Physician Reputation Research Articles

Recognition Awards in Pathology Specialty Societies.

Recognition awards build physician reputation and facilitate career advancement. We hypothesize women physicians are underrepresented as award recipients by pathology medical societies compared with representation in the specialty. We analyzed publicly available online information about physician recipients (January 2015 to December 2021) from three general pathology society websites. Recipient gender was determined by pronoun use, first name, and photograph. Representation was compared with Association of American Medical Colleges (AAMC) specialty data from 2015 and 2019, which showed a minimum of 36.7% women pathologists in 2015 and up to 43.4% in 2019. Twenty-six awards and 230 physician recipients were included in the analysis. A total of 159 (69.1%) men physicians and 71 (30.9%) women physicians received awards. Overall, women physicians were underrepresented in recognition awards compared with AAMC benchmarks. Prestigious awards (defined as those that recognize a person's body of work over time) showed a similar disparity with 22 (30.1%) of 73 recipients being women. Men physicians were more likely to receive multiple awards. Women physicians are underrepresented overall for recognition awards by pathology medical societies. Disparities are greater for prestigious awards. Further research is needed to better understand the reasons for these findings and how they affect women physicians' careers.

Word of Mouth and Online Reviews Are More Influential Than Social Media for Patients When Selecting a Sports Medicine Physician

PurposeTo (1) identify the percentage of patients seen in an orthopaedic sports medicine practice who use social media and (2) identify the role that social media has in physician selection as compared with other factors.MethodsAfter institutional review board approval was received, new patients aged 18 years or older who attended a single orthopaedic sports medicine office from February 2020 to May 2021 were identified for inclusion. Sociodemographic information was recorded, and each patient was asked to fill out a questionnaire that assessed social media usage and online resources used to choose and formulate opinions regarding the patient’s provider.ResultsTwo hundred patients met the inclusion criteria and completed the questionnaire. Of these, 96.5% reported social media use. The most common online method of searching for and identifying a physician was Google (50.5%). Social media outlets such as Facebook, Instagram, or LinkedIn were only used 15.5% of the time to search for and select a physician. Older patients were more likely to use recommendations from friends and family in their consideration when selecting a physician.ConclusionsDespite almost all participants stating that they use social media, only 15.5% of patients reported that they used social media to search for and potentially select their physician. Our study suggests that although social media can be a helpful tool for patient education, other factors such as physician education and physician reputation through word-of-mouth referrals, online reviews, and online ratings seem to play a larger role in the patient’s selection of his or her physician.Clinical RelevanceThis information may be of value to orthopaedic surgeons looking for ways to build their patient base, online reputation, or other aspects of their practice on the Internet.

What factors are important to new patients when selecting an orthopedic oncologist?

BACKGROUNDUnderstanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.AIMTo identify factors that patients consider important when choosing an orthopedic oncologist. METHODSNew patients presenting to an orthopedic oncology clinic within a tertiary academic medical center from January 2019 to August 2020 were invited to complete an anonymous survey. The questionnaire consisted of 27 items including a Likert-type assessment of the importance of selection factors.RESULTSA total of 101 new patients with a median age of 66 years (range, 14 years to 91 years) responded. Most were referred by another doctor (n = 63, 62.4%), and of the referring providers, the most frequent specialty was orthopedic surgery (n = 32, 51%). Using a Likert-type scale with 1 representing ‘least important’ and 5 representing ‘most important’, the most important factor was the hospital reputation (mean, 4.65; SD, 0.85). Additional factors of importance were the number of years in practice (3.87 ± 1.3) and a primary care provider referral (3.71 ± 1.6). Patients younger than 40 years old found social media (P = 0.016) and internet presence (P = 0.035) of their surgeon to be more important than older patients. In contrast, older patients considered care within an academic center to be of greater importance than younger patients (P = 0.014).CONCLUSIONThis investigation suggests a primary care referral, as well as hospital and physician reputation, are among the most important factors when selecting an orthopedic oncologist. Furthermore, social media utilization appears to be more important for younger patients.

Cross-Border Health Care Services as Inward Internationalization

Purpose: The research aimed at investigating the pre-conditions and the decision-making process by which physician-entrepreneurs adopt CBHCS as part of their business. Method: The study uses the case method of investigation. Main results: Results showed that, in the cases studied, international experience and international networking are relevant characteristics of the physician-entrepreneur, besides country reputation, cultural and language similarities, and physician reputation. In addition, the decision processes of the physician-entrepreneurs in these organizations are based on an effectual logic. The offer of cross-border health care services was a combination of given means and contingencies, which helped the entrepreneurs to discover, or to create, the opportunity, and then develop it. Relevance/originality: The research combines the literatures on effectuation and inward internationalization to study the decision-making process of adopting CBHCS by medical clinics. Theoretical contributions: The study contributes to the literature by identifying certain pre-conditions and providing an in-depth analysis of the use of effectual logic by physician-entrepreneurs in their decision-making process of adopting CBHCS.

The organizational culture as factor of assurance of loyalty of personnel of medical organizations

The organizational (corporate) culture is relevant to beliefs and values existing in the organization during long time and also to behavior practices of personnel effecting attitude to work and interpersonal communications. The healthy corporate culture promotes development of positive reputation of physicians, trust and loyalty of patients and medical personnel. It also supports higher compliance to therapy, culture of treatment and forms corresponding behavior of patient (increasing of preventive activities). The purpose of study is to consider opportunities of organizational culture of medical institutions in promoting loyalty of personnel and decreasing of stuff turnover.

How Patients Choose a Laryngologist: A Pilot Stated Preference Study.

ObjectivePatients consider many factors when deciding how to receive medical care. This study used best-worst scaling (BWS), a technique novel to otolaryngology, to quantitatively examine preferences among patients choosing a laryngologist. Our objective was to quantify in a pilot cohort the relative importance patients place on a variety of attributes when seeking a laryngologist.Study DesignBWS survey.SettingAcademic voice clinic.MethodsNew patients were recruited to take a computerized BWS survey developed using attributes derived from patient input, expert opinion, and literature review. Attributes were grouped into 4 categories: physician reputation, physician qualifications, hospital-related factors, and other nonclinical factors. Responses were analyzed using multinomial logit regression to determine importance scores and associations with other variables.ResultsEighty-seven of 93 patients recruited participated (93.5% response rate). Physician qualifications were the most important attributes to patients, with specialty laryngology training receiving the highest importance score (20.8; 95% CI, 20.2 to 21.5; P < .0001). Recommendations from referring physicians (15.6; 95% CI, 14.3 to 16.9) and use of cutting-edge technology (11.9; 95% CI, 10.7 to 13.1) were the second and third most important, respectively. Least important were nonclinical factors, including wait time to get an appointment (4.3; 95% CI, 2.8 to 5.8) and convenience of office location (1.5; 95% CI, 0.9 to 2.1). Just over half of patients (51.2%) reported willingness to wait 4 weeks for an appointment with a laryngologist. Older patients were less concerned with convenience-related factors.ConclusionNonclinical factors were less important to patients than clinical factors, and laryngology-specific training was paramount. Stated preference methodologies can elucidate underlying preferences and help providers make care more patient centered.

Analysis of Massive Online Medical Consultation Service Data to Understand Physicians' Economic Return: Observational Data Mining Study.

BackgroundOnline health care consultation has become increasingly popular and is considered a potential solution to health care resource shortages and inefficient resource distribution. However, many online medical consultation platforms are struggling to attract and retain patients who are willing to pay, and health care providers on the platform have the additional challenge of standing out in a crowd of physicians who can provide comparable services.ObjectiveThis study used machine learning (ML) approaches to mine massive service data to (1) identify the important features that are associated with patient payment, as opposed to free trial–only appointments; (2) explore the relative importance of these features; and (3) understand how these features interact, linearly or nonlinearly, in relation to payment.MethodsThe dataset is from the largest China-based online medical consultation platform, which covers 1,582,564 consultation records between patient-physician pairs from 2009 to 2018. ML techniques (ie, hyperparameter tuning, model training, and validation) were applied with four classifiers—logistic regression, decision tree (DT), random forest, and gradient boost—to identify the most important features and their relative importance for predicting paid vs free-only appointments.ResultsAfter applying the ML feature selection procedures, we identified 11 key features on the platform, which are potentially useful to predict payment. For the binary ML classification task (paid vs free services), the 11 features as a whole system achieved very good prediction performance across all four classifiers. DT analysis further identified five distinct subgroups of patients delineated by five top-ranked features: previous offline connection, total dialog, physician response rate, patient privacy concern, and social return. These subgroups interact with the physician differently, resulting in different payment outcomes.ConclusionsThe results show that, compared with features related to physician reputation, service-related features, such as service delivery quality (eg, consultation dialog intensity and physician response rate), patient source (eg, online vs offline returning patients), and patient involvement (eg, provide social returns and reveal previous treatment), appear to contribute more to the patient’s payment decision. Promoting multiple timely responses in patient-provider interactions is essential to encourage payment.

The Influence of Physician-Rating Websites on Patient Physician Preference.

BackgroudPhysician-rating websites (PRWs) are designed to publicly report physician quality information while bringing forth a sense of transparency. This study looks to identify the influence PRWs have on a patient's choice of orthopedic hand surgeon while stratifying patient physician preference by various demographic characteristics.MethodsThis survey-based study was conducted in a suburban outpatient orthopedic hand practice. All patients between 18 to 89 years of age who presented for an appointment were asked to participate. Survey questions aimed to identify patient demographics and the sources patients used to choose their hand surgeon.ResultsOverall, 104 patients completed our survey. Our study population was predominantly between 51 and 70 years of age (50.0%), women (60.6%), and Caucasian (84.6%), received a general education degree or high school diploma (36.5%), was employed (49.0%), and owned private health insurance (59.6%). One hundred and two patients (98.1%) answered that their physician's reputation is important. Seventy-five patients (72.1%) reported that they heard about their surgeon by physician referral, while only two (1.9%) used online search engines. Sixty-six patients (63.5%) noted that physician referrals were most trustworthy. Only 10 patients (9.6%) consulted PRWs to choose their surgeon, most of whom were younger than 50 years (n = 6), Caucasian (n = 8), and employed (n = 7) and had schooling after high school (n = 8).ConclusionsDespite increases in digital information exchange platforms, PRWs are not commonly used by suburban orthopedic hand patients to exchange information about or choose their hand surgeon. Patients still primarily rely on physician referrals and word of mouth from family and friends to choose their surgeon.

Factors that influence infertile couples’ selection of reproductive medicine centers---A cross-sectional questionnaire study

ObjectiveThe number of infertile women undergoing in vitro fertilization (IVF) cycles has increased annually. Due to this competitive environment, we designed a questionnaire and aimed to investigate factors affecting the choice of reproductive medicine center among infertile couples. Materials and methodsThis was a retrospective cross-sectional study that analyzed questionnaires provided by the reproductive medicine center of the Kaohsiung Veterans General Hospital from January 2018 to June 2018. In the questionnaire, there are six categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and other) and 36 items. The identified factors were scored and then weighted using principal component analysis. ResultsMost of the 100 identified infertile women were aged 31–35 years, were married 1–3 years, and had a university education level. In the weight analysis, “Clean outpatient clinic and medical equipment” had the greatest weight in the dimension of environment and equipment. The item with the greatest weight in the dimension of service quality was “Waiting time for registration, charging, and receiving medicine”. In the dimension of patient safety, “Privacy is highly respected by medical personnel” had the highest weight. The item with the greatest weight in the dimension of medical quality was “Success rate of reproductive medicine center”. The three items with the highest weights in the dimension of information acquisition channel were “Newspapers and magazines”, “TV media”, and “Facebook page and website of our hospital”. In the other dimensions, the two with the greatest weights were “Reputation of the hospital” and “Reputation of physicians”. ConclusionIn the infertile couples' view, optimal reproductive medicine centers should have a high success rate and great reputation on the internet and in mass media. Additionally, a short waiting time and high levels of privacy and confidentiality are also imperative.

The Effect of Online Effort and Reputation of Physicians on Patients' Choice: 3-Wave Data Analysis of China's Good Doctor Website.

BackgroundNowadays, patients are seeking physician information more frequently via the internet. Physician-rating websites (PRWs) have been recognized as the most convenient way to gain insight and detailed information about specific physicians before receiving consultation. However, little is known about how the information provided on PRWs may affect patients’ decisions to seek medical advice.ObjectiveThis study aimed to examine whether the physicians’ online efforts and their reputation have a relationship with patients’ choice of physician on PRWs.MethodsA model, based on social exchange theory, was developed to analyze the factors associated with the number of online patients. A 3-wave data collection exercise, covering 4037 physicians on China’s Good Doctor website, was conducted during the months of February, April, and June 2017. Increases in consultation in a 60-day period were used as the dependent variable, whereas 2 series of data were analyzed using linear regression modeling. The fixed-effect model was used to analyze the 3-wave data.ResultsThe adjusted R2 value in the linear regression models were 0.28 and 0.27, whereas in the fixed-effect model, it was .30. Both the linear regression and fixed-effect models yielded a good fit. A positive effect of physicians’ effort on the aggregated number of online patients was identified in all models (R2=0.30 and R2=0.37 in 2 regression models; R2=0.23 in fixed effect model; P<.001). The proxies of physicians’ reputations indicated different results, with total number of page views of physicians’ homepages (R2=0.43 and R2=0.46; R2=0.16; P<.001) and number of votes received (R2=0.33 and R2=0.27; R2=0.43; P<.001) being seen as positive. Virtual gifts were not significant in all models, whereas thank-you messages were only significant in the fixed-effect model (R2=0.11; P=.02). The effort made by physicians online is positively associated with their aggregated number of patients consulted, whereas the effect of a physician’s reputation remains uncertain. The control effect of a physician’s title and hospital’s level was not significant in all linear regressions.ConclusionsBoth the effort and reputation of physicians online contribute to the increased number of online patients’ consultation; however, the influence of a physician’s reputation varies. This may imply that physicians’ online effort and reputation are critical in attracting patients and that strategic manipulation of physician profiles is worthy of study. Practical insights are also discussed.

Online Physician Reviews Do Not Reflect Patient Satisfaction Survey Responses

Online physician reviews have become increasingly prevalent and are a common means by which patients explore medical options online. Currently, there are no data comparing physicians with negative online reviews and those without negative reviews. We sought to compare industry-vetted patient satisfaction surveys (PSSs), such as Press Ganey (PG) PSSs, between those physicians with negative online reviews and those without negative reviews. Overall, there were 113 unique individuals with negative online reviews from September 1, 2014, to December 31, 2014, with 8 being nonphysicians. We matched 113 physicians in similar departments/divisions. We obtained PG PSS scores of both groups and compared the mean scores of the 2 groups. Press Ganey PSS scores were available for 98 physicians with negative online reviews compared with 82 matched physicians without negative online reviews. The mean raw PG PSS scores were not different between the 2 groups (4.05; 95% CI, 3.99-4.11 vs 4.04; 95% CI, 3.97-4.11; P=.92). We also noted no difference in mean scores on questions related to physician-patient communication and interaction skills between those with poor online reviews and those without (4.38; 95% CI, 4.32-4.43 vs 4.41; 95% CI, 4.35-4.47; P=.42). However, there was a significantly lower non–physician-specific mean in those with negative online reviews (3.91; 95% CI, 3.84-3.97) vs those without negative online reviews (4.01; 95% CI, 3.95-4.09) (P=.02). Here, we provide data indicating that online physician reviews do not correlate to formal institutional PG PSS. Furthermore, physicians with negative online reviews have lower scores on non–physician-specific variables included in the PG PSSs, emphasizing that these discrepancies can negatively affect overall patient experience, online physician reviews, and physician reputation. It is prudent that an improved mechanism for online ratings be implemented to better inform patients about a physician's online reputation.

Do online reviews diminish physician authority? The case of cosmetic surgery in the U.S.

This article analyzes the substance and perception of online physician reviews, which are qualitative and quantitative assessments of physicians written and shared by patients, in the case of U.S. cosmetic surgery. Like other cash-pay medical specialties, cosmetic surgery is elective and paid for largely out of pocket, with patients having latitude in their choice of surgeon. Drawing on qualitative data from interviews, observations of an American Society of Aesthetic Plastic Surgery professional meeting, and online reviews from the platforms RealSelf and Yelp, I identify two interdependent contributors to physician authority: reputation and expertise. I argue that surgeons see reviews overwhelmingly as a threat to their reputation, even as actual review content often positively reinforces physician expertise and enhances physician reputation. I show that most online reviews linked to interview participants are positive, according considerable deference to surgeons. Reviews add patients' embodied and consumer expertise as a circumscribed supplement to surgeons’ technical expertise. Moreover, reviews change the doctor-patient relationship by putting it on display for a larger audience of prospective patients, enabling patients and review platforms to affect physician reputation. Surgeons report changing how they practice to establish and maintain their reputations. This research demonstrates how physician authority in medical consumerist contexts is a product of reputation as well as expertise. Consumerism changes the doctor-patient relationship and makes surgeons feel diminished authority by dint of their reputational vulnerability to online reviews.

Amitai Etzioni Retrospective

Policy researchers — and think tanks — are rarely evaluated in terms of the results of their endeavors. This is the case despite the fact that American society tends to rank most everything from the reputation of physicians to the number of books an author sells, from football players to the number of Nobel Laureates. This article evaluates four policy recommendations on the basis of evidence and reviews provided by independent sources.

국민건강보험 이용자의 의료전달체계 인식에 따른 진료의뢰 개선 방안

이 연구는 국민건강보험 이용자의 입장에서 의료전달체계에 대한 인식에 따른 진료의뢰 개선방안을 제시하기 위해 수행되었다. 국민건강보험 이용자가 1단계 의료기관에서 진료의뢰서를 받아 서울에 소재한 S대학병원(소위 '빅 4병원'중 한곳)을 방문한 207명의 외래환자를 대상으로 설문조사를 하였다. 설문 신뢰도는 Cronbach's <TEX>${\alpha}$</TEX>가 0.7이상 이었고 연구방법은 인구학적인 특성은 pearson카이제곱과 Fisher's exact 검정을, 인식도와 개선요구도 간에는 pearson상관 분석을 실시하였다. 연구결과, 내원환자의 5.9%가 상급종합병원에서 의뢰되어 상급간의 의뢰를 확인하였고, 병원선택요인은 의사의 명성과 신뢰(<TEX>$4.40{\pm}.92$</TEX>)가 가장 높았다. 진료의뢰제도에 대해 서울의 대형 상급종합병원으로 쏠리는 현상을 가장 높게 인식하였고(<TEX>$4.24{\pm}.97$</TEX>) 서울의 대형 상급종합병원으로의 집중화현상이 최우선 개선과제로 나타났다(<TEX>$4.05{\pm}1.02$</TEX>). 의료전달체계의 인식도와 개선요구도의 상관계수가 0.326으로 매우 유의미한 양(+)의 상관관계를 보였다(p<.01). 이번 연구를 통해 향후 의료전달체계 개선 시 공급자나 보험자가 아닌 이용자중심의 제도개선이 이루어지기를 기대해 본다. This study was carried out to suggest hospital referral system improvements based on health insurance subscriber perceptions of the delivery of healthcare. Health insurance subscriber outpatients (n = 207) referred from a stage 1 medical institution to the S university hospital located in Seoul responded to the study survey. The study's item reliability is reliable as the Cronbach's alpha coefficient was greater than 0.7. This study results showed that 5.9% of patients were referred from a higher stage hospital to a same stage hospital. The main factor attracting patients to S university hospital were physician reputation and confidence. The highest factor (<TEX>$4.40{\pm}.92$</TEX>) was xxxx. In addition, survey respondents reported that the concentration of patients in extra-large hospitals in Seoul (<TEX>$4.24{\pm}.97$</TEX>) was an important issue, and the issue with the highest priority for improvement (<TEX>$4.05{\pm}1.02$</TEX>). A positive correlation was detected between the recognition and improvement of delivery of healthcare (p < 0.01). Based on the results, we suggest that improvements in the delivery of healthcare should focus on patients rather than suppliers of national health insurance or other insurers. Keywords: delivery of healthcare, health services accessibility, national health insurance, tertiary care centers, hospital referral.

Republication: History of physicians fighting frivolous lawsuits: An overview

Legal and medical professions are intertwined in an intimate and complex relationship. Medical malpractice arguably constitutes the biggest point of contention between the two professions. While a significant proportion of medical malpractice complaints is not frivolous and is based on appropriate research and screening criteria, most of these complaints are ultimately settled or taken to trial, with a fairly good chance that the outcome will be favorable or at least satisfactory to the involved physician. At times, the legal system fails to “filter out” frivolous cases. Such cases can and at times, do end up in court. Although majority of them are ultimately decided in favor of the defending physician, the emotional anguish and the potential damage to the physician's reputation can be significant. In addition, the spiraling costs of malpractice insurance and the fear of further malpractice insurance rate increases following a legal complaint cause many doctors to engage in costly and sometimes dangerous practice of defensive medicine. Due to the overall magnitude of the malpractice lawsuit misuse and the devastating consequences of such misuse, frustrated physicians have resorted to initiating countersuits in response to abusive and frivolous lawsuits. This review presents cases where physicians who were unfairly sued filed successful countersuits against the plaintiff's attorneys. A review of relevant medical and legal literature is also included. The following core competencies are addressed in this article: Interpersonal skills and communication, Practice based learning and improvement, Professionalism. Republished with permission from: Dippolito A, Braslow B, Lombardo G, Hoddinott KM, Nace G, Stawicki SP. How David beat Goliath: History of physicians fighting frivolous lawsuits. OPUS 12 Scientist 2008;2(1):1-8.

Medicolegal Sidebar: Blowback: The Unintended Consequences of Medical Liability Reform

The Medicolegal Sidebar column addresses issues that orthopaedic surgeons may face at the intersection of law and medicine. One of the goals of the column is to assist orthopaedic surgeons in making legally sound clinical and business decisions. In doing so, the column focuses on legal issues, avoiding the public debate on whether our current malpractice system favors providers or patients. Accordingly, our column will periodically publish articles by distinguished guest commentators to express their personal opinions on the current status of our malpractice system. The goal of these commentaries is to stimulate discussion among our readers and others who have an interest in malpractice litigation. Our first distinguished commentator is attorney Christopher Stombaugh. Mr. Stombaugh is an accomplished trial attorney, a faculty member of The Gerry Spence Trial Lawyers College and Past President of The Wisconsin Association of Justice. —B. Sonny Bal MD, JD, MBA, Lawrence H. Brenner JD While physicians and trial lawyers in the medical liability system may speak the same language, they really misunderstand each other. Physicians and lawyers, like the United States and Great Britain, are ‘‘[t]wo nations divided by a common language’’ [5]. A clear example of this disconnect is when we discuss medical negligence claims and medical liability reform. The common impression among many physicians is that a claim for medical negligence is, in essence, a claim that a physician is a ‘‘bad doctor.’’ Worse yet, verdicts against physicians can result in those physicians being reported to the national databank, and even unsuccessful claims have to be reported to future hospitals when one seeks employment. Litigation, therefore, can adversely affect a physician’s reputation and livelihood. Trial lawyers in the medical liability system, however, would submit that the issue should not be the fear of litigation, rather the fear of carelessly injuring patients. The latest statistics (August 2015) from the New York Law School’s Center for Justice and Democracy reveals that medical negligence cases made up Note from the Editor-in-Chief: We are pleased to publish the next installment of ‘‘Medicolegal Sidebar’’ in Clinical Orthopaedics and Related Research. The goal of this quarterly column is to encourage thoughtful debate about how the law and medicine interact, and how this interaction affects the practice of orthopaedic surgery. We welcome reader feedback on all of our columns and articles; please send your comments to eic@clinorthop.org. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. C. D. Stombaugh JD (&) Stombaugh, Smith & Co., 600 Washington Ave., Towson, MD 21204, USA e-mail: chris@stombaughsmith.com Medicolegal Sidebar Published online: 28 October 2015 The Association of Bone and Joint Surgeons1 2015

The High Costs of “Free” Drug Samples

The High Costs of “Free” Drug Samples

Pushing the Outpatient Quality Envelope

Pushing the Outpatient Quality Envelope

Medical ethics and self-regulation in Korean medical society

Consumption of medical services has been expanding since the health insurance system was established in the Republic of Korea. However, physicians do not seem to be satisfied with the current state of medical practice. One of the main reasons for this dissatisfaction seems to be related to underpayment of costs. The monopolistic insurance agency has kept reimbursements for appropriate medical services below cost. The public also seems to have less trust in doctors than in the past because of repeated scandales in the news media such as doctors' accepting inappropriate rebates from the pharmaceutical industry. Patients are vulnerable to illness and depend on their doctors' decision making and advising. Plus family members and taxpayers must share in caring and the financial burden that patients face. Therefore, society has high ethical standards for physicians. The medical society also has been responding to these practices. To meet society's expectations, doctors should not abandon self-regulation through the medical society. Furthermore, because the identity of a professional healthcare provider is based on the trust and endorsement of society, physicians should attempt to maintain appropriate care for patients' best interests. The public should support physicians' appropriate medical practice via reasonable reimbursement of medical costs. Through self-support and self-regulation to maintain appropriate medical practice for patients, physicians can enhance public trust. In turn, public trust in doctors will address this country's distorted medical services and restore the eroded reputation of physicians as healthcare professionals.

Protecting Psychiatrists’ Reputations on the Internet

Back to table of contents Previous article Next article Communications and UpdatesFull AccessProtecting Psychiatrists’ Reputations on the InternetAlan A. Stone, M.D., and Paul S. Appelbaum, M.D.Alan A. StoneSearch for more papers by this author, M.D., and Paul S. AppelbaumSearch for more papers by this author, M.D.Published Online:1 Sep 2012https://doi.org/10.1176/appi.ajp.2012.12050623AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The reputation of physicians is now at risk on the Internet. Dr. Gabbard’s clinical case conference in the May issue (1) provides a striking example. A resident providing good clinical care seems helpless to protect his professional reputation in the face of critical web postings by the patient’s mother, becoming a victim of “the Internet era.” Dr. Gabbard suggests that guidelines on “how to respond to [such] attacks should be developed.” We would like to offer some ideas about how to begin that process.Although there are services (e.g., emerit.biz [2]) that offer to help doctors establish and protect their reputation by being proactive, these entities apparently have no effective remedy against negative postings. Indeed, one web site has a “wall of shame” that lists physicians who have tried to prevent postings of negative comments (3). Sites are protected by federal law against suits for defamation, and anecdotal evidence indicates that physicians who initiate legal action against the posting individual are likely to make matters worse.It seems to us that this is a problem that requires some institutional remedy; self-help is apparently unavailing. What can the aggrieved psychiatrist ethically do given the constraints of confidentiality? Confidentiality is waived when ethics complaints or malpractice suits are initiated by patients; psychiatrists have the right to defend themselves. Perhaps an attack on the Internet might be considered to constitute a “limited waiver.” As in this case, it was ethically appropriate, even without consent or a waiver, to have a clinical case conference and to publish what we take to be a disguised (unidentifiable) account. We suggest the creation of an Internet ombudsman—a mental health professional not involved in the care of the patient or the family. An aggrieved psychiatrist acting under the partial waiver and the accepted practice of consulting a colleague would identify the derogatory posting. The ombudsman would review the patient’s care and the posting and when appropriate would go to the web site and post a limited response (e.g., “I have reviewed this posting in my capacity as ombudsman [for the clinic, for the hospital, for the medical school, for the District Branch of APA] and am of the opinion that this posting misrepresents the quality of the clinical care provided by the doctor.” In the Internet age, it may well become necessary for every organized mental health setting to have a page on their website to which the ombudsman could refer those accessing the derogatory posting for further information about the psychiatrist and the provision of treatment.In this case report, the postings included “antipsychiatry” material. In responding to these allegations, an institutional site might do a service not only for aggrieved psychiatrists but for the entire profession. These are tentative suggestions, but one thing is clear: one cannot deal with the challenges of the Internet without becoming part of it.Cambridge, Mass.New York, N.Y.Dr. Appelbaum has equity in the Classification of Violence Risk program (COVR, Inc.). Dr. Stone reports no financial relationships with commercial interests.References1 Gabbard GO: Clinical challenges in the Internet era. Am J Psychiatry 2012; 169:460–463Link, Google Scholar2 Medical Justice. http://emerit.bizGoogle Scholar3 RateMDs Inc. www.rateMDs.comGoogle Scholar FiguresReferencesCited byDetailsCited ByNone Volume 169Issue 9 September 2012Pages 991-991 Metrics PDF download History Accepted 1 June 2012 Published online 1 September 2012 Published in print 1 September 2012