Sounds illegal to me. "Hmm I deny you treatment based on the fact you wish to keep your first amendment rights - prohibits the United States Congress from making laws "respecting an establishment of religion" or that prohibit the free exercise of religion, laws that infringe the freedom of speech, infringe the freedom of the press, limit the right to peaceably assemble, or limit the right to petition the government for a redress of grievances.

Sounds like they are trying to limit freedom of speech and press to me.

I saw a poll about this on Angie's List the last time I logged in. You sign so much paperwork when you go to an office at times I worry about someone trying to sneak crap like this in on me.

For the most part I am healthy and I haven't had any issues with my healthcare, but to not be able to speak out and give my experiences with a certain caretaker/doctor would piss me off.

Sigh. The first amendment only covers GOVERNMENT regulation of speech. Anyone else, employers, business partners, etc are free to limit speech as a contractual obligation.

@Saboth: Erm. While I think these gag orders are shady, it's not an infringement on free speech.

This has an easy solution:
1) Enroll in such services anonymously, or use a common name (John Smith of 123 Fake Street). Let the doctor try to trace that!

2) Leave out opinion and 'how the Doctor made me feel unloved' comments. Stick to facts: Doctor did 'X', which I later found out was the incorrect procedure. He should have done 'Y' instead, and this caused me to have negative consequences. (This works doubly well, since it's helpful to others reading the review. Also, libel claims are dismissed if the statement is truth.)

3) Refuse to do business with any doctor who wishes you to remain silent about your treatment. Just because HIPAA doesn't allow the Doctor to talk about your health doesn't mean that you can't talk about his/her level of care.

Wouldn't it be more beneficial for both the Dr and patient to have an "after visit" survey before leaving the office? Or the Dr creates their own private website where anonymous complaints or comments can be left for him/her to read? If I had complaints, I'd rather they be brought to MY attention then the internet.

And as much as some patients can be a real pain in the ass... some Doctors are unwilling to believe that their etiquette or practices need improvement. One word: Denial.

Health care is just like any other business- you don't like the reviews? (Who does?) Then maybe you should look at the business model as a whole. As for patients who will never be satisfied, well... there's no changing them. Unless they blatantly lie, there's no recourse as well.

"You've got shyster in my malpractice magnet."
"No, you've got malpractice magnet in my shyster."
[both taste the other's cup]
In unison: "It's delicious!"

@Saboth: The *government* has to protect your first amendment rights; private individuals have no such obligation. Not that I agree with this in general, but just to clarify.

Or just don't sign the form. Just because someone hands me a stack of papers to sign doesn't mean I sign them.

@Repique:

yes, but if all medical practices went to this method, basically you would have to choose between your rights and medical coverage.

@Repique: And first amendment rights don't mean you can go around saying anything you want about anyone else, either. Slander and all that good stuff. You can always go to another doctor if you don't want to waive your rights.

Plus, "closed mouth" contracts are pretty much everywhere -- from a juror forbidden to reveal details of the case he's on, or a lady who settled with a huge company and isn't allowed to talk about the details, or a company that restricts employees from revealing trade secrets.

@TheRedSeven: "Leave out opinion and 'how the Doctor made me feel unloved' comments" This can be relevant to the care given, though. Doctors need at least some bedside manner. If I go in to get my yearly gyno exam and my gyno is an ass -- getting too personal, judging me for having sex and not being married, judging me for being on birth control, judging me if I ask about abortions, whatever -- then you damn well better believe I'm going to report it.

And re, 3): Great in theory, but not everyone has the option to change doctors.

@TheRedSeven: And do you really want people to go to the doctor using a FAKE NAME? That's ... not right and could cause problems in the future.

@jamesdenver: Likewise, they can refuse to provide you with service if you don't agree to their terms.

@nakedscience: They are an infringement on free speech in that they are you agreeing to waive that right in respect to your doctor's treatment.

@supercereal:

yes, but in those cases, you aren't necessarily going to DIE because you didn't sign a NDA. "Hmmm I can always find another job if I don't agree with the NDA from this company" or "hmm I won't get my 50k if I talk, but I deem my rights more important".

Not "Hmm every doctor has an agreement, so I can either get cancer treatment and give up my speech, or not and die"

@Saboth: IANAL, but if it were a medical emergency, you might be able to make a case about signing under duress.

If this does become a popular thing with doctors I can see them next requiring a signed document saying you wont sue them if they screw up. I guess that would lead to lower prices at the Dr. because they won't have to carry malpractice insurance..

or not

@Saboth: That presumes that you have a right of free speech as against the doctor.

The first words of the First Amendment are "Congress shall make no law" not "Your doctor shall make no rule."

The waiver is a stupid idea but that doesn't make it unconstitutional.

My doctor is wonderful. That said, if I had a problem with him or with one of his staff, I would first go to either him or the office manager (or whoever is in charge there). If I didn't get any resolution, then I'd escalate.

If they tried to make me sign something like that, I'd flat out refuse and start looking for another doctor. Assuming I could find one that didn't do that and it wasn't something my healthcare network did across the board.

As nasty as this is I have a hard time blaming the doctors. With these review sites anyone can sign up and make any kind of claim and it's nigh on impossible to have even the most spurious ones removed.

Add to that things like the alleged shakedown by Yelp sales people and I'd be doing all I could to protect myself too.

@Saboth: That still doesn't make it unconstitutional.

@Saboth: But you don't have rights like that from a private individual, is what I'm saying. So what you'd be choosing between is *speech* and medical coverage. This is totally wrong, ethically, but not for reasons that have to do with the first amendment, for the same reason that religious discrimination in employment isn't a protection of your first amendment rights; it's a protection of your rights under various employment laws.

Nobody's arguing that this is morally right, here, only that it doesn't have anything to do with that particular selection of rights that people have under the law.

There is a problem in that if you make a complaint about a doctor, how can he respond without being sued for violating doctor/patient privledge?

Does talking about one aspect of your treatment with a doctor allow him to rebutt the accusations if it includes potentially embarassing details?

How do you think people would react if this exchange played out on RateMDs.com?

Joe Schmoe - Dr. Schmendrick didn't treat my butt pimple effectively.

Dr. Schmendrick - It was because you had un-diagnosed HIV

Now that being said, I am all for rating doctors just like any other profession. I just think it isn't as simple as rating a plumber.

If I went to a doctor that required signing a form like that I'd question the their confidence in and ability to provide quality medical care. I'd definitely find a new doctor.

As much as I enjoy Yelp and other such sites, I only really use them for restaurants and such.

Angie's List for contractors.

But Doctors? I don't know if I'd trust a bunch of anonymous people on the internet to give me reliable advice on medical treatment.

But I still think Doctors have no right to make anybody sign a waiver such as this.

@nakedscience: He's talking about using the fake name to register for the review service, not using it at the doctor's office.

First, I'm thinkin' this guy is engaging in the unauthorized practice of law, which North Carolina is surprisingly willing to prosecute. (Went to law school down there, they went after the craziest stuff as unauthorized practice.) Providing legal documents to others without a law degree is uncool. And since I doubt he thinks any moron should be able to hang out a shingle and practice medicine without a license, I'm interested that he's willing to do that with the law.

Second, this is PHENOMENALLY BAD PRACTICE if not actively unethical (and, if not, it should be). One of the reasons malpractice and doctor/patient relationships are such a big issue in this country are the ways that hospitals, insurers, and even doctors' groups have protected "bad apples" and kept them in practice. That leads patients not to have a lot of trust in their doctors or in the system that's meant to protect them. Any doctor who participates in a system that is meant to shut down complaints is participating in protecting bad doctors who shouldn't be in practice -- and I would refuse to go to such a doctor on the grounds that he's probably one of them if I have to sign a gag order.

Again in North Carolina, there was a doctor who had sexually abused more than 30 women WHO WERE WILLING TO COME FORWARD in North Carolina over a period of years who was REPEATEDLY shielded by his hospital and insurer and other doctors and the state med board when the women used proper channels to complain. (And this was the second state he'd done this in; the first state had agreed that if he left the state, they wouldn't say why and his first insurer had agreed if he went with someone else, they'd give him a recommendation.)

This doctor is providing protection for assholes like his sexually-abusive cohort there. That's been going on long enough.

@JeffMc: "nigh on impossible to have even the most spurious ones removed."

Traditional libel and slander lawsuits can take care of it. Unless what they're saying happens to be true.

I hate these ratings sites as well, but this is a totally inappropriate way to handle it.

I admit to recently using Yelp *as part of* my process of finding a doctor. What I was looking for from Yelp reviews were indications of bed side manner, does the doctor listen, does he/she make you feel comfortable and take your thoughts and opinions into consideration, etc. All things in which you really need the opinion of a former/current patient to get. I got a list of doctors together whose reviews I liked, and then I moved on to the AMA website, the website of the doctor's board certified specialty, the doctor's own website, and whatever Google had to offer to see 1. that they were board certified in the specialty I was looking for, 2. to view their education and employment background, and 3. to view their disciplinary and legal history.

I think word of mouth is hugely important and the doctors who fear this and try to repress this by having their patients sign these forms do so because they are most probably lacking in some way. Even the best doctors will get some bad reviews, there is no avoiding it, but if they are good, the positive reviews will overwhelm the bad and give the consumer/patient a good picture of the type of physician they are.

If this goes to court, any lawyer worth his salt would argue that the public right to know about how a doctor operates is greater then the doctor's right to keep such information private. Because of a Doctor's public work, and the risks of that work, for people's health and possible life threatening conditions, it is different then people knowing that XYZ metal fab shop makes shotty bed frames. If the doctors weren't in such a delicate field, then a Judge would be less likely to throw these gags out.

@Trai_Dep: Wait... what?!

@Saboth: Right now I'm deciding between food for my kid and medical coverage.

God Bless the USA!!!

@RecordStoreToughGuy: Yeah, I misread, thanks :)

@supercereal: That's fine, I'm not going to sign an unconstitutional document just because it's signed to me. Take my ass to court.

@ViperBorg - Facebook is the new AOL.: Ga, just because it's handed to me.

Sigh...

Apparently, only the Gods are allowed to have an edit button.

Medicine is a business.
There's no "care" left in health care.

Imagine if every business did this (made you sign a form saying you couldn't talk about them or their products and services online, ever).

@Saboth: "Not 'Hmm every doctor has an agreement, so I can either get cancer treatment and give up my speech, or not and die.'"

I'm not sure it's so black-and-white. Do you really think it's illegal to say "I will not do business with you until you agree not to post malicious statements about me online?" Especially when the punishment is "the comments are removed from being posted." It's not exactly the same thing as being locked away and muzzled, especially given the wild and wooly nature of the internet.

I don't know if this is automatically evil (although it's certainly not a First Amendment issue), given that the internet is a relatively new phenomenon that is bending the rules of permissible speech and libel/slander all over the place before law and/or morality has a chance to catch up. Don't get me wrong, I'm not saying it's obviously the best thing since sliced bread either, just that it's a complicated issue.

@cheviot: Sadly, yes, non-disclosure agreements are legally binding depending on who they are with. Although, I don't think they should be. In my opinion, the mere presence of a non-disclosure agreement for this type of contract indicates unclean hands. What other purpose could it serve than to prevent people from true but negative things? Doctors, and everybody else, already have protection from libel and slander given by the US government. Another contract only gives them license to deliver inferior or incomplete service.

@johnva: I think if it weren't for the logistical hurdles (combing review sites, tracking down reviewers) quite a few businesses would be interested - especially those that rely on reputation and word-of-mouth for customers.

That said, medical practice is not entirely a business. Obviously, money changes hands and in a lot of ways the practioner is providing a service to the customer. But medical ethics are completely different than business ethics, and (with some very limited exceptions) you have to put your patient's well-being first. Well beyond what companies are expected to do for their customers.

I think the fact that this doctor is considering these waivers highlights how much medical practice has become just another service industry, which is a shame.

So why don't they try to suppress bad reviews by, y'know, giving quality care? If I were given such a form to sign, I would probably we wary of the Doctor handing it to me.

I'd assume they weren't just being proactive. Perhaps more likely they have a history of trouble with their patients.

@jamesdenver: I provide the bare minimum information a doctors office needs to provide medical services. Name, contact information, insurance information and medical history.

I quit giving them social security numbers and any other information including employers. I decided they don't have a use for my SSN and it is a ID theft risk. The rest of the things on those forms are largely not really needed.

So far nobody has called me out on not giving that info or refused treatment.

There are a number of things I want to know about a doctor before even considering trusting them. Do they have extreme religious views that impact how they treat patients. Where I live that is a very common problem. I want to know if that doctor is condescending to women or does not take their complaints seriously. Some are like that and it can really hurt your treatment. Hopping from doctor to doctor can get you labeled a doctor shopper so knowing what your dealing with ahead of time can save some problems. I also want to know if they are hostile towards their patients. A few are but get protected by the system.

That said I take ANYTHING I read online with a big grain of salt. But if your seeing multiple sites and multiple reviews citing similar problems it might be a problem.

@sleze69: Exactly. Why do you think there isn't a "rate your patients" website? The system is inherently unbalanced in many ways, sometimes towards patients, and sometimes against them. If you have a problem with a doctor, talk to them. If that doesn't work, go to the local licensing agency.

@darthsodomizer:

As a general comment, something really needs to be done about medical malpractice lawsuits in the US. The cost for malpractice insurance is so high for doctors that people aren't doing the low-paying specialties like primary care or pediatrics because they don't like being paid 90k a year, paying 20k malpractice insurance, and having to pay off their loans at the same time after over 10 years of school.

@Yamunation:

that's the problem with insurance companies... doctor's have to over-extend themselves like crazy to be able to make any money

I swear to god this country is going to have a massive lack of qualified doctors in ten to twenty years. Being a doctor isn't nearly as great as it used to be. Unless you're one of the few that makes it into the well paying specialties like dermatology or orthodontics you're really not making that much money (like 90k for primary care doctors in NY). Plus, imagine getting paid 90k after 10+ years of school, having to pay back loans, while malpractice insurance costs you 10-20 thousand each year because everyone and their mother can sue a doctor for the stupidest reasons. There is inherent danger in EVERY procedure, sometimes bad things just happen, it's not necessarily negligence on the doctor's part because your result wasn't perfect. OB/GYNs are dropping the OB from their names because patients are suing them if their kids turn up with down syndrome, plus they can make twice as much money as only a GYN with less patients. There is going to be a severe lack of primary care/pediatricians/OB's soon unless the government does something to limit a) the amount of frivolous malpractice suits and b) the cost of malpractice insurance...