A Tangled Web

It's the Information Age. With the click of a mouse you can communicate with practically anyone, anywhere, and an unfathomable number of sites crowd the World Wide Web. All of this access to information is a good thing, right? Is it possible there is too much information? Some physicians may think so.

A growing number of states, medical organizations, physician practice groups, and for-profit organizations are peppering the Internet with physician profiles. They are available to anyone with access to the Net, and offer information about physicians' education, medical specialties, board certifications, and office locations.

That's the good part. On the flip side, many of these profiles also offer information on malpractice judgments or disciplinary actions, putting some physicians at a distinct disadvantage for attracting patients and maintaining their professional integrity.

There is general agreement that these profiles can be helpful tools for consumers making important decisions about their medical care. Moreover, they can generate free advertising and publicity for doctors. Online profiles are probably most beneficial to physicians who provide high-profile services like plastic surgery, says Stan Colquitt, founder of Medical Market Analysts, a Charlotte, N.C.-based physician marketing and business consulting firm. Tertiary-care doctors get most of their business from word-of-mouth, Colquitt notes, so patient access to information on the Internet probably only serves to confirm or refute what they hear about a doctor.

But some physicians may find they are on the receiving end of just the kind of advertising they don't need; and some in the medical field question whether the content of these sites, especially those operated by private companies or established by physician practice groups, is accurate - or of any value at all if the information isn't put in proper perspective.

'Nothing to hide'

"There is not a direct connection between bad doctors and bad cases," says Michael A. Grodin, MD, of the Boston University School of Public Health. In other words, a single lawsuit brought against a physician is generally not a reflection of poor professional performance. Grodin, who is also an attorney, believes that profile information should be available to consumers, but that online profile creators must be "appropriate, responsible, and sensitive in what appears."

"We thought people would be able to make appropriate choices with the information we put out," says Bruce W. McIntyre, deputy chief legal counsel of the Rhode Island Board of Medical Licensure and Discipline. In 1997, Rhode Island followed Massachusetts' decision a year earlier to place physician information on the Internet; they are among the growing number of states that post judgments or actions against physicians.

Physicians, for the most part, appreciate that these sites provide them with free marketing, says Dale Austin, interim CEO of the Federation of State Medical Boards of the United States (FSMB). "Most doctors have nothing to hide and a great deal to share and it gives them an opportunity to tell their story," Austin says.

Several years ago, however, the New England Journal of Medicine reported that about 23 percent of doctors had either a malpractice award or disciplinary action on their records. Such physicians worry that patients discovering even one such incident in a profile will consider it the rule, not the exception. Meanwhile, McIntyre and others say it's rare for more than one disciplinary action to ever be filed against a doctor.

Patients going online to research their doctors must receive enough information to make informed decisions, says Louis Goolsby, MD, senior vice president for medical affairs for the Medical Center of Central Georgia, a 518-bed regional facility in Macon, Ga. But he and others question whether consumers can understand the data contained on physician profiles. Do consumers know that hospitals, managed-care organizations, and insurance carriers often dictate settlements regardless of guilt, he wonders?

"If good assessments are put where consumers can see and understand them, then that's beneficial to everyone, but if they are just data points, with no explanation, no perspective, then that can be bad," Goolsby says.

"An Internet site looks like an Internet site looks like an Internet site," adds Austin. "It's hard to distinguish one from another, good content from bad, self-reported or self-promoting from verified information." His organization suggests guidelines for putting physician profiles online, including verification of all information by the state and the doctor.

The American Medical Association posts some information at its AMA Physicians Select Web site, as do the American Board of Medical Specialties and the Administrators in Medicine. But none of these sites offer reports on medical malpractice awards or disciplinary actions taken.

Tell it all

Some physicians, in states where self-reporting is mandated, might choose to skip reporting their infractions. In June, the Florida Board of Medicine fined 16 doctors $250 each for lying about their records when providing information to the state-run profiling Internet site, according to Bill Parizek, spokesman for the Florida Department of Health.

Parizek says half of those charged had failed to report convictions for driving while under the influence of alcohol, while others had been convicted of crimes ranging from resisting arrest and tax fraud to marijuana possession and illegal possession of fireworks. When Florida officials ran FBI fingerprint checks to verify information submitted by some of its 45,000 doctors, they found that about 2,000 of them had criminal records.

Florida officials require doctors to report any malpractice award of at least $5,000 and any conviction or disciplinary action occurring within the last 10 years, Parizek says. The state usually relies on random audits to ensure the accuracy of their information on the consumer Web site, which receives more than 130,000 hits a month.

Florida's level of care in ensuring accurate information is what AMA seeks. Richard F. Corlin, MD, a gastroenterologist and president of AMA, suggests the need for a uniform reporting approach - a template that would provide the same information across the board, as well as context. AMA supports providing information to consumers, but wants to make sure that consumers can interpret the information accurately.

States, because they are best able to verify the profiling information, should be the key source for physician information for consumers, Corlin says. "States have the most valid data and they have no motivation not to keep it up-to-date," he says. Sites promoting a practice or a Web site, Corlin argues, "might not be as scrupulous as the state. These third-party sites might be interesting, but they're not as informative."

Corlin says he is wary of the motivations of private organizations and companies putting doctor information online. "Their motivation is profit, and we run the risk of them not checking and rechecking the data because it cuts into their profit."

Talk to your patients

On the plus side, says Corlin, information about malpractice and disciplinary actions can open a dialogue between doctor and patient. If the goal is informing patients about their choices in doctors, then explaining a malpractice case or a disciplinary ruling is essential. However, in some cases, doctors are prohibited from commenting about a case as a condition of the settlement.

AMA supports the disclosure of profiling information, but only if the source provides context and explanations for how malpractice awards are decided and when disciplinary actions are typically taken. The organization also seeks a statement suggesting that just because a doctor has an infraction, there's no guarantee that he or she is unworthy of practicing medicine.

Disciplinary actions should serve as a red flag to people considering care, Corlin contends. "Finding out about these things is better than not finding out. I don't think people should be shy about asking about what they found on these sites."

Bob Graham can be reached at editor@physicianspractice.com.

This article originally appeared in the January/February 2002 issue of Physicians Practice.