Doctors can compel you to remove negative reviews from Angie's List

It's time for your yearly physical. Walking into the doctor's office is like any other visit: the same corny elevator music, the same outdated magazines, and that stack of paperwork the receptionist always hands you to fill out. But there's something new in that paperwork. Your doctor is asking you to sign a new agreement. What it asks for surprises you.

Your doctor wants you to turn over the rights of what you may say about him or her online. Sound ridiculous? It's not and is the newest method medical professionals use to protect their reputations. One company is spearheading this effort, and has become the target of criticism for its practices.

The Doctor Owns What You Say

The company is Medical Justice, a North Carolina-based outfit behind what is called a "Mutual Agreement". Used by an undisclosed number of the 3,700 doctors nationwide represented by the company (Medical Justice claims it "doesn't keep track"), signing the agreement hands over the copyright of your Internet posts on ratings sites to the doctor. If a physician considers your posting "egregious", then you must remove it.

"We don’t want your practice to be judged by two or three patients", Medical Justice founder and CEO Jeffery Segal says. He argues that the increasing criticism over its practices result from first efforts more than two years ago to combat negative reviews.

Medical Justice then supplied its clients with a much stronger agreement -- which opponents liken to a gag order -- giving the doctor free reign to compel removal of any post for any reason.

Segal, who is a MD, claims the company's "revised" agreement is far less hardline, and is designed to be used sparingly. "I can't guarantee that some doctors may be abusing it", he admits.

The Reliability of Doctor Ratings May Be At Risk

Medical Justice's failure to guarantee its clients are not sugar-coating their reputations has ratings sites upset. Of the three ratings sites that responded to BetaNews' requests for comment for this story -- RateMDs.com, Angie's List, and HealthGrades -- all say they have had contact with Segal's company.

RateMDs.com and Angie's List are fighting back, however. RateMDs.com maintains what it calls the "Gag Contract Wall of Shame", while Angie's List places an "Unfriendly Consumer Practices" tag on doctor’s profiles that it knows uses such waivers.

"We've been alerting consumers to [the posting agreements] and opposing them everywhere we can", Angie’s List spokesperson Cheryl Reed tells BetaNews. RateMDs.com co-founder John Swapceinski says it's an issue of free speech.

"The contracts ask sick patients to trade their freedom of speech for medical treatment", Swapceinski argues. "It is reprehensible".

While Segal claims in our interview that he does not contact the sites demanding removal of bad reviews, HealthGrades tells BetaNews that the company heard from Dr. Segal himself on several occasions including threats of legal action, according to spokesperson Marsha Austin. These contacts occurred as recently as the end of 2010, a year after Medical Justice claims to have changed its policies.

All three ratings sites say they have never removed any reviews that Medical Justice has contacted them over. Doctors using Medical Justice may find themselves paying for a service with a very low rate of success, and puts the firm's business model into question.

Is Medical Justice Gaming The System?

Segal and Medical Justice may realize the shortcomings of their strategy. He tells BetaNews that the company has an internal system in development where patients can review their doctors at the office itself. These reviews are not shared publicly right away: the doctor will see them before Medical Justice attempts to post them online.

This raises a whole new set of issues. What's the benefit to Medical Justice in posting negative reviews that patients may give? While Segal points out that the company does not edit reviews, one ratings site shared with BetaNews data that shows a pattern of extremely positive reviews coming from IP addresses traced to Medical Justice.

Between November 5, 2010 and March 29 of this year, RateMD.com noted 86 positive reviews for 38 doctors in 14 states. In every review, the doctor was rated five out of five stars in every category. RateMD banned those IPs and removed the suspicious reviews.

It is not clear whether these reviews were the result of a test of the new system described by Segal. Due to patient privacy laws, it is impossible to confirm anything about these patients' reviews.

Ratings sites may have the most to lose with this new system since accurate reviews may be harder to ensure given there are companies like Medical Justice that allegedly could game the system.

Gag orders on Internet reviews may seem like a clear affront to free speech but according to noted First Amendment lawyer Lawrence Walters, the agreements are completely legal. "People are free to give up their right to post negative comments by signing contractual agreements with private companies, containing such restrictions", he says.

Walters does believe the practice its questionable. "Requiring a patient to give up his or her right to communicate about the quality of a physician's services as a condition of treatment raises some ethical concerns, even if it is not illegal".

Patients are responsible to know what they are signing. If a doctor asks you to sign away free-speech rights, legally the only recourse you have is to find another doctor.

Medical Justice is undeterred and will move forward. "Our goal is to provide a more accurate online picture of a doctor’s practice that also contributes to an enhanced patient-physician feedback system with better checks and balances", Segal argues.

"This system will not only encourage more reviews, but will create a feedback loop to drive quality practice improvement and faster resolution of patient concerns -- all while fortifying the patient-doctor relationship", he emphasizes.

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