This page contains a single entry from the blog posted on March 4, 2009 11:07 AM. The previous post in this blog was Probable phish alert. The next post in this blog is Cha-ching! More green for the boys. Many more can be found on the main index page or by looking through the archives.

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Wednesday, March 4, 2009

Need medical help?

First promise in writing not to say anything to anyone if you're not happy with the care you get.

Comments (8)

Can the doctor that requires this nonsense!

Is that even enforceable?

The Medical Justice blog responds- a doctor and client should be entitled to reciprocal privacy rights. Apparently a doctor can’t controvert a patient's anonymous comment on the internet without violating doctor-patient confidentiality. Medical ethics make it impossible to confront the accusing patient.

The ethical duty of attorney-client confidentiality seems similar, except that it features the doctrine of "preemptive self-defense" which allows for the limited sharing of client confidences to dispel accusations of attorney wrongdoing in the course of representing the client. ABA Model Rule 1.6(b)(5). See also Comment 10 to Rule 1.6. However, the exception probably doesn’t allow for public (internet) disclosures. Comment 14 to ABA Model Rule 1.6. Seems like you have to convince the client to take the accusation back first.

Can the doctrine of "preemptive self-defense" can be stretched this far?

Okay back to studying for the MPRE.

This will never fly in court, especially since the web sites are generally not complying with requests to take down negative reviews. My wife is a doc (disclaimer here) and we've looked at reviews such as those in the Portland Monthly. What most people don't realize is that the "outstanding doctors" campaign for those ratings on Portland monthly. Those don't come in from anonymous readers. My wife is asked all the time to "rate" her own providers and to recommend them for the PM survey. She demurs as she feels it is unseemly. We have good medical care, but wouldn't check Angie's List or elsewhere to find out about "customer satisfaction". If you are nice to a patient (who can be a complete a**hole) you *might* get a good review, but there is no guarantee. My wife gets commendations galore from patients but they don't pay the rent, don't lead to more money. In fact, all they do is increase the workload with no increase in compensation. Some reward for good service and patient care.

Some people seem to treat a doctor’s office as though it were an Oil Can Henrys franchise.

Yeah...And some doctors treat their patients like a grifter's mark. Need a new boat? Just convince this clueless patron that they need this unneeded, or risky, surgical procedure. Promise anything, deliver crap.

Of course, after the crap is delivered and the patient realizes they've been lied to and robbed, the surgeon hides behind the waiver the patient signed on the understanding of the surgeon's unmet promises.

Keep in mind that in-hospital medical mistakes are still one of the top ten morbidity sources in the US. The doctors hide behind medical associations, close ranks against consumers, and basically act as though they are not responsible for their work. Then, at places like OHSU, they get even more cavalier when the state limits the liability to which they are exposed.

I think something like this is long overdue. The consumer has waaaay imperfect knowledge entering this market and the market is stacked against the patient.

Also, if OHSU is any indication, if you have a problem, don't go to the institution's "Patient Advocate". That's a dead loss. That is the point person for the institution's Risk Management Department, and they will deny any liability or wrongdoing on the part of the hospital, clinic or their physicians and surgeons. If you want to fight it, it will require an attorney.

And...As we all know, justice is the purview of the wealthy. Poor folks can't afford an attorney. Even middle class folks can't afford an attorney to sue doctors and/or hospitals who have panels of professionals on retainer to protect them from their own mistakes.

Oh...Also, if a doctor promises you any result from therapy or treatment, tell them that you will consider it if they write down their promise and sign it in front of another person who is not a member of their staff.


No reputable doctor will "promise" you anything. That's why you need to sign an "informed consent" indicating that you understand the risks of the procedure or therapy. While the majority of cases may produce the desired result, the reality is that human variability affects outcomes. Despite all best attempts, shit happens. My wife is a living testimony to the shit happens department. A $1.3 million set of surgeries at the best medical institution in the west still had unexpected, but listed, side effects. This nearly doubled the bill as the doctors tried to get her healthy enough to finish the surgery. Aspiration pneumonia is not fun and she was in critical condition for a week. Malpractice or bad surgery - hell no. Shit happens. Yes.

If you go to a doctor expecting a perfect result without considering the risks of whatever procedure you need, you're foolish.

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