (i.e. knowledge work)

    The whole “doctors are in a special business where their customers are idiots” line is garbage. It’s a hold-over of the “god complex” from the white lab coat era of institutional medicine.

    • Antinous / Moderator says:

      The whole “doctors are in a special business where their customers are idiots” line is garbage.

      In the US at least, which currently enjoys the educational standards of a third world country, most people don’t understand one single word that their doctor says to them. I’ve asked friends or relatives to tell me what their doctor told them and three quarters of them can’t even tell me their diagnosis. Patients have surgery and chemotherapy and radiation and they don’t even know what wrong with them. If that doesn’t constitute being an idiot, I don’t know what would qualify.

  16. Anonymous says:

    there’s also the option of doctors reading the reviews and maybe realizing they are crappy doctors. not all bad reviews are from former patients with am axe to grind. if a doctor has more than one or two negative reviews, that doctor needs to do a little more listening.

    i would be worried about a doctor that made me sign such a document because they clearly have something to hide. i would assume they had negative reviews in the past, and that would give me additional cause to walk out.

  17. Narual says:

    Maybe the doctors should request the reviews be disemvoweled instead… it might get them more favorable press here.

  18. Takuan says:

    (it only really works well if you can convince the surgeon to don a Hannibal Lecter mask just as the patient starts to go under.)

  19. dainel says:

    Faustus, if we substitute “mechanic” for “doctor”, much of your argument still holds. Yes, good, hard working people may have their livelihood jeopardized by unwarranted bad reviews. Whether they are a baker, barber, tailor, etc. Doesn’t mean all these people should get their clients to sign gag-contracts.

  20. David2000 says:

    It seems to me that instead of doctors using these reviews as a way to improve their patient satisfaction, they are fighting it. Patients often resort to doctor ratings sites, which are growing by the day, to vent their frustration. Good doctors with patient friendly front office staff rarely get bad reviews. I have looked at reviews in MyDocHub.com and RateMDs.com and though some are bad, a good portion are great. My $0.02 is that spending money on lawyers to craft nifty EULAs is a waste of money since patients will still tell as many people as possible if they feel that their doctor treated them unfairly, was inattentive or their office staff were rude.

  21. Felix Mitchell says:

    Faustus:

    What about the situations that reviews are meant to avoid? i.e. bad doctors continuing to harm patients because no-one knows about it.

    Obviously some reviews will be misleading, but some reviews will be accurate, like in any field. Taking a position against patients reviewing doctors means that you think it’ll do more harm than good.

    Patients may not be experts in medicine, but they do understand many other parts of a doctor’s job. Also, the public is also aware of some of the areas where doctors and patients might be in conflict, like over-prescription of antibiotics.

    If doctors do not like negative reviews then they should work on educating the public about why they have to make unpopular decisions, and have better self regulation.

    I think online reviews are a symptom of low public confidence in medical regulatory bodies: patients DO know that medicine is complex and difficult to understand. They are only turning to each other for help because they don’t trust their doctors.

  22. Felix Mitchell says:

    @ DAINEL: I totally agree. What’s the automotive equivilant of over-prescription of antibiotics though?

  23. bartoncasey says:

    Simple solution: The review sites should just flag the physicians that require their patients to sign a gag order. That looks worse than any number of bad reviews.

  24. aelfscine says:

    Who trusts internet reviews anyhow? I’ll look at reviews on sites like Consumer Reports or CNET, where there done by people who know what the heck they’re talking about. But sites where people just write in and give their opinions are almost always just filled with people bitching, usually about pointless nonsense.

    I live in one of the nicer apartment complexes in my town, but the apartments.com reviews of it are all terrible, and mostly don’t have anything to do with the complex. (“My horrible neighbors…”) Most people hated the last place I lived too, which was quiet, well-kept, and lovely. People on review sites by and large only post if they’re pissed off, and often are people that get pissed off about everything.

    While I think the EULA is too much (I’d just not bring up the subject), it is worrisome to think that a legitimate doctor could have their practice hampered because they didn’t diagnose a hypochondriac jerk-off to their specifications.

  25. Anonymous says:

    I’d sign the agreement, but only because I know a blatant First Amendment violation when I see one. And an unenforceable one at that.

  26. Snig says:

    I sympathize with docs who get unjustly dissed, but it just means they need to work harder for their average patient to write something nice about them. There are definitely doctors out their who should be labelled as defective.
    The argument that patients may not understand what’s going on is true, but that can be a legitimate measure of doctors. Docs who take the time to explain things will get less negative reviews for that reason. Yes, some patients will never understand it, or will always blame their doctor. If 5% of the reviews are like this, most people will discard it. I 100% are, then you have to wonder. No, reviews don’t measure medical success in terms of cure rate, but they measure patient satisfaction. Patient satisfaction is important. Some docs sadly don’t give a rat’s ass about it, and deserve to be called for it.

    Reminds me of this story:
    http://www.washingtonpost.com/wp-dyn/content/article/2007/03/12/AR2007031201548.html?sub=AR
    of a contractor who sued posters on a review site for negative reviews.

  27. EeyoreX says:

    So, suppose that a patient went online and wrote something like “He cured my rash, but he made me sign a stupid EULA before he would even look at me. Whats up with that?”
    Would the mention of the EULA in itself fall under the terms of the ELUA?

  28. aeon says:

    Takuan:

    If you’d like your very own kidney then feel free to come to NZ for your nephrectomy. By law here you have the right to your own body parts after we’ve removed them. It’s because Maori like to be buried intact, so if necessary they’ll collect their mortal remains as they go along just to make sure. Your kidney will be handed to you respectfully wrapped in it’s very own baggy as you leave hospital if you so desire it.

    As to giving in to temptation and winding up a patient, then no. Pick the wrong person and it’s an instant complaint. Pick the right person on the wrong day – it’s a complaint. The day of an operation is generally the wrong day as most patients are secretly crapping themselves while putting on a brave face. So no off-colour jokes while the patient is awake. ;-)

  29. sirdook says:

    It’s true that Doctors have an interest in avoiding being bad mouthed by patients who don’t understand that what happened wasn’t the Doctor’s fault. It’s also true that patients have an interest in being able to vent their frustration and in being able to learn from one another who is and isn’t a good doctor to see.

    It’s also worth noting that one basis of the EULA’s reasoning is mistaken. It assumes that patients are not in a position to judge the qualifications of their doctor. It’s true that patients aren’t medical experts, but it’s just as true that doctors aren’t (ordinary) patients. There are some things only doctor’s are qualified to judge – sometimes even when things go badly it’s not the doctor’s fault, but patients might not always know that. But there are also a number of things that doctors aren’t in a good position to judge – does she have a good bedside manner, does she make (non-doctor) patients feel comfortable discussing their ailments, does she explain things in a way that (non-doctor) patients can understand.

    For good, decent, doctors, especially those operating individual practices, there is a very good way of balancing these competing concerns: Let your patients know that you’re concerned about the possibility of unwarranted reviews getting out on the internet, where they can last forever. As such, you hope that patients will first discuss any problems they may have with you or your staff so that reach a reasonable solution. If you’d prefer that no reviews at all be posted, you can ask nicely. If you have a good practice and a good relationship with your patients, that should be almost as effective (perhaps moreso) than insisting on abusive agreements. And if you don’t have a good practice… too bad, so sad.

  30. sadmarvin says:

    Y’know what’s awesome? Socialised healthcare. Canada FTW!

  31. sirdook says:

    In case anyone is still reading this thread: the ‘gag order’ is not unconstitutional and it doesn’t violate your first amendment rights. This is a private party saying, “If you want to do business with me, you have to promise not to talk about it.” As far as the first amendment goes, it’s just like your friend saying, “I’ll tell you a secret, but only if you promise not to tell.”

    I’ve argued above that I think these agreements are counterproductive and, at least sometimes, abusive of the doctor patient relationship. But it’s not a constitutional issue.

  32. Anonymous says:

    If a doctor tried to force me to sign one of these I would immediately wonder what he was hiding and I would lose any trust I had for him..

  33. Nur says:

    I’m not actually sure about the title of this entry – censorship’s bad but, hey, so is posting negative, business hurting reviews based on no actual reasoning just because you have a text box.

    I think it’s ok to leave the pitchfork at home this time, honestly. Yesterday there was a post on this very site about how messed up the Yelp system was and how the only way to beat it was to make fun of it. That’s ok in pizza but terrible in medicine. Online reviews are far too easy to skew and can be totally unaccountable.

    I agree that although the immediate reaction you get from the title of this post, keywords in capitals: “Doctors FORCE patients to sign GAG ORDERS FORBIDDING online REVIEWS” is that the evil doctor is clearly trying to hide his unethical gas chamber experiments but actually, Bugs is right. This is basically “please don’t go online and slag me three ways past Tuesday if you arbitrarily decide something’s not right with my performance”. It means you have to use the official complaint process which the doctor gets to defend himself in. It’s absolutely impossible to defend yourself from anonymous online reviews – they’re out there and they’re influencing your customers’ opinion of you – and that’s just not fair on the doctor.

    The “gagging orders” are preventing you doing the medical equivalent of putting anonymous product reviews on Amazon – you might be getting paid to do it or you might have an undisclosed personal gripe that has nothing to do with the product or the service. If the orders banned you from reporting the doctor to a regulator, beginning legal procedings for malpractice or just generally doing anything that’s called “an official complaint” then wow, dear god that’s horrific and that needs stop right now but that’s simply not what’s happening here.

  34. DeeAnAy says:

    @ 44

    “That being said, if the review said something like “Doctor told me there was no use for a urine test in a girl my age. Six months later my kidneys began to fail” then I would consider that a bad doctor.”

    But is he or she really a bad doctor? There are guidelines we follow based on expected outcomes. If you have diabetes or urinary symptoms and no urinalysis is done, that would constitute bad medical practice. If you are healthy without risk factors for kidney disease, I agree with foregoing a urine test.

    I could run every test known to mankind every time a patient walked through the door in the hopes of catching every single problem in its infancy. That doesn’t make me a better doctor.

    Anyway, I would probably only be able to do this for ~5 years before we all started paying $50K a year for health insurance.

  35. Takuan says:

    darn.
    So is it true that sometimes when they wake up they remember what was said around them while they were under?

  36. nehpetsE says:

    When a person writing a review, is the source of the difficulties it is usually pretty evident in how they write the review.

    I respect that even the best mechanics, bakers and doctors sometimes have off days.

    Usually i only look up reviews only AFTER having a negative experience myself. If see that 12 other people have had the same variety of complaints that i did, the establishment officially looses that benefit of doubt.

  37. bolamig says:

    Doctors should encourage people to rate them online. The more reviews they get, the more the occasional crackpot patient review gets lost in the noise. On ebay, I generally trust sellers who have 99.5% or greater positive feedback, and deeply distrust those who have 98% or less positive feedback. It’s all about the numbers, not individual reviews.

    People who would avoid a doctor because of a single negative review in a sea of positive reviews are probably the kind of poor judges of character that the doctor doesn’t want deal with anyway.

  38. MB says:

    Antinous, you’re illustrating the problem perfectly. Speaking without listening, thus missing the point.

    If this BB gig doesn’t work out for you, I guess you can always fall back on medicine.

  39. aeon says:

    Hearing is the last sense to go – think of when you last fainted: Your vision greys out around the edges, the world fades but you still hear voices before you black out completely. As you’re anaesthetised the same happens.

    Some degree of recall of auditory information probably occurs fairly frequently but isn’t necessarily unpleasant as it is generally divorced from painful stimuli and usually occurs before or after the operation itself, ie. on the way ‘down’ or coming back ‘up’. It’s actually possible to “wake” someone up sufficiently from an anaesthetic during a procedure such that they are able to hear and obey simple commands without them having explicit recall of the event (and this is sometimes required in specialist spinal or neurological surgery).

    The “OMG I was awake all the way through, couldn’t move and felt every cut” situation is extremely rare. It generally represents operator error or equipment failure and it’s usually psychologically devastating for the patient concerned. Believe me it’s the last thing anyone wants to happen and we take a lot of care to guard against it. It’s priority number 2, just below keeping you alive.

  40. Takuan says:

    good to hear, very good to hear! I have to remark that of all the various specialists I’ve met over the years, anaesthesiologists seem among the most painstaking and prone to self-recrimination/examination. Orthopedic surgeons, on the other hand, should all wear bearskins and horned helmets.

  41. Snig says:

    I’d guess that most docs would be much happier with an online dis than a lawsuit or a complaint to the medical board.

    Mocking Yelp whining is one thing. Making diners sign a Eula before ordering pizza would make me lose my apetite.

    It’s really NOT impossible to defend yourself against negative reviews. The cure for pollution is dilution. Do right by the majority of the patients, and someone will say something nice.

    Also, people can usually find another pizza joint. Sometimes patients have little choice in what doctors they see, due to referrals (for specialists), insurance restrictions or just geography.

    You can easily print up a statement saying:”Please don’t go online and slag me three ways past Tuesday if you arbitrarily decide something’s not right with my performance”. Having people sign a presumably legal binding agreement with a monitoring company and the threat of the law behind it is more along the lines of a threatening gag order and a little less like “please”.

  42. sofa0ne says:

    I personally don’t see anything wrong with a Doctor or any business wanting to protect themselves from complaints that are groundless.
    However what about accurate information and complaints. I myself would be scared if a Doctor handed me a form like this and I would probably get up and leave. Why? First thing that would come to mind is this Doctor qualified, when a Doctor is worried more about image than their patients. I see a problem. Ultimately it’s their practice/business and if they want me to sign a Gag-order before being treated so be it. I would risk the lawsuit if I felt what they did was medically incorrect and I would find legal counsel to make sure I could air my grievances.

    Ultimately if this isn’t an ER situation you do have the chance to go elsewhere.

  43. pissedoffdoctor says:

    I use this form because I don’t want ratings …. good or bad on the internet. I’m not a plumber. If you want McDonald’s medicine please go elsewhere. I don’t need or want you as a patient. Physicians don’t have to treat everyone. We get to decide whom we’ll treat. I believe that patients get the health care they deserve. If you’re a jerk your doctor probably is one too because anyone skilled in their field with a touch of bedside manner doesn’t need to put up with your crap. The doctor has no relationship with you until you are seen as a patient. If you don’t sign the form. You aren’t seen. You’re not a patient. You can wait another three to six months to see someone in my field. Most of my new patients come from word of mouth from other patients which doesn’t happen if you’re not good at what you do. By the way these forms were created as the only available tool to protect physicians against libel on the internet. The sites can’t be sued and the people posting can’t be identified. Libel is not protected speech.(Some sites have even approached doctors with negative ratings offering to remove them “for a fee.” Nice huh!)
    These forms do not stop you from reporting a physician to their State Board or discussing them with a friend or another physician. Your doctor, however, can’t discuss you with anyone which is why the playing field on these rating sites is uneven. I simply refuse to put up with the latest “tool to abuse physicians” and other physicians are joining the fight. I have a number of patients who are lawyers who think the form is “cool.” They need one to protect them from “Rate My Lawyer.”

  44. Nur says:

    #63 Snig:

    I’d be just as careful of a site full of glowing reviews (Amazon pay-for reviews) as I would of all negative ones but I’d be highly surprised to see the former. I think that the malcontent population becomes massively exaggerated as soon as you only look at after the fact commentary. I think it’s just human nature to pay more attention to the things that jar rather than the things that work properly – for example I went to the supermarket earlier today and there weren’t any baskets at the front door and that stuck in my mind much better than the fact that the shelves were all stacked with more food (I picked up everything that I came in for) than I needed and so on.

    The Internet has made it much easier to write to people, it used to be the people who were willing to literally attach a stamp to a piece of paper and post it who were the only people who wrote in to TV companies etc, now you can go to their site and fill in an online form so the number of people who do it has greatly increased but it’s still not effortless so it’s still people actively deciding to take time to do it. If you’re rushing about in life then you may not feel willing to take time out and review services.

    I think the general attitude as regards doctors is to take your medicine or advice and go back to work without much hassle. I think that contrasts with the attitude towards putting commentary online changing hugely as time goes on, the scope and depth of content that’s being put onto social networking sites shows that very clearly, but it’ll always be something else to do in your day and it comes down to if you actually want to take time doing it. I think it’ll still be a minority of customers who ever appear on these review sites and the question is simply which minority they belong to.

    I’m happy to see it’s anything but all bad reviews but I think there’s a natural human tendency to write an angry letter before a happy one.

  45. Nur says:

    I think you either trust online reviews or you don’t, I personally take the average online review about as seriously as when someone says “no, really, I’m a doctor” – fine but, as the saying goes, [citation needed]. It’s all very well to say that “people will be objective when they read the reviews” but unless that person is ok with the thinking “well, yes, that comment did just accuse the doctor of a sexual assault (the whole fist prostate exam is the best malpractice example I’ve heard in a while) but I’m going to assume that person is a crank and therefore I’ll just sign up for that doctor and if he does put more fingers in than he needs then I’ll know he’s bad and I’ll write my own negative review” ( a sad face is hugely appropriate for this scenario actually) then there’s an issue of not risking it when you see a review anywhere, not to mention that there’s many people who believe what they see written or on tv. That will mean that people will simply go for the doctor with the extra star rating on his badge.

    People are very good at not admitting that the reason they don’t like their new bathroom, lupus medication or breasts is because they’re kinda unreasonable and contributing to the events going so wrong. I don’t think many reviews are as cut and dry as “I got EVIDENCE off the INTERNET and HE SAID IT WAS NOTHING!” because you can simply filter those out as irrelevant. It’s ones like “bad bedside manner with vulnerable patients”, “refused to do tests”, that sort of thing. They’re subtle and if you want to complain about someone it’s tempting to leave out the things that make you look bad, they leave out “he refused to come near me because I tried to stab him with my dirty drugs needle” or “refused to do tests because I was healthy”. It’s also very reasonable to leave out personal medical details so you can’t even call for full disclosure to fix it – I think I can still believe a doctor is bad even if I don’t want to tell the whole Internet about, say a mental illness I suffer from. Even though if it’s serious enough it might well affect my opinion and the review it’s still private. The doctor’s simply not allowed to say, “Yeah, but he also has hallucinations about the Government experimenting on him, he’s really not well” because that’s privileged. It’s fatal to the complaint but he’s not allowed to tell.

    Snig:

    I’m sorry you took my comment to mean that people are bad, I was only saying that contented people don’t seek out ways to complain. I thought that was obvious? It’s certainly been observed in studies enough times. The good or badness of that didn’t really come into it. If you ask me about the number of people who are looking to get doctors into trouble out of badness then I would say that is extremely low just as it is the real world.

    I also don’t think that it’s fair to say “people are basically good” based on more :) than :( – what if those doctors paid for the negative reviews to be moved? ;).

  46. Nur says:

    #34 Snig:

    “Doctors just have to work harder so their average patients write good reviews.”

    Wait, what? You mean the average patient will go online and write “I went to this doctor and I got better. A+++ seller. I will use them again”.

    They clearly won’t. The kind of people who review doctors online are often the kind who write “I went to this doctor (and a car hit me a week later) and my leg fell off. I want to sue”.

    The kind of people to whom something truly horrific happens tend to go straight to the media and court and bypass the review site entirely. That means that the seriously affected and contented both fail to post in any real numbers and you’re left with the mildly irked and possibly bored making up the lions share of the posting masses. Not the average patients.

    I don’t think it’s a matter of working hard so that people write nice things because it’s hard to get people to write a thank you note when they think someone’s just done their job. I find it an incredibly optimistic way of thinking. Getting better after visiting the doctor isn’t something a lot of people think really needs an online review. It’s like how no one writes to WalMart for always having carts by the door, they see it as someone doing their job and just accept it silently. You might tell your friends as an aside if it comes up “oh, that doctor’s nice, you’ll like him” but it’s not the average response, at present at least, to go and write an unsolicited online review about it.

  47. pissedoffdoctor says:

    Sorry you can’t handle the truth MB. Self rightious twerps like you are sooooooo annoying. What makes you think that physicians were put on earth as slaves to serve you. Shortly if
    our current administration gets its way you’ll be getting the garbage health care you deserve. Check
    out Rate.MD’s and see how the Canadians like their
    system. The answer is they don’t. Actually where will the poor Canadians go for their health care now. In Scandinavia you get to carry a card if you are over 55 so that the government can decide whether you’re worth saving or whether you’re DNR and Tatoo or Takuan or whatever your name is….the oath taken on graduation from many U.S. medical schools has been modernized. Lend patients money…I don’t think so.

  48. aeon says:

    Takuan @ #66

    It’s already happening on the quiet. The more cautious (craven?) of us already try to avoid dicey situations and high-risk procedures for fear of being sued. I’m not one of them, but I’m yet to be burnt – no complaints that weren’t obviously nuts. But I may change my mind if a groundless complaint ever gets anywhere: I have a family to feed. A system that favours the complainant isn’t in the best interest of the population at large if it inhibits the competent majority from taking risks that need taking. Online rating sites just encourage defensive practice.

    Oh, and sadly there’s almost no such thing as a cure. That was Medicine 101 by the Dean of the Medical School on day one. Our lives would be so much easier if there were.

  49. Ito Kagehisa says:

    And yet, most patients do the mental equivalent of sticking their fingers in their ears and humming when their doctor tries to explain it to them.

    I have spent 40 years trying to get physicians to explain things to me. Sometimes they become enraged and refuse to see me any more.

    My doctor now is pretty good, though. She hasn’t got the “god complex” problem so she doesn’t freak out if I question her decisions.

  50. bardfinn says:

    This is some serious neo-Libertarian (Neo-Conservative) bullshit, inching us towards an end-run around the laws that require doctors to provide a minimum standard of care where necessary to save a life. It’s bad enough that we have to be financially beholden to them for a massive amount of time – now we get to be socially beholden to them as well! Oh frabjous day! I think I’ll learn how to remove my own appendix.

  51. Snig says:

    #41 NUR
    Go to RateMDs.com

    My unscientific review notes more :) than :( faces. Many 5.0 out of 5.0′s.

    Yes, I think that the average person is basically good. Sue me.

  52. zuzu says:

    Hey tell me, have you ever once given into temptation and just when they wheel the patient in, pretended to be taking hits off the gas mask and looking a little loopy?

    What do you mean pretend? ;)

    well, I meant kidneys and other good stuff all the rest of us have to hang around the dumpster for, but OK.

    I’d assumed some sort of Fentanyl / Versed cocktail. :p

    (Sorta like becoming a nurse for the Quaaludes, before that party ended.)

    Oh, and if you haven’t seen the Medical Mavericks episode on anesthesia, check it out.

  53. bp says:

    Can’t the doctors just make t-shirts quoting the bad reviews?

  54. bp says:

    @ #1 BP:

    Dude, this is serious, stop cracking wise!

  55. MB says:

    I hope you’re up front about it, PissedOffDoctor. Because I certainly wouldn’t want to waste my time as a patient with someone who obviously has very little faith in his/her own skill.

    ~

    We wonder why we’re having problems with healthcare? Self-serving nitwits like this are high on the list.

  56. bp says:

    @ 2 What’s the matter, rookie-fuckwad, can’t take a joke?

  57. Nur says:

    #43:

    Oh, I’d forgotten. I’m deliberately using your word of “average patient” because that’s not the kind of people who complain. If the average patient, meaning the bulk of people whose treatment was neither exceptionally bad or exceptionally good and was just “typical” wrote into ratemyMD then it would be a bigger site than MySpace.

    The numbers of people involved are seriously gigantic, lots of people around the world may not have healthcare but it’s a vast number of people that do but of that group there are still people who are on the two edges of the “average patient” who will write a note to an online site. Think about how many products and services you’ve used today without reviewing them online – it’s not typical behaviour.

    I’d left out one important point – I’m Scottish. I get free healthcare. The best way to make people ambivalent about something is to make it free. In Britain you might send flowers to the ward if you were in hospital for a long time but the average, typical person just wants out of there as soon as possible and not to go again until their lungs are hanging out.

  58. Anonymous says:

    I am a physician and the practice of medicine & helping patients is a beautiful and gratifying thing. But more and more, I and my colleagues are feeling dismayed by the paranoia that we feel. I perfectly understand a patient feeling frustrated with a doctor, his/her bedside manner or his/her perceived ineptitude. The problem is some patients are nuts. Honestly. 99.9% of patients are a pleasure (and a privilege) to see. But all it takes is one patient who thinks (s)he knows it all, does not listen to us or accept what we say, storms out of our office (and refuse to pay by the way – happens all the time) and writes a scathing review. And our practice can suffer. But the review thing is fine – I have no problem with a patient, even a crazy one, writing a scathing review. But I think it should be a law that once a patient puts things in the public arena, then the doctor should be able to respond. Like on ratemyprofessor.com, the professors can respond. If the patient is allowed to get personal, then so should we. Instead we can do nothing. Just hope no one listens and hope that our medical licence stays intact. It’s particularly frustrating when a patient is crazy and unreasonable and we cannot defend ourselves.

    • Antinous / Moderator says:

      I worked in a hospital for 20 years. There is very little relationship between quality of medical care and patient satisfaction. A completely incompetent but charming physician will get almost no complaints. Some of the best physicians on the planet, who tend to be brusque, will get complaints and lawsuits all the time. Anyone who shops for a doctor by an anonymous online ratings system is going to get a doctor with a great personality who may or may not have any real professional skill. If you want to have your appendix removed by Ryan Seacrest, go right ahead, but I’ll take the ill-tempered, snaggle-toothed, old crank who knows what he’s doing.

  59. bp says:

    #3 Really?!? Quoting Major League? And what’s worse but quoting it incorrectly? It’s “can’t you take a little joke,” dumbass.

  60. bp says:

    #3 bp: Yeah, real fuckin’ funny, y’ass-hole!

  61. bp says:

    @ 4 Yeah, like you’ve never made a mistake! Dick…

  62. AirPillo says:

    Exploitative EULAs need to be made illegal. And I mean today.

    Isn’t everyone else tired of being forced to agree that they have no consumer rights as a precondition to being allowed to purchase things?

    Imagine if this were to become standard practice in the medical industry, and they broadened the limitations of the EULA.

    “I hereby agree that (organization name) can do whatever the bloody fuck they want and I will furthermore have no recourse against them”.

    Don’t want to sign that? Well, no kidney transplant for you, then, asshole.

  63. bp says:

    @ #1 Oh, I get it, like the SF pizza joint! The diagnoses must be made primarily of pig grease, ha ha… er, yelp, yelp?

  64. Anonymous says:

    Very simple. If you see your review online, sue your doctor for releasing your information to a 3rd party non-related medical company.

    I promise no doctor will ever use the service again. It’s math that’s really, really simple. If you were the type that liked to get rich and were sue happy, you might just look up one of these doctors, post a review then sue the dr. and 3rd party company.

    It’s completely unethical for a dr. to even share your first name without clearly understood approval. No judge would ever let a dr. get away with a signed contract for name release EVER.

  65. bp says:

    @#7 gET oFFA mY tHREADZ!!!!

  66. bp says:

    TENTH!!!!!!!!!!!!

  67. Antinous / Moderator says:

    Patients have a lot of rights, and denial of care is a minefield for physicians. A toxic, nuclear minefield filled with zombies. I’d be pretty surprised if this survived a legal challenge. Disgruntled patients (and the lawyers who love them) love to sue.

  68. AirPillo says:

    To those that are trying to explain things from the doctor’s perspective how this seems a reasonable course of action, take a look at software EULAs.

    Years ago, software EULAs were simple, spartan things. They explained necessities that you needed to agree to, for example explaining the terms of what you were buying so that you agree that when you bought the software you were not assuming ownership of the company’s IP rights, or having you agree that if you bring legal action against them it will be in the jurisdiction where the company HQ is, and other such simple harmless stuff. The companies were merely just using these things as a way to protect very simple interests on their parts to shield themselves from malicious behavior.

    Then, of course, the companies started realizing that a) everybody who sells software is using an EULA and b) the customers almost never reads them. So, they started adding more and more predatory clauses into them. The software can damage your computer, and you agree to have waived your right to legal recourse. The software license can be spontaneously taken away from you at a whim by the publisher without cause, explanation, or notice, and you agree that you paid for a license that they can revoke just for shits and giggles. You agree to waive every single consumer protection right that you have which your local jurisdiction does not specifically forbid them from making you waive. The EULA for software changed from being protection for the company against malicious behavior, to being the company’s primary instrument in making you the victim of malicious behavior.

    Basically, with many modern software EULAs, you agree to be their bitch. This is what happens when an EULA is status quo in an industry. Once you can’t really go anywhere that doesn’t have an EULA as a condition of doing business, everyone adjusts theirs to prey upon customers for their own convenience. In order to buy anything, you have to bend over and sign a consent form to be screwed.

    Seeking medical treatment can be harrowing enough, the last thing we need is even more exploitation and dehumanization of the patients brought about by the horrors of the EULA.

  69. blueelm says:

    “patients of this doctor see the review and are discouraged from visiting him. ”

    I’m sorry, but patients have the right to be idiots online. That’s the nature of the business. I don’t know, but personally I take people’s online opinions with a big grain of salt. If I ran across a review that said “OMG doc wouldn’t believe that I have lupus because I say I do!” I wouldn’t assume that was a bad doctor.

    That being said, if the review said something like “Doctor told me there was no use for a urine test in a girl my age. Six months later my kidneys began to fail” then I would consider that a bad doctor.

  70. TheBlessedBlogger says:

    I’ve written positive and negative reviews of doctors online and will continue to do so. Any doctor that even asked me to sign one of these things would be short a patient because I’d walk out and never come back. Medical services are still services and we pay for them, therefore we have a right to expect good service and discuss the quality of the service we received. If someone is posting blatantly false and libelous remarks about you then you take legal action. But if I simply think you had a poor bedside manner and you weren’t clear about test results that’s my opinion and I’m entitled to share it. Any doc who asks me to sign something like this is automatically (in my mind at least) hiding something and probably a crappy doctor.

  71. Jonathan says:

    Their characterization of CDA 230 is a keeper: “an arcane nuance of cyberlaw“.

    Anyone have anything more on this? Or the use of similar tactics by other professionals? With the rise of lawyer review sites like Avvo, surely there’s been similar strategies by lawyers.

  72. pissedoffdoctor says:

    Absolutely up front. We are having problems with healthcare in the U.S. because patient expectations are way out of line.” Ask any physician practicing today. Doctors are in a special business where their patients are idiots.” I try to screen mine. Idiots go elsewhere please.

  73. rudegar says:

    What’s the big deal? If you don’t want to sign the EULA from a doctor that doesn’t want bad reviews online, go find another doctor. If a doctor is losing business because of such a silly clause they will realize the errors of their ways.

    There is a difference between the service of a restaurant and the care you entrust to your doctor.

    • Antinous / Moderator says:

      If you don’t want to sign the EULA from a doctor that doesn’t want bad reviews online, go find another doctor.

      Because, unless you have $50K in your back pocket to pay for your surgery in cash, you are probably limited to one doctor or one medical group who will all have the same EULA.

  74. Takuan says:

    I wonder how many doctors a year from retirement spend it poisoning the more obnoxious ones?

  75. halfvenus says:

    I am a lawyer for doctors. When one of our docs got a negative rating on a “rate-a-doc” website, she went nuts. She wanted to sue, blah, blah, blah. Of course, the negative rating was about her personality/bedside manner, not her care. If it’s the care, they sue.

    The proof was in the pudding. We advised to ignore it and not see pt again if she didn’t want to.

    No, I would NOT be one of the lawyers advocating that patients sign such dreck. Wouldn’t hold up in court, anyway. If what the pt. says is true, well, too bad and so sad.

  76. Anonymous says:

    All patients need to have the right, and to feel free to express their opinion about their doctor and about how they were treated. Its imperative in order to ensure quality, standards and accountability. It is also a question of free speech. I can speak personally from experience of treatment by doctors who, the minute you mention your dissatisfaction with their care, or question their care or authority, or call them (correctly) on a mistake, then take the attitude that they are more than happy to dump you (or your Father or loved one) like a pile of garbage by the roadside. Doctors are big business: they do not want to be bothered with anyone imperiling their operation. A recent article in the Washington Post pointed out that in a recent survey, over 63% of doctors admitted to covering for colleagues who made mistakes instead of holding them accountable, telling the truth or reporting them. Doctors are not high minded individuals who live by the hippocratic oath (some are) but most times its a matter of money. Never sign a Eula, never give up your right to hold doctors accountable, never give into the belief that they can do no wrong. Hold them accountable, if you care about your health or the health of your loved ones.

  77. Takuan says:

    Modern translation of the English:[4]
    “ I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

    To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art–if they desire to learn it–without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.

    I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

    I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

    I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

    Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

    What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.

    If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

  78. william says:

    I’m intrigued by the claim that medical skills are all that should matter to patients. Yes, that’s definitely something I look for, but that’s far from everything. Some of the worst doctors I’ve had are people with obvious medical skill and little personal skill or human interest in patients.

    Skills are a neutral thing, both practically and morally. A doctor may evaluate himself by his medical skills, but thinking that all patients must use his criteria or be subject to lawsuit seems like arrogant idiocy to me.

  79. aeon says:

    Zuzu @67

    The comparison with other knowledge workers falls down when you consider that if the plumber, car mechanic, architect and web site designer do their job properly then the outcome will be as advertised. Their skill & knowledge alone determines the standard of the outcome. You may disagree with them during the process, but if they produce the result you know that they were right.

    Unfortunately Medicine doesn’t deal with black and white outcomes. It deals in probability and shades of grey. I can give you expert care and *still* have a poor outcome and your perception of *why* there was a bad outcome may be totally at odds with reality. An undiscovered quirk of your physiology might leave you dead or disabled if I give you a drug that works flawlessly on the rest of the population. You blame me for throwing the dice on your behalf, despite the fact that I weighted them heavily in your favour.

    My own specialty (Anaesthesia) is always being compared to the aviation industry and there are indeed many useful parallels. The big difference is that a pilot flies the same type each time and doesn’t have the engineer crawling in and around the aeroplane disabling bits and repairing things while he’s actually flying it. How many of you want my job?

  80. Takuan says:

    EULAs that remove all rights will result in people asserting their rights in other ways. It is in our nature to get even. These things balance out over time.

  81. MB says:

    Trying to peg the irony meter there, OnePissedOffDoc? Because you’re filtering for the idiots.

    I’m guessing you’ve gotten more than a few complaints in your career. The sad part is that you’re probably under the impression that it’s always the patients’ faults, and never yours. Which only does harm to both of you.

  82. Takuan says:

    well Aeon, we all know you get to take stuff home so…maybe.

  83. Anonymous says:

    Listen, the major difference between your mechanic doing this and your doctor is that the doctor is prohibited by law and by ethics from commenting on care given. If you trash your mechanic for a bad hose job, he can reply and say you wanted the cheapest used hoses he could find or somesuch.

    As for preventing bad docs from plying their trade, any time there is possible malpractice, it should be reported to the department of public health (in the US), who then launch a full investigation, with the possibility of pulling that doc’s license. In that case, the doc CAN respond, and it makes arbitration a little more fair. Flame away!

    KJ

  84. JorgeBurgos says:

    Just go out and write bad reviews about the doctors that make you sign these ridiculous wavers.

    If doctors are going to operate like a business then they can play the same game that regular business-people play.

  85. jjasper says:

    What happens if you ignore it and rate them anyhow?

  86. Antinous / Moderator says:

    To reiterate my comments at #64 and #71, there’s no relationship between quality of service and complaints in medicine because the customers don’t have the faintest idea what’s going on in the transaction.

  87. stanfrombrooklyn says:

    The problem is that we’re seeing more and more popular sites where anonymous reviewers can write anything about a doctor, a hair stylist, a restaurant, or a product and not have to show any accountability. So you can’t blame someone whose business is dependent upon positive word-of-mouth to take umbrage with these sites. If my doctor neighbor is rude to me one morning in the parking lot, I shouldn’t be able to post anonymously that he used his whole fist when giving me an annual prostate exam.

  88. aeon says:

    I can understand why they’re doing it. Step back for a minute and picture yourself working in a job where your “customers” generally don’t understand the service they are purchasing so you can’t always give them what they want. Then imagine that your customers can bad mouth you to all and sundry, misrepresent your decisions, make groundless complaints to multiple bodies, report you to the media and generally make life miserable… And you can’t say anything in your defence. Nothing, nada, not a word, no matter if the accusations are completely inaccurate or even malicious, even if your name is in the papers. You have no right of reply.

  89. Snig says:

    Nur,
    I was being silly in dividing it into good vs. evil. I didn’t mean to suggest you were saying people were inherently evil. But it seems that more people who sought out that site decided to say something positive about a doctor than negative, which I feel supports my point that these sites do not just appeal to malcontents.

    If the case is that most people who used that system had something nice to say, would that change your mind?

  90. Halloween Jack says:

    Because, unless you have $50K in your back pocket to pay for your surgery in cash, you are probably limited to one doctor or one medical group who will all have the same EULA.

    Not necessarily. Doctors compete against each other for patients. Also, unless they’re particularly oblivious, they realize that their main source of referrals will still be word of mouth.

  91. Bugs says:

    To play devil’s advocate, in the current system the doctors are being publicly reviewed by people who aren’t qualified to understand the limitations of medical science or what the doctor is actually qualified to do.

    I get the impression that you BBers are a fairly educated bunch, so maybe this doesn’t apply. But I work with some medical doctors, and constantly hear stories about patients complaining that the drugs they’re prescribed don’t make them feel better when the doctor had made it clear that “these _might_ help, but there’s nothing on the market guarrunteed to”, or angry that the doctors refused to agree with the diagnosis they found on the first page in google and give them treatment for some obscure genetic defect instead of something that actually does match their systems. Then there are the patients that fail to take the whole course of prescribed drugs, or take them with alcohol, or take them all at once instead of throughout the day, etc. and then blame the doctor for the drugs not working. You can argue that part of the doctor’s job is to communicate this stuff to the patient and that’s true. But the simple fact is that even if you have the science background and/or trust in the doctor to believe their explanation, some people don’t want to hear it; they just want a magic pill that makes them feel better and to get out of there ASAP.

    So yes, it’s important to be able to review doctors. But I can understand doctors being scared of having their reputations ruined by angry patients who didn’t follow treatment instructions (amazingly common – one of the biggest problems in drug trials) or don’t understand the limitations of medicine (demanding antibiotics for a cold, etc).

    /devil’s advocate
    (for the record: no, I wouldn’t sign it either)

  92. sirdook says:

    StanFromBrooklyn,

    I think you’re mistaking the categories of what people shouldn’t do with the category of what people shouldn’t be ALLOWED to do. The internet has long been a place where assholes could anonymously post whatever they like. The alternative to allowing that is allowing other, usually more powerful, assholes to keep people from pointing out that they’re assholes. Given the choice, we’re all better off with the first arrangement.

  93. LX says:

    The law already provides both doctors and patients with everything they need, so the EULAs for treatments are preposterous.

    If a patient implements his right of free speech in writing a report about his treatment on the net, he is liable to civil charges in case he violated the private rights of the doctor. If he can’t prove what he wrote, his comments will be deleted. If he can… bad news for the doctor.

    Trying to reshape the legal system in such ways is mostly a bad move. Good thing in Europe such waivers would be mostly worthless.

    Greetings, LX

  94. Ito Kagehisa says:

    Dr. Arthur Mencher once asked me, “Do you know what they call the least talented guy who ever graduated medical school?”

    I said “no.”

    He said, “Doctor“.

  95. MB says:

    A patient is a human being, too, Antinous, and as such is pretty clearly qualified to judge a physicians failure to listen, adequately explain themselves, and a host of other basic-interaction items relevant to the experience.

    I suspect that the vast majority of poor physician reviews can be boiled down to “My doctor is a jackass.” Which is pretty well supported by the constant repetition (including your posts) of “patients are idiots, and should shut up, because MDs know better.”

    • Antinous / Moderator says:

      patients are idiots, and should shut up

      I’m not suggesting that they should shut up. I’m suggesting that they should stop being idiots. Health care decisions are some of the most important (and frequently last) decisions that you will make in your whole life. And yet, most patients do the mental equivalent of sticking their fingers in their ears and humming when their doctor tries to explain it to them. Which, by the way, is frequently how they got so sick in the first place. Patients should be free to rate their doctors, but if you make your health care choices based on those ratings, you’ll get the health care that you deserve.

      Choosing a doctor by popularity contest: priceless.

  96. Michiel says:

    Haha, I’ve completely forgotton what this article is about now. Thank’s BP :)

  97. sum.zero says:

    “Not necessarily. Doctors compete against each other for patients. Also, unless they’re particularly oblivious, they realize that their main source of referrals will still be word of mouth.”

    employer provided hmo health plan = few to zero options

  98. DeeAnAy says:

    Anybody picking a doctor through an online review needs to seriosly think of another way. Word of mouth works fairly well but much better than a review from someone you don’t know (or what their motive is). I almost thnk a dart would work better.

  99. pissedoffdoctor says:

    Who needs EULA’s. I just found out that 17 states
    have criminal libel statutes. I say doctors should press charges!

  100. jonjonz says:

    I think I will start a competing service. Our added value will be to provide astroturfing whitewash anytime our clients are dissed in pubic forums.

    We will use the latest CRM boilerroom techniques to slather any negative comments under an avalanche of what appears to be just plain folks standing up for our good doctor clients.

    I will be laughing all the way to hell.

  101. Anonymous says:

    I only ever visit osteopaths – they seem pretty good. Friends of mine who’ve taken their business to oncologists have had some awful outcomes. :(

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