Health 2.0

Because it’s on the Interwebs, it must be true

Locally we’re supposed to diss the SF Weekly because it’s been trying to put the “genuine independent” local free weekly the SF Bay Guardian out of business and has lost a major lawsuit against it. But SF Weekly reporter Ashley Harrel has written an excellent article figuring out that one San Francisco plastic surgeon has paid a marketing company to plaster good reviews about her all over the web, and to make her the number 1 result on Google for “San Francisco Plastic Surgery”. The marketing agency unsubtly used the same name in all its reviews–the actual shortened version of the owner’s name–and has a video up on its site featuring the doctor as a happy client. Not exactly bright. Harrel also reminds us of the case of the chain plastic surgery center LifeStyle Lift that conducted a huge astroturfing operation and eventually settled with the NY Attorney General promising to stop.

Only one person on the San Francisco consumers bible Yelp seems to have noticed about this article but the person who died from a minor procedure hasn’t posted–although a few grumpy others have. (So apparently you either like this doctor or she kills you. My dad the surgeon always said he buried his mistakes!). And frankly that’s true for many patients and many doctors. In any event, the doctor is on probation from the state medical board–although that seems like a slap on the wrist.

The answer is twofold. First, get state medical boards to be more pro-active and aggressive in dealing with bad doctors. But realistically we know where that’s been going for years and its unlikely to change.

The second answer is to get better information in specialized places on the web, and elevate those.

Google searches aren’t going to help you but how about trying a Vitals search on this plastic surgeon. There’s a big red flag  next to her name. The two ratings are OK, but they’re lifted from Yahoo, not directly input on Vitals, so they could have been astroturfed too. If you scroll down you see that there are 2 disciplinary actions against her. Unfortunately that doesn’t say exactly what went wrong

Date: 07/03/2009
Authority: State Medical Board of California

Sanction / Action:

THREE
YEARS PROBATION WITH VARIOUS TERMS AND CONDITIONS. DURING PROBATION,
DR. RAJAGOPAL IS PROHIBITED FROM SUPERVISING PHYSICIAN ASSISTANTS.
Date: 10/10/2007
Authority: State Medical Board of California

Sanction / Action:

ACCUSATION FILED. THE PHYSICIAN HAS NOT HAD A HEARING OR BEEN FOUND GUILTY OF ANY CHARGES.

This doesn’t help that much, but it’s probably enough to put me off going there to get my man boobs reduced. I also left a link on Vitals about the SF Weekly article. And by the way, Vitals allows docs to edit/delete a very limited number of comments–so we’ll see what happens to my comment.

And I highly suspect that the team at Vitals will be getting better information here soon, not the least because their main competitor Healthgrades doesn’t use the red flag but tells you rather more. Here’s Healthgrades entry (which is a tad out of date as the patient is now dead)

Substandard Care, Incompetence or Negligence (7/02/09)

Issued To:


Dr. Usha Rajagopal; License # A53230

Nature of Complaint:

The
physician performed a surgical correction of persistent glabellar
creasing in the forehead area between the eyebrows which involved the
transfer of fat from the patient’s abdomen to her forehead at the
physician’s surgery center. The physician advised the patient to eat on
the morning of the surgery complicating the patient’s risks of
nausea/vomiting, potential aspiration of gastric contents, and
respiratory arrest. There was no nurse or anesthesiologist present to
monitor the patient’s vital signs during the surgical procedure. The
patient was not given any IV solution or oxygen. The physician mixed the
patient’s tumescent solution which contained approximately four times
the usual amount of Lidocaine used for this type of procedure. The
physician administered 145cc of the solution into the patient’s
abdominal wall and shortly thereafter the patient became clinically
unresponsive and was transferred to a hospital. The patient remains in a
permanent vegetative comatose state at a hospital in Sacramento.

Action Taken:

The board has Revoked the physician’s license to practice medicine and surgery in the State of California. The revocation is Stayed and the physician is placed on Probation for a period of three years subject to the following terms and conditions:

  1. The physician shall complete forty hours per year for each year of probation of a board approved educational program/course in addition to the continuing medical education requirements for licensure renewal.
  2. The physician shall successfully complete a medical record keeping course within the first six months of probation.
  3. The physician shall successfully complete all phases of a clinical training program equivalent to other PACE Program.
  4. The physician shall submit proof of compliance of the notification requirement to the board.
  5. The physician shall not supervise physician assistants.
  6. The physician shall obey all laws and all rules governing the practice of medicine in the State of California.
  7. The physician shall submit quarterly declarations of probation compliance to the board.
  8. The physician shall appear before the board upon request.
  9. The physician shall pay probation monitoring costs.

So the answer is, we need to promote specialist review sites that combine much more information than just patient reviews. Oh and getting a medical board with some cojones would be nice too. It doesn’t sound as though the world needs this plastic surgeon to still be practicing.

But as well as better consumer protections, much much better information about doctors is required that a simple cheap SEO strategy can’t defeat. I suspect that Vitals, Healthgrades, CastLight and others will be forcing this on the Googles and Yelps of the world soon.

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JesseNateBarbara Feder OstrovCorpuscle Connie, MD Recent comment authors
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Jesse
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“So the answer is, we need to promote specialist review sites that combine much more information than just patient reviews” I completely agree. I wouldn’t trust any reviews online they can just be gamed to easily, hopefully the FTC starts cracking down on the new law they passed this past December about having proof for all testimonials that you have about your product or service online. Maybe this would stop it not sure though.

Nate
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Nate

“So the answer is, we need to promote specialist review sites that combine much more information than just patient reviews. ” Is this best left to 3rd party sites to aggregate data from where they can or forcing state medical boards to publish everything that crosses their desk? Seems the first route will always have holes. For years NV was a medical wild wild west, anyome that lost a license some place else would come open shop here. Only way to prevent this is a single national repository. Such actions in any state should follow your license anywhere in the… Read more »

Barbara Feder Ostrov
Guest

Great post! For those who are interested, former Los Angeles Times investigative reporter William Heisel has been covering bad doctors and inadequate medical board oversight in great detail in his Antidote blog at ReportingonHealth.org. You can see his latest posts at http://bit.ly/awfMr6.
Barbara Feder Ostrov, deputy editor, ReportingonHealth.org

Corpuscle Connie, MD
Guest
Corpuscle Connie, MD

Wonderful discussion.
You know as well as I that there are “bad” doctors, whatever that means, and outspoken doctors who criticize hospital administration for jeopardizing patient safety who are sham peer reviewed. The latter are brought before medical boards with greater frequency than the former.
What is needed is an Assessment Board to review the conduct of hosptial administrators. The JC is supposed to do that but fails terribly (F-) in exacting its tandards from hospital administrators who hijack the hospital for personal gain.