BuzzFeed: Doctors are losing the online comments war

Physicians' hands are tied by HIPAA, experts say

Doctors are increasingly vulnerable to incendiary online reviews posted by former patients, but confidentiality laws prevent them from fighting back against even the most outlandish of claims, BuzzFeed contributor Jake Rossen reports.

A recent Pew Research Center study reveals that 72% of U.S. internet users accessed online health information in 2012, and 30% of those consumers looked at provider reviews, which allow nearly anyone to post comments with near anonymity.

How 'important' are online physician ratings? It depends.

As online physician rating websites have proliferated, so have the number of libel and defamation cases against providers. "It's something that's come up in the last year or two that we've never seen before," says Liz Brott of the professional liability insurance company ProAssurance. She added "We've had to figure out a strategy to address these complaints."

Why doctors' hands are tied

HIPAA prevents doctors from discussing patients. Disgruntled and anonymous patients can complain with little concern of retaliation, and in some cases, patients can mount coordinated attacks against physicians with the intent to destroy careers and irreparably damage reputations.

"I would say the internet has not yet matured to the point where there's a way of easily understanding the difference between an allegation that has some merit and an allegation that's simply someone venting who has an axe to grind," says Gary Nissenbaum, a lawyer with expertise in commercial litigation.

Many online physician ratings sites are unable to screen for potentially fraudulent posts. For example, RateMDs.com's FAQ page offers instructions for physicians to issue subpoenas and cautions that review sites are not liable for user comments. "It is not possible for us to verify which raters had which doctors, so always take the ratings with a grain of salt," the disclaimer says.

Mitch Rothschild, CEO and co-founder of Vitals.com, acknowledges that, without a paywall to enforce identities, his website cannot verify posts targeting certain physicians. He says the website can suppress a review at the physician's request, but there is no "throttle" to check beforehand if a reviewer's IP matches a doctor's location. "We don't view it as a social situation, we view it as commerce," Rothschild says, adding, "People want to see what other people thought about something they want to buy."

Defamation case raises questions about online criticism of physicians

John Swapceinski, co-founder of RateMDs.com, says most reviews are posted during the week, when doctors are in practice and patients are more likely to complain "in the heat of the moment." Although the site has algorithms to prevent spamming, most comments—with the exception of threats of physical violence—are permissible. "Any doctor going into practice knows about HIPAA ahead of time," Swapceinski says, adding, "It's a risk they take upon themselves."

AngiesList.com is likely the most progressive when it comes to authenticating reviewers, according to Rossen. Users must disclose their names in order to submit a post. If they want AngiesList.com to launch a complaint, they must sign a HIPAA waiver that allows the physician to disclose their medical data.

Doctors pay close attention to their online reviews

Physicians who choose to dispute negative online reviews often run the risk of attracting more attention to the issue. The First Amendment protects anonymous free speech, and the Communications Decency Act of 1996 authorizes websites to serve as third-party broadcasters without any liability.

"The laws are stacked against the doctor," says Nissenbaum, adding, "You're arguing against something designed to protect free speech. That trumps any case of defamation" (Rossen, BuzzFeed, 4/4).


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