To Quell Criticism, Some Doctors Require Patients to Sign 'Gag Orders'

By Sandra G. Boodman
Special to The Washington Post
Tuesday, July 21, 2009

Until recently, patients whose doctors kept them waiting for hours without explanation, brushed off their questions or seemed downright incompetent had little recourse, other than complaining to family, friends or, in egregious cases, the state medical board. That was before the Internet gave everyone with an e-mail address the ability to reach a vastly wider audience by posting -- often anonymously -- critiques of doctors, in much the same way travelers rate hotels on such Web sites as TripAdvisor.

In the past five years more than 40 Web sites, among them, Angie's List, Yelp, DrScore and (motto: "where doctors are examined"), have begun reviewing physicians, providing information about one of the more difficult and important decisions consumers make routinely.

As these sites proliferate -- a reflection of the hunger for information about doctors in an era where patients are expected to make sophisticated decisions about their care -- questions about their usefulness, accuracy and fairness are intensifying. In some cases the freewheeling anonymity of the Internet has collided with the rights of physicians who are constrained by laws that protect patient privacy.

As a defensive measure, some physicians are requiring patients to sign broad agreements that prohibit online postings or commentary in any media outlet "without prior written consent."

Critics call the documents gag orders. Many experts say they are both unethical and unenforceable.

But an increasing number of doctors view them as an appropriate response to sites that not only ask detailed questions about a doctor's punctuality, availability, communication skills, office staff and the effectiveness of treatment, but also permit comments that may be untrue. Some are scathing.

Case in point: A veteran District internist has attracted nearly 40 comments on one site, compared with the more typical one or two. Most are negative, focusing on his off-putting demeanor, dirty office and hostile staff.

"The worst doctor I have ever encountered in my life," one recent posting said. "Impolite, unengaged and unfocused." Said another: "Long wait, rude staff, never sent me a follow-up on my tests."

To Angie Hicks, founder of Angie's List, which last year added doctors to its reviews of plumbers and roofers, physician ratings are an extension of the contemporary zeitgeist.

"Consumers have been talking about their experiences with physicians forever," she said. "It's moved online, just as other parts of our communication with friends and family have.''

Unlike other sites that rate doctors, Angie's List does not allow anonymous postings (the site knows writers' identities, although the public does not) and its reviews are available only to members who pay a fee.

Many other sites are free and accessible to the public. John Swapceinski, a founder of, one of the oldest and largest sites, said he was inspired by the success of the reviews on and thought consumer rankings could be applied to professors and physicians. After Swapceinski launched, he took RateMDs live in 2004.

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