Tuesday, February 22, 2011

The Patient Who Didn't Like the Doc. On-Line.


KevinMD has a post up today by Tobin Arthur called

Online reputation can have career implications for physicians

Arthur also refers to a post on the AMA's website back in October by Amy Lynn Sorrel,

Negative online reviews leave doctors with little recourse

Good timing because I wanted to post a vignette about a friend who is distraught about the on-line reviews he's gotten from patients. To protect both the innocent and the guilty, I'm confabulating the details & demographics, but the gist of the story is real and I'd like to hear your comments.

Dr. Tom Shrinky (not his real name) is a friend of mine who practices in Sanetown, PA (not a real place). He's an excellent psychiatrist with a great reputation, a packed practice with a long wait for new patient entry, and he's as conscientious as they come: he carries his cell phone everywhere and he returns all calls within the day. Plus, he's a nice guy, though I may be biased because we're friends.

One day, a patient says to Dr. Shrinky, "Doc, you know, I Googled you, and it wasn't pretty." Alarmed, Tom goes to Google himself and discovers that he's got a patient review up on one of these rate-your-doc sites. The comments are strangely personal, they comment on his recent weight loss, and say that he's in bed with the drug companies. There are a couple of other reviews, all 5 star, all saying how he's the best shrink in the world, but his overall rating is 3 star, and you'd wonder if he wasn't dying from the comment.

Okay, you hate a restaurant, you zing it on Yelp and you don't go back.

But Tom believes he knows who put these comments up. He has a patient, a lawyer he sees for weekly psychotherapy sessions. The patient is often hostile towards him, often treats him in a demeaning fashion, and this relationship does not feel good. The patient left treatment once briefly, years ago, but returned because, "You shrinks are all nuts and you're better than Dr. Cashew." Why Tom took him back, I'll never know. Tom tries to get the patient to focus on his hostility as part of the treatment.

So, a drug rep did stop by the office once to drop off samples while the patient was in the waiting room, and the patient had made a comment about this. And Tom had lost a lot of weight recently-- he'd taken up running and before he knew it, he was doing half-marathons. He cut back on carbs, beer and soda, and 60 pounds had dropped off him over 14 months. He looked great, and everyone commented including his patients. This particular patient, however, had said nothing, and one day walked in, looked Tom up and down, and said, "Have you got cancer or AIDS?" So the comment on the review about how he'd lost a lot of weight recently and looked like he had cancer. Tom could think of no one else who was unhappy with him or who would do this.

Unlike the restaurant patron, Tom's patient continues to show up weekly for psychotherapy. Tom feels a bit intimidated by him (this is not new) and is always happy when he cancels. So far, Tom hasn't asked if he wrote the review, but it bothers him. Others have put up counter-reviews, but there is a second bad review, and Tom thinks this is also the same patient. A colleague mentioned that a patient he tried to refer would not see him because of the reviews.

So, my thoughts, and then please do add yours:

--It seems to me that sometimes people have negative feelings in the course of a psychotherapy (ah, we might call this transference, but it would be dismissive to attribute all negative feedback to negative transference). In this case, it's no longer a doctor-patient issue, but one that has potentially included the entire world via the Internet.

--Should Tom ask his patient if he's put up the reviews? What does that get him? The patient may become embarrassed or defensive, or he may say he didn't do it (and maybe he didn't?) and be angry at the accusation.

--How does a psychiatrist (or any doctor) continue to treat someone who publicly struck at their reputation?

--And here's another problem for the doc--- a patient who would do this might also go to the physician licensing board and complain, and so Tom may worry that to terminate this patient's care may incite the patient's anger and result in a complaint and investigation of his practice. The patient is a credible professional and a complaint from him would likely be taken quite seriously. While Tom is certain he's provided responsible care and has not violated any standards of practice, he's well aware that a Board investigation (if a complaint did progress to that) takes years and causes a great deal of expense and agony, and so he may well be worried about fanning any flames.

--And finally, Tom is worried about upsetting the patient. He's been taking care of this patient for years, and he doesn't want this to end badly.

So what should Dr. Tom Shrinky do?

41 comments:

HappyOrganist said...

Wow, that sounds awful. I don't have any advice. I'm aware that there ARE times when it is appropriate to discontinue a doctor-patient relationship, and it looks like this (or back when he took him back) is/was one of those situations. ...
I will say that the online reviews DO make it bad for future clients. A doctor I didn't like (saw him once) had some negative reviews online (also a couple positive). But it was half and half.. And given my experience, if I were to look up another doctor and his/her reviews were half and half, I'd be less likely to see him/her.
I really don't have any advice. That sounds like a tough situation. ;/ =(
There ought to be a reason he could find to terminate the relationship (?) relatively gracefully.. "I don't feel like I'm helping you enough.. can I recommend ___?"
???
good luck..

moviedoc said...

Professionals do not need reason to terminate a relationship. This treatment sounds like it might have been terminated long ago. Is this not a kind of blackmail? I feel the same way when I discover a patient has run up a big balance: I could stop treating them, but then I might be less likely to collect. Rock and hard place. Patients can say whatever they want for whatever reason. "Moviedoc refused to prescribe me Valium and give me free 4 day a week psychoanalysis, so I'll flame him on the Web." I hope the more this happens the less prospective patients will take the negative comments seriously. Dr. Shrinky should not worry too much about the medical board. I have received a couple of letters from mine stating that a complaint was closed for lack of cause for further investigation. Even if they investigate I can't imagine it go much beyond providing records at which point he would know the identity of the complainant. He should, however, consider the patient's potential for violence and take steps to minimize risk and protect himself and his family, including assuming the patient knows or can discover where he lives.

tracy said...

What a terrible situation. And this Psychiatrist soundsa excellent, wish i could find one like him!
i once rated a wonderful Psychiatrist, i think i gave him "5 stars" on every thing but "Ease of getting an appointment". That was because he isn't taking patients. (I saw him as a Resident).
Now i feel bad because that brought down his review! Hummmm....was i angry because i couldn't get in to see him....?

The Hyperlexian Aspie said...

according to his multiple online reviews, my medical doctor is a disinterested a$$hole.

but he isn't like that. he's brusque and fast and highly professional. he is well-suited to my personality. i don't normally want to malinger or chat.

however, when i recently suffered a tragic loss in my family, he listened to me talk about some of the medical details, and he provided some explanations and answers i had been seeking.

so, those reviews are not always a deterrent for new patients. perhaps if a physician or psychiatrist notices a drop in clients, it could be a concern. but really, one or two potential patients being scared off is hardly a big worry. this imaginary shrink probably loses more patients every year because of his scheduled hours, his office location, or the demeanour of his front office staff (for example) than the number of people who would be deterred by negative reviews.

Marie said...

What a horrible situation.

Maybe he could post his own "review" to address these concerns? Just sign in as himself and address the unhappy reviewers directly.

It's not the same thing, but I recently rented a condo for a vacation that had some bad reviews. The owners chimed in with an explanation -- everyone in that area had trouble with bugs during that time, but they had hired an exterminator and the problem had been taken care of. They also offered the unhappy reviewers a refund, if they contacted them.

So...I went ahead and rented the condo.

Best of luck to your friend!

moviedoc said...

Wow. Marie's idea of addressing reviewers directly is obvious but intriguing and raises more questions that had not occurred to me: Does it bring the treatment onto the Web? Would there be an ethics problem in responding? Might a carefully crafted response be therapeutic? damaging? In fact, even if the doc doesn't respond, should he copy the complaints into the chart? But he is not certain who the reviewer is. It might not even be a patient! Marie makes me realize some of this social media stuff we are warned about is beyond our control. Duh. Should we address this possibility in our new patient agreement in some way? Thanks for a truly valuable comment, Marie.

simetrias said...

Fascinating. I'd say Dr. Shrinky would be acting in the best interest of the patient to say, simply, that the treatment has gone as far as it can with him, and it's time to work toward an end. Because of Shrinky's negative feelings (justifiable) toward the patient, what good is he doing the patient to continue in a one-on-one therapy? I'd say time to end it and for Shrinky to work through the issues with an understanding co-shrink!

Anonymous said...

No professional should have to put up with that sort of behavior from a patient. Tell Dr Shrinky to terminate the patient (even if he didn't write the review, but if he did it will probably prompt more attacks).

Anonymous said...

A couple of years ago, I was going to rate my shrink, planning to give the doc mostly high marks--except for one ridiculous thing he did (can't remember now what it was) that I was going to put in the text of the review. I held off because I knew that the comment was probably unique to my situation and I didn't want to have the review traced back to me.

Don't consumers see right through scathing comments and realize they're always written by someone with an axe to grind? And with online restaurant ratings, isn't it obvious that the owner's nephew has written the 5-Star review? It is to me!

Oh, and I'm a lawyer and we are not all bad, yet some doctors pre-judge us. I hardly mentioned my profession except on the patient data questionnaire or the time I was asked at an initial appt. (not with a psychiatrist). I was just there to get answers about debilitating migraine headaches, but the doc made demeaning comments about lawyers suing people (which I nevr responded to)and, when I later got a copy of some of the records, saw that the vitriol spilled over into my patient reports in a passive-aggressive way: "Dear Referring Doc, Thank you for referring Attorney So-and-So. Treatment options were discussed in everyday language quite simple to understand." Plus other snarky comments. How is the patient supposed to defend himself against this type of "medical record?"

Marie said...

Thanks, Moviedoc. I wasn't thinking the response would be therapeutic, though it might be. It would provide some PR damage control, though, for his practice. He could also include some instructive comments, like the fact that these sorts of feelings (anger) are common in therapy, but they need to be dealt with in therapy and not online.

I'm not a therapist, but I've been in therapy. I think the therapist should talk to the disgruntled patient about how unhappy he seems in therapy. It doesn't need to be confrontative (he doesn't know for sure he posted the negative feedback), but I think it's appropriate for the dr. to refer this patient to someone else, as he seems completely dissatisfied with his treatment.

Just my two cents. :-)

Anonymous said...

Dinah,

I don't mean to get off topic but the other side of the coin is that the local best doctors' which is based on ratings by other doctors isn't always accurate.

A parent and I came very close to becoming victims of malpractice of this one particular specialist who was on that list. They were separate incidents and we didn't know what had happened to the other person until we spoke.

Regarding your friend, I really feel for him as that sounds like an awful situation. Since I have read about doctors terminating patients for what seems like trivial reasons, I don't why this guy couldn't terminate what seems to be a very destructive relationship. But of course, I really don't know what his options are.

Personally, I would be afraid to post a bad evaluation regarding a doctor unless I was 100% sure I was never going to see that person again. Anonymous, the lawyer, nailed it perfectly about the fear that my negative comment would be traced back to me.

I do confess to using rate md and have found it to be generally accurate. That is how I found my dentist who is wonderful.

AA

Rach said...

On what grounds would this "patient" have to go to the physician licensing board? Shouldn't one have a legitimate complaint (ie: sexual misconduct, failure to adhere to standards in practice of medicine, etc).

It sounds like this particular shrink has a particularly difficult patient, and like Movie Doc said, maybe should consider termination if the therapeutic relationship is heading downhill.

~Rach

Zoe Brain said...

From a total novice here...

Is it ethical given the suspicions for the doctor to continue to attempt to treat?

I don't see how a healthy therapeutic relationship is feasible under the circumstances. The patient isn't suicidal, there's little obvious danger in termination of the therapy.

Yes, this might lead to problems, I'm afraid. Having an obnoxious stalker maligning your professional reputation is something I wouldn't wish on anyone.

But you have to look at what's actually ethical, and not the consequences to the appearances.

I therefore don't think he has a choice.

Anonymous said...

I am surprised at all the comments who think the person may have no reason for leaving negative ratings. Now if you hate a therapist or dr that much - find a new one and quit going to old one would be my approach, but no one here knows how this doctor treated this client and perhaps there was counter-transference - it does sound as though the dr does not like the guy either. I am a lawyer too and there is a certain dynamic that can get set up by drs being defensive.

moviedoc said...

There are several problems with the local "Best Doctors" lists, not the least of which is that one person's best is another's worst, a fact we should keep in mind as we move into health care reform. We need to be able to choose our docs.

Marie reminds me that this doesn't just have to happen in the context of psychotherapy. So how do you work on it if you (like me) just do those much-maligned med checks? If there even is a psychotherapist this would be one of those things that must be discussed by the treatment team.

Zoe Brain: (great blog BTW!) The only ethical problem with continuing to treat arises if you allow your dislike or fear of the patient to damage the treatment. There's potential for that even if patient and reviewer are not the same person. It might be unfortunate to terminate if that is not the patient who wrote the review, but the patient might end up with a better fitting psychotherapist anyway. Two heads are better than one. How this is handled will depend a lot on the psychotherapy method employed.

moviedoc said...

The last anon lawyer reminds me: Most patients probably would leave a doc they don't like. But this one seems intensely ambivalent which may be a more dangerous ingredient.

Sarebear said...

The patient in question here may not even BE a lawyer, since Dinah confabulated details.

Milo said...

opinions are like butts... everyone seems to have one. Now how much you want to give a damn about other people's behind... is the choice that you make. And as far as I am concerned, if he knows he is good (and obviously he is not the only one), the nice little lawyer can have his opinion and shove it right up his @#$*
Milo

Anonymous said...

The patient is not a lawyer. I confabulated the details. Lawyer: responsible and credible professional. First thing that came to mind.

So the patient really wants to stay in treatment with the doc. The doc seems to have some issue with saying, years into this, you should see someone else. The patient would be wounded by the rejection, but I agree that ultimately this is a distressing relationship (at least as I've heard it).

Dr. Shrinky is not hailed as a "Top Doc" by any magazine.

And there are certainly reasons one might want to complain about a doc (?online...well, I've personally never put a bad review of anything on line...oh, maybe a book...forgive me Danny)...I treat wait staff who live in terror of bad reviews on line. But long waits, inattentiveness, inability to reach the doc in emergencies... all reasons one might complain. But even "didn't return my emergency call." I had one patient years ago tell me her doctor didn't return her call when she was having a panic attack for Three hours. Another patient felt I should be returning calls at 10 of the hour when he assumed I was breaking between patients (no running over for him, and no getting that drink of water for me!, per his rendition of how I should be conducting business).

The attacks on Dr. Tom were personal: His appearance doesn't belong on an on-line review.

I agree there is a certain dynamic set up when the doc feels defensive. Usually it doesn't help with treatment.

Stefani said...

Hmm.

I've been to those rate-your-doctor websites. For the most part (and don't yell at me, please), its the psychiatrists who get the nastiest reviews. I assumed it might be due to the patient population they treat. With patients suffering bi-polar, schizophrenia, etc., isn't it likely that typ of ill patient will perceive a problem more than the mentally healthy patient? Just my thought based on the statistics of the reviews to various providers.

Here is what I suggest- rather than confronting the patient, ask the patient how he feels about their provider-patient relationship. Does the patient believe the doctor provides good care? Does the patient feel comfortable talking to the doctor? What could the doctor do to better improve their trust and overall relationship?

If the patient responds negatively and indicates he does not like/trust the doctor, the doctor could then suggest that the patient (for his own good) really should be seeing someone he is more comfortable with. The doctor could then recommend alternate providers.

If the patient claims he is happy with their existing relationship, the doctor could says he's worried about the patient not feeling comfortable with him because the patient is always angry, etc when he comes for an appointment.

Turn the conversation around to (1) a concern for the patient, and (2) a desire to steer the patient to someone he is more comfortable with.

See what happens. Bottom line is, life is too short to be that nervous or unhappy every time the doctor has to see this patient. If he can't convince the patient to go elsewhere, he may have to terminate their relationship.

moviedoc said...

So Dinah, how long have you been entertaining these fantasies of demanding, punitive, critical attorneys as patients? What do you think that means?

Stefani: No yelling! If psychiatrists get more negative evaluations one factor may be that expectations are way too high. We are just docs, not gurus or wizards, but media and myth would suggest we have special powers. And those TV ads for drugs probably fuel the problem too.

Anonymous said...

Hi Stefani,

You said, "For the most part (and don't yell at me, please), its the psychiatrists who get the nastiest reviews. I assumed it might be due to the patient population they treat. With patients suffering bi-polar, schizophrenia, etc., isn't it likely that typ of ill patient will perceive a problem more than the mentally healthy patient? "

I won't yell you but that it the type of thinking that caused someone I know with schizophrenia to have a complaint about a med not taken seriously by her psychiatrist. This is a person who has taken heavy duty meds without complaints all her life.

She became admittedly belligerent when her psychiatrist attributed her complaints to her illness. Totally understandable as that was pretty insulting and stigmatizing.

Anyway, the guy forcibly committed her against her will because of this situation. She did get her meds changed but she experienced the trauma of being handcuffed by police among many things.

So perhaps those folks that you think didn't perceive a situation well might have received the same type of treatment. Of course, we don't know the story but please don't assume that just because someone has a mental illness that they are wrong and the psychiatrist is right. My friend's situations is a perfect example that the psychiatrist was totally off base and was a disgrace to his profession the way he traumatized her because he refused to listen to her complaints about a med side effect.

AA

Anonymous said...

I've left all positive reviews for physicians I've seen except for one, and the negative one was for the psychiatrist. But, I wasn't the only one who shared the negative opinion. He earned his review. Some people are jerks and he was one of those.

Anonymous said...

In response to Stefani perceiving that the ill population a psychiatrist encounters must have no control over themselves and are highly likely to abuse an internet doctor-rating site, My Dear, I have Bipolar I Disorder and have been severely ill and even I managed to rein myself in and not leave nasty comments (i.e., took the high road). How stigmatizing that you presume people with certain disorders go around causing trouble! I don't think your hunch is based on any hard data.

Battle Weary said...

The site "rate-my-professor" allows professors to log on to their reviews and reply...would the site in question have that sort of option?

Also, when I go to rate-my-professor myself, I pretty much toss out overly negative and excessively positive comments. One of the best professors I've ever had, had an average rating because she had one comment that equated her to Einstein and another that literally said "I got an F, this woman sucks, I hate her". Umm...only Einstein is Einstein and clearly someone who got an F has an ax to grind. In reality, she is a very tough grader, has high expectations of the students, is excited about her topic, has frequent office hours, answers emails within hours, and loves giving A's when they've been earned! My point is...I can't be the only one that assumes comments on both ends of the spectrum might be about more than the person being "reviewed".

Q said...

I'm wondering about the S&M style relationship that's developed between the doc and pt. Why is a person in charge of treatment intimidated by the person being treated? I would not be surprised if the pt realizes that he is intimidating his psychiatrist and is angry that he is able to do so.

My advice would be to get supervision as to how to deal with a difficult pt such as this to ensure treatment is successful or drop the pt by saying the type of treatment offered is deemed inappropriate.

stock trading said...

This treatment sounds like it might have been terminated long ago. Is this not a kind of blackmail? I feel the same way when I discover a patient has run up a big balance: I could stop treating them, but then I might be less likely to collect. Rock and hard place. Patients can say whatever they want for whatever reason.

Sarah Glenn said...

I'm wondering if the doctor couldn't contact the site and point out that these entries make several personal comments that have nothing to do with his practice. They might take it down if he requests it.

If not: tell them he will subpoena the name/e-info of the author with an eye towards suing the site AND the author for libel, for suggesting that he is a. diseased, and b. in a dishonest collusion with the drug companies. See if they remove it then...

Anonymous said...

Sure, some people might take the reviews seriously while looking for a psychiatrist, but I would think that most understand that online rating sites often attract bitter people. The comments on weight loss, I would think, would show that the problem is with the commenter and not with his doctor. Unless the doctor notices a definite and worrisome loss/decrease of business, he should do nothing. Don't say anything to the patient--such people are often shocked that the internet doesn't provide perfect anonymity.

Chrysalis Angel said...

I hope you don't mind my adding my thoughts to this issue. This is definitely something that the medical community should take very seriously. As patients begin to leave comments in these types of forums, they can damage the professional, and personal lives of practitioners.

I would advise your friend not to confront this particular patient with his suspicions. I would not let on that he knew about the comments what so ever.

He absolutely needs to terminate the theraputic relationship as soon as possible, but he should seek legal counsel regarding the situation- before he does anything further. It's best for the patient and the practioner.

priced916 said...

i think alot of people are focused on the wrong issues in life. there are far more important things to be discussing. like over population and monitary enslavement... common people get real. time is not our friend at the minute. lets focus. http://www.youtube.com/watch?v=yTGI7SUTzdA

Maggie said...

Moviedoc: shouldn't that read "So, Dinah, how long have you been entertaining fantasies of lawyers as responsible and credible?" (Sorry.. I couldn't resist the joke. JUST a joke.)

The problem with most ratings sites is that people usually need a reason to make the review. Who bothers to seek out a place to say "This person/business/product/service is as expected, I'm mildly satisfied"? With a few exceptions (off the top of my head, eBay puts a pretty big emphasis on reviews, and PatternReview.com is centered around reviews of sewing patterns to the point that reviews are as much social venue as they are a means of rating) it's pretty unusual to want to share something with the world unless you have a strong opinion about it.
It does seem very strange that someone would leave a bad review of a doctor they keep seeing, especially if it's someone with the means to see another doctor, which sounds like the case here.

Betsy R said...

Since time began, patients have had little recourse against doctors. Medical boards won't discipline them and malpractice is very difficult to prosecute.

The internet levels the playing field. Doctors whine about online reviews; that's tough!

I selected a dentist for dentures from online reviews. He had two reviews: very courteous, good, and good staff; and one that said he put in a crown and the tooth was still infected. I call the bad review due to human error and the inexact nature of medicine. I also told my new dentist and his staff about a notorious local dental chain that gets plastered in the ratings, and that's what his office also hears about the chain. Now my dentist has a 3rd very good review.

In Dallas, TX, there is a psychiatrist who repeatedly gets good peer reviews and has not been state disciplined. However, the federal government imposed civil penalties and repayment on him for upcoding and monitored his practice for 5 years.

The online patient reviews of this guy coincide with his federal legal trouble and my own experience with him. He sees patients as little as possible and delegates his work to nurse practitioners.

The internet has enabled patients to get more clear info about doctors than we ever could before. Patients who make these reviews are not profiting, and that would also make slander charges hard to prosecute.

If a doctor tracked asuch consnd sued me for slander, I'd be thrilled. I don't have anything. I would also then have a public court case about his or her misconduct that I could publish online. This is how a net savvy person responds to oppression.

Get used to it! It's a changed new world!

Anonymous said...

Doctors hurl insults at patients all the time in the privacy of their offices. The patient has no defense.

A doctor who lets an online review intimidate him or her is a gutless wonder.

Anonymous said...

This scenario is beyond silly. The best term, for Dr. Shrinky's attitude is PARANOIA.

If the alleged slanderer were a lawyer-patient, the lawyer knows constitutional free speech law.

Actors and actresses have fought media slander for years, usually in vain. Larry Flynt parodied Jerry Falwell in Hustler to help sell his mag. Falwell sued for slander and eventually lost in the US Supreme Court. Falwell was legally a public figure. It was parody!

Does Dr. Shrinky think he can get the info and sue for slander? How would he prove slander, that it made him lose business? Where was the profit motive in publishing the statement?

Jerry and Larry were also much richer than the average doctor and lawyer and could sustain the fight Years later, Jerry extended a hand to Larry and they became friends.

The mythical Tom Shrinky can endure a little adversity.

Anonymous said...

Ironically, I posted my first negative online review, ever , of a physician today ,who happens to be a psychiatrist. My review is accurate, and did not include any personal attacks. It involves considerable restraint, actually. The choice, frankly was filing a complaint with Medicare which would be far more likely to have an impact on the Doctor's practice and career, or posting a negative review, and I think a restrained negative review will have zero to no effect on his career. I AM looking for a new psychiatrist, believe me,and he has not been my psychiatrist for long.. It isn't easy to find a psychiatrist in N.Y. who accepts insurance, but the minute I do, I will. My phenomenal psychologist, whom I have rated as five stars on every possible website, works in the same practice, had actually had kindly volunteered to come stop by on his break on my last session with the psycho-pharmocologist to ensure that the psychiatrist answered my questions about particular medications this time around. Last time, the session was cut short by a personal cell phone call the Dr. took.My psychologist is actively assisting me in finding a psychiatrist outside of the group practice ! If he felt that my unhappiness with the psychiatrist was unfounded, surely he would be engaged in trying to have me "work it through". My complaints include the psychiatrist 1)answering and holding personal, non-emergency, non-work related conversations on his cell phone during my session, without excusing himself, (this is a fully staffed office; emergency calls would be answered by a receptionist, who would knock on the door in the event of an emergency),apologizing, or making up the time
2)failing to warn of medication adverse effects and side effects denying that medications he had prescribed could cause adverse effects which was clearly listed in the manufacturer website, the drugstore printout, had been told to me by the pharmacist, etc ,until 4 months later, when two other M.D.s of mine told me that serious symptoms I was having were being caused by those very medications. 3) the last time I saw him, he spent only a fraction of the time he should have with me, and failed to ask me about most of my symptoms. He had started the session 15 minutes late, and was intent on catching up on his schedule. This time will be fully billed to Medicare, as it has been in the past,I might add,which troubles me greatly. What I would really like to do is to file a complaint with Medicare, but I fear repercussions if he finds out because the psychologist is such a an extraordinary therapist and they are employed by the same establishment.Overall, I believe that the psychiatrist is incompetent, and arrogant, and either unaware of medication side effects, or simply too condescending to admit them to a mere patient. I am perfectly or imperfectly sane, I am not in the habit of writing negative reviews of doctors. In fact, the few reviews I have ever written before have been extremely glowing ones where I felt compelled to review someone such as my psychologist because he is so competent and so incredibly compassionate and devoted, that I feel it is the least I can do .
btw, I would be very interested to hear feedback as to the issue of psychiatrists and other therapists leaving their cell phones on during session.

Roy said...

I think your response, anon, of posting the negative review was very appropriate. You could also write a letter to the medical director or the president of the group employing him. As to the time spent, some of the med management codes do not have any time components; this sometimes results in unscrupulous doctors inappropriately doing a series of 5-minute "med-checks" to pack in a bunch of billable codes in a short time-frame.

The cell phone issue is not straight-forward, IMO. For example, some docs use a cell phone for emergency calls, so may answer it during a session. Or they may be on-call. It would be very appropriate to ask a new doc their routine for handling calls during a session. If their reply is unsatisfactory, let them know it is disruptive to you and ask if they'd accommodate your need to limit these interruptions. If they won't, then you can try someone else. I think the Golden Rule applies here.

Anonymous said...

roy - i agree that sometimes a doc may have to take emergency calls: my psychologist always lets me know when she is on call for her group practice. however, i was being seen by an ortho once and he took a call to negotiate the closing of his house (i know how much he paid for it). sometimes it is very obvious that it is a personal call. this was the first time i had ever seen the ortho and found it to be highly entertaining: he could have stepped out of the room, appologized, etc. instead he started trying to schedule surgery. i opted to find another surgeon for various reasons but part of it was the lack of focus in the apt.

had it been an emergency? yes, i would have understood. but setting up when he could close on the house? not an emergency. and really? quite off putting.

Anonymous said...

To the anonymous who posted March 12 about the bad psychiatrist:

Neither Medicare nor a medical board will do anything about the doctor. If Medicare got SCADS of complaints, they might look into the billed time.

Google "Dr. Joel Holiner" and you will find one psychiatrist who did get in trouble with the government. He had to repay a bunch on Medicaid and Medicare overcharges. Nothing said about private insurance overcharges!

Since the so-called authorities will not police the medical profession, we now have the ability to post doctor reviews online.

So doctors like Dr. Shrinky need to calm down and learn to live with it. And, address their own behavior as appropriate.

Anonymous said...

Ha! Ha! Now dentist Stacy Makhnevich has made a public idiot of herself for requiring patients to sign a form that states no badmouth reviews on net.
So many medical "professionals" ranted here on how awful the mythical Tom Shrinky was being treated! It's cause the medical professions are not used to having any real accountability!
Accept it, folks!
The internet gives patients you screwed a voice!
You are in business just like Wal-Mart is.
If you people were really smart, you would start looking at real accountability in your professions, including patient redress without access to the courts.

East Coaster said...

I think that some sort of online rating system could be useful. Some people might prefer a brisk, brusque doctor and others might want a different style. Right now I look at medical school, residency and fellowship training and find out what I can about the orientation of their training. Is this fair?

I've also found such sites to be useful when evaluating dentists. Does the dentist rely on the most expensive technology? Is s/he very aggressive about saying you need expensive dental work? How does the office handle billing etc.?