What to do!? On-Line Physician Bullying.

I’ve been to this great APA meeting, great that is, because of the people!  Wow!  The fellow attendees, the exhibitors, the speakers – just, WOW.

I’m going to try to share content with you but it will take me time.

bully

For today, “Are You a Sitting Duck Online?,” reminded me of our earlier discussions on the doctor-patient relationship and a previous post, on July 11, 2012, that went like this:

Hello Friends.

Please tell me how I’m doing on this.  Just out,

Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice

This is important to me as I treasure both my medical practice and our community, connection, exchanges on-line.   I don’t want to do anything that jeopardizes either, nor the implication that if I did, that means I would have mistreated a patient.

Thank you for this, what I call, a “good problem” to have – the joy of medical practice and participation in social media/networking.

So many of you resonated with this and engaged.  I am still super grateful.  I’d love to continue with you in further discussion and with your comments!

For me, one of the many reasons I was so excited about this recent talk at the APA is because of the mucho online stuff connected to my name that affects my patients and the dynamics in our patient-doctor relationship.

In my practice, these are just a few sites that have wrong information (demographics) on me:

  • healthgrades.com
  • vitals.com
  • betterdoctor.com
  • ucomparehealthcare.com
  • insiderpages.com

They didn’t ask to clarify my demographics.  They didn’t ask me if I wanted them to become an on-line reference on my behalf.  They use my practice information to drive “eye-balls” to their site so they can get advertizing money and more.  They impose incorrect information about my practice, knowing that in so doing, I will be pressed, (I call it bullied,) into contacting them with my correct information.

If I don’t do this expensive effort, (money, time, emotional expense – all in limited supply, to correct what they post incorrectly,) patients will continue to tell me that they couldn’t find my contact information.  When they Google me, instead of my website coming up, these other sham pages pop up.

Some patients call dead numbers or even drive to incorrect locations to find treatment.  Instead of whomever is behind these websites being held responsible, the medical providers are.

These are the notes I took from my colleagues, as I heard them say.

Unfortunately, I was late to the meeting so I missed two of the four speakers.  Even so, this is worth it.


Dinah Miller M.D., Author of “Shrink Rap” and writing regularly for Clinical Psychiatry News.

Dr. Miller told us about the difficulty of “patient” (or nonpatient, i.e., sham-patient) reviews online.

Who can review the physicians?

  • your patients
  • Friends and lovers
  • enemies
  • trolls – a negative internet stalker

Every practitioner has an idea that they are a pretty good doctor.  So it isn’t easy for any of us to hear otherwise ;).  After getting unsolicited feedback from a person who took the time to write a comment on a site that listed her, a site that listed her profile without asking her, Dr. Miller chose not to play the victim.  She decided to call “Health Grades,” and with her persistence, they took her information down.

On “Vitals” – she got an answering machine with a person’s voice mail and no name and number.  So she called CEO, Mitch, who stated she wasn’t able to take her profile down.  She didn’t ask to open herself up to trolls.

Dr. Miller asks, what shall we do, as physicians?

  • do nothing
  • write a response
  • try to call the company

There are many whose livelihoods depend on public opinion.  For example, waitresses/waiters – many lose their jobs if they get even one negative reviews.

The practitioners in the group responded with resonance with Dr. Miller’s ideas.  They also had thoughts that if left alone, the democratic process would win out over time, truth would come out and such.  (Maybe the nearby statue of Liberty played into our thoughts :).)


Paul S. Appelbaum, MD, Dollard Professor of Psychiatry, Medicine & Law, Columbia University

Principles that Might help physicians Identify Constructive Responses

  • Responses should be Effective
  • Practical
  • Compatible with medical ethics
  • Positive rather than negative consequences

Problematic Responses by Individual Physicians

  • Request removal by website – typically declined.  Saying you’re writing a public article on it might help.
  • Contact the patient who wrote a negative response to request removal – Patient not likely to remove response, many patients post anonymously, most websites won’t allow patients to remove them
  • Flood site with fake positive reviews – deceptive, embarrassing if discovered, ? inducing a person to rely on a statement that may be used to their detriment (fraud)
  • sue patient for libel – identify patient might be difficulty, people have a right to their opinions – would have to prove statements untruthful and not merely opinion, $$ in money/time/and emotion

Encourage Satisfied Patients to Post Reviews?  We could refer to a firm to do this.  $$

Some sites, similar to “Vitals” offer the option to the practitioner to respond to a posted review.

Negative Reviews:

If we do respond – how?  We don’t want to come across arrogant or insulting.  We fear violating patient-doctor confidentiality. In the end, we recognize we don’t have the last word.  We may respond with a soft word of concern.  “If you would call my office, I’d be happy to schedule at no fee to speak with you about this and see if I can help.”

Can Patient Reviews Be Controlled?  There once was a company that tried this.  “Medical Justice” developed a form that gives control over of copyright of all reviews to MD.  – Didn’t work.  See article, “Company tries to stifle online reviews with patient ‘gag orders’.”

Another idea is that medical practitioners help themselves by coming together to develop an internet ombudsman.  This would be a medical/mental health professional not involved in care of patient.

  • Independent (unrelated party) investigation of physician about the case.  A successful investigation may give a third party opinion.  There’d have to be a reason for the world to trust this opinion.

It is difficult for healthcare professionals to protect themselves from inaccurate complaints about their care.

Positive Reviews

Does it put undue pressure on the patients?

A sign in waiting room perhaps.  Make the information available w/o practitioner knowing if they have or have not commented.

There is a dissonance between the position of being a business person that says we must practice democratically and compete fiscally, yet stay in congruence with what tradition holds us to.


The issues addressed in the talk weren’t specifically about being bullied by sham-websites, but it included that idea, along with other difficulties physicians are experiencing in the rapid transition of 3000 years of tradition as a healthcare providers to spending the majority of their time serving patients first to now, the reckless $ burden of running a media vulnerable business.

In the practice of psychiatry, a traditionally extreme-private practice, this is dissonant to many.

Q:  How do we treat the extremely delicate practice of psychiatry as a business when we are held to currently minimally defended standards like this?  Please speak out and let it flow!  We need to hear from you!  …and, Keep on.

Self-Care Tip:  Deal with internet sham-sites and reviews in a method that is consistent with Me, and temperament, while doing the least damage to oneself. It will be better for oneself as well as others.

 

Free To Do Self-Care, Despite Our Bully

Demonstration in London supporting Serbia

Image via Wikipedia

Bullying:  Series Continued.  (I didn’t even realize I was writing a series until now!)

  • #144 Leave Space In Your Beliefs To Grow
  • #163 “He’s Never Hit Me.” Abuse.
  • #251 Just Ordinary Bullying – The Bully and The Bullied
  • #253 How to Be A Friend To Yourself When Thinking About Your Bully

Bit’s and parts of us are unbelieving in what number of options to self-care that we have, when it comes to being bullied.  I don’t say this lightly about terrors.  Terrors change us irrevocably and hurt to the brink of our own abyss.

The question is, are we free to do self-care even when we are bullied?

Yesterday, Carl in his candid way, said,

Empathy and forgiveness? You gotta be kidding. Do you know what it is like for a twelve year-old to face this…  for an entire school term? Probably not? Cope? Isn’t coping with a chronic negative stimulus as debilitating as being unable to cope….  There may be situations where “book smart” stuff is not applicable because we cannot negotiate with the bully.

Go Serbia

Image by SanforaQ8 via Flickr

We cannot negotiate with the bully.  True, to the degree that Carl said, if I understand him.  (Carl you will surely set me straight soon.)

It is true that people who like to fight, fight well.  People who bully generally will bully better than I can ever defend myself.  They have had a lot more practice.  Have you heard this?  You never want to go up against someone who has nothing to lose because the only one that will lose is you.

When someone is agitated, in psychiatry we learn that it is good not to make eye-contact.  Avert the body.  Keep your voice low and don’t engage as much as possible.  It reminds me of letting the mist of early morning dew expire the coals in the camp fire.  Getting attacked is something we want to avoid.

Early on in my training, I was rounding on the inpatient psychiatry ward.  We often have people who are agitated admitted there and this morning, I remember it was about seven AM on a Sunday….  This particular patient hadn’t slept well.  He wasn’t well-groomed and he scowled.  All the nurses where in another room in a nurses meeting and I didn’t notice he and I were alone in the hallway.  I looked him in the eyes directly.  I didn’t concern myself with tempering my interview.  I was still sleepy myself and wanted to get out of there as quickly as possible to start my Sunday stuff at home.  (I know.  Stellar attitude for a resident-physician, right?)  He grabbed me around the waist and I nearly lost my water!  I screamed at him like a she-dog and he let go.  That was all.  No big deal right?  Well I was ticked at him and at the nurses for not being available.  No one was at the nurses station, which is illegal too.

In truth, I was pretty much an idiot on all accounts.  It doesn’t condone the assault but I have since been better about not negotiating with the bully.  

That probably wasn’t exactly what Carl was talking about but it is related.  It is by no means a full year of negative harassment, but when responding to the concept of not being able to negotiate with the bully, I don’t know at what point in degrees of trauma experiences that becomes true for us.  Perhaps it isn’t a matter of qualifying them or quantifying them.  Perhaps more depends on the victim.  I don’t know.  Do you?

What I do know, is that Carl and I are both partly wrong.  We can.  I don’t know about then.  We can now.  We are free even from those molesting monsters because of who we are.  We were created free and those horrors can’t extinguish that bit of us.  We are free not because of the protection or lack of protection we’ve lived in life.  We are free.

We don’t claim to know all the innumerable forms of suffering out there.  That is not what this self-care engages with.

Questions:  How do you find yourself free at this time in your life, despite it all?  How do you describe your freedom, even with your bully?  How have you seen others in this context?    Please tell me your story.

Self-Care Tip #254 – Free yourself from your bully.

Additional Resources: