Where should I, a physician, draw the line at commenting on health-related posts in AskMe? July 15, 2005 8:29 PM Subscribe
Where should I, a physician, draw the line at commenting on health-related posts in AskMe?
I enjoy thinking about folks' medical puzzles and often learn something in the process of trying to solve them. However, I'm a neurologist, so most of what I comment on is well outside my scope of practice. I've tried to make it clear in my user info that I'm not commenting in my professional capacity as a medical advisor, but instead as "just another Metafilter user." But if you scroll down to roofus' thought-provoking post a few days ago, you can read about a number of harmful things that we docs could inadvertently be causing, including but not limited to the inflammation of hypochondria, acute bad-adviceFilter, and sudden dismemberment or death.
What do folks think? Should I just can it before I get sued?
I enjoy thinking about folks' medical puzzles and often learn something in the process of trying to solve them. However, I'm a neurologist, so most of what I comment on is well outside my scope of practice. I've tried to make it clear in my user info that I'm not commenting in my professional capacity as a medical advisor, but instead as "just another Metafilter user." But if you scroll down to roofus' thought-provoking post a few days ago, you can read about a number of harmful things that we docs could inadvertently be causing, including but not limited to the inflammation of hypochondria, acute bad-adviceFilter, and sudden dismemberment or death.
What do folks think? Should I just can it before I get sued?
Ufez:
"... if you scroll down to roofus' thought-provoking post a few days ago, you can read about ..."
I think ikkyu2 knows about the previous post.
posted by mr_crash_davis at 8:39 PM on July 15, 2005
"... if you scroll down to roofus' thought-provoking post a few days ago, you can read about ..."
I think ikkyu2 knows about the previous post.
posted by mr_crash_davis at 8:39 PM on July 15, 2005
As a lawyer, I feel I'm in a similar predicament, although admitedly any bad advice I give is probably less life threatening. Bottom line, I don't think we can comment as "just another Metafilter user" when we comment on areas in or near our specialized area of knowledge. More than other areas of expertise, our domains are regulated both by professional organizations and by state and federal agencies. Our professional, ethical, and legal obligations mean that we can't simply give off-the-cuff advice.
Just because doctors and lawyers are subject to certain restrictions when giving advice, however, does not mean we can't comment on other users' questions. I try and give my opinion on legal principles and point other users towards helpful resources, but I do my best to avoid giving any advice that might relate to the specifics of a given scenario. A polite disclaimer is probably also useful.
posted by monju_bosatsu at 8:40 PM on July 15, 2005
Just because doctors and lawyers are subject to certain restrictions when giving advice, however, does not mean we can't comment on other users' questions. I try and give my opinion on legal principles and point other users towards helpful resources, but I do my best to avoid giving any advice that might relate to the specifics of a given scenario. A polite disclaimer is probably also useful.
posted by monju_bosatsu at 8:40 PM on July 15, 2005
Here is an article relevant to your question. The footnotes contain a bunch of pointers to other articles on the same topic.
posted by monju_bosatsu at 8:44 PM on July 15, 2005
posted by monju_bosatsu at 8:44 PM on July 15, 2005
Teach the bastards a lesson, give fatal advice a couple of times and the requests for medical advice will drop right down.
posted by substrate at 8:52 PM on July 15, 2005
posted by substrate at 8:52 PM on July 15, 2005
Here is an article relevant to your question.
No. No. I'm nipping that in the bud. I don't give professional advice over the internet. It's kind of like Snoop Dogg on loving hoes, you know? Never have, never will.
I want to know about what I actually do, which is (advice-free) general commentary on health- or biology-related questions.
posted by ikkyu2 at 9:08 PM on July 15, 2005
No. No. I'm nipping that in the bud. I don't give professional advice over the internet. It's kind of like Snoop Dogg on loving hoes, you know? Never have, never will.
I want to know about what I actually do, which is (advice-free) general commentary on health- or biology-related questions.
posted by ikkyu2 at 9:08 PM on July 15, 2005
There's no question in my mind that advice-free general commentary on questions within your area of expertise is permissible, and there's no reason you should stop providing such commentary. However, it's important to know where the boundary between general commentary and advice is, and that's where the article I linked, and those it cites, might be relevant.
posted by monju_bosatsu at 9:16 PM on July 15, 2005
posted by monju_bosatsu at 9:16 PM on July 15, 2005
I don't know what to tell you, but as long as I've got you here, does this look infected to you?
posted by crunchland at 9:33 PM on July 15, 2005
posted by crunchland at 9:33 PM on July 15, 2005
Yes: If medical professionals refrain from comment, the utility of medical threads will be (no pun intended) crippled. Yes, you should knock it off. And yes, the correct resource to direct your question is your malpractice carrier -- not a bunch of internet strangers who have no stake in your well-being.
Put it this way: Have you got a wife? A kid? Imagine telling them that you blew your financial stability because you were screwing around on the internet. It may be unlikely, but so is getting sued for file-sharing by the RIAA. Ask the defendants if they regret their conduct.
posted by cribcage at 9:50 PM on July 15, 2005
Put it this way: Have you got a wife? A kid? Imagine telling them that you blew your financial stability because you were screwing around on the internet. It may be unlikely, but so is getting sued for file-sharing by the RIAA. Ask the defendants if they regret their conduct.
posted by cribcage at 9:50 PM on July 15, 2005
I want to know about what I actually do, which is (advice-free) general commentary on health- or biology-related questions.
I always appreciate hearing from people who have far more education on a specific topic than myself.
Provided you're not giving specific advice, I don't see the problem. If your words can stir someone to go to the doctor's office, I'd say you're operating well within the confines of the Oath.
posted by Civil_Disobedient at 10:19 PM on July 15, 2005
I always appreciate hearing from people who have far more education on a specific topic than myself.
Provided you're not giving specific advice, I don't see the problem. If your words can stir someone to go to the doctor's office, I'd say you're operating well within the confines of the Oath.
posted by Civil_Disobedient at 10:19 PM on July 15, 2005
Where should I, a physician, draw the line at commenting on health-related posts in AskMe?
you're the doctor...
posted by quonsar at 10:31 PM on July 15, 2005
you're the doctor...
posted by quonsar at 10:31 PM on July 15, 2005
When you frame something with: "My understanding is.." "From what I know.." "If I had a patient like this I'd probably.." &c you're at least removing yourself from saying "my advice is..."
Add a caveat in your profile saying that not only do you not give professional advice over the internet, no information you share in your comments should be construed as medical advice - such advice should always be obtained from your regular Doctor or the somesuch.
Otherwise I think most of the time you do usually comment in a way that is providing information rather than actual advice, the roofus scenario notwithstanding.
I hope you continue approximately in your present fashion. I sure learn some stuff and the community will have a better information base with you around. I know USA is litigious as hell but there's a long jump from anyone being harmed in any way by (mis)following something they read on a community website to sheeting home responsibility to a Doctor who was contributing information in tandem with other members of that community, particularly if it's framed properly and caveats attached where you feel they are appropriate.
posted by peacay at 10:40 PM on July 15, 2005
Add a caveat in your profile saying that not only do you not give professional advice over the internet, no information you share in your comments should be construed as medical advice - such advice should always be obtained from your regular Doctor or the somesuch.
Otherwise I think most of the time you do usually comment in a way that is providing information rather than actual advice, the roofus scenario notwithstanding.
I hope you continue approximately in your present fashion. I sure learn some stuff and the community will have a better information base with you around. I know USA is litigious as hell but there's a long jump from anyone being harmed in any way by (mis)following something they read on a community website to sheeting home responsibility to a Doctor who was contributing information in tandem with other members of that community, particularly if it's framed properly and caveats attached where you feel they are appropriate.
posted by peacay at 10:40 PM on July 15, 2005
Thinking of the last thread:
"I am a physician, but I am not your physician. I have not examined your or consulted with anyone who has. I do not know you from Adam's housecat, and this is not medical advice.
That thing you feel inside you sounds like an internal suture, which is common and harmless -- necessary, even, to keep your guts from exploding inside you, which is bad. But it could also be Horrible Thing, Awful Thing, Dangerous Thing, Invariably Fatal Thing, or even an alien chest-burster.
If this concerns you, you should phone your surgeon's office and ask about it. They should be able to get you accurate information within a short while, and act quickly if what you describe seems abnormal to them."
If you really want to keep posting on it without much fear of being sued, create a sockpuppet that goes to a throwaway yahoo account and link to metafilter through proxy scrubbers. Don't call it ikkyu3 or n3uro_dud3.
Certainly you should feel free to offer straightforward information like "Here's how the eyeball works" or "No, you dope, SSRI's work like this," and so on.
posted by ROU_Xenophobe at 11:01 PM on July 15, 2005
"I am a physician, but I am not your physician. I have not examined your or consulted with anyone who has. I do not know you from Adam's housecat, and this is not medical advice.
That thing you feel inside you sounds like an internal suture, which is common and harmless -- necessary, even, to keep your guts from exploding inside you, which is bad. But it could also be Horrible Thing, Awful Thing, Dangerous Thing, Invariably Fatal Thing, or even an alien chest-burster.
If this concerns you, you should phone your surgeon's office and ask about it. They should be able to get you accurate information within a short while, and act quickly if what you describe seems abnormal to them."
If you really want to keep posting on it without much fear of being sued, create a sockpuppet that goes to a throwaway yahoo account and link to metafilter through proxy scrubbers. Don't call it ikkyu3 or n3uro_dud3.
Certainly you should feel free to offer straightforward information like "Here's how the eyeball works" or "No, you dope, SSRI's work like this," and so on.
posted by ROU_Xenophobe at 11:01 PM on July 15, 2005
As a lawyer (though Canadian, as I am increasingly thankful), I would (and this is not legal advice, mmkay) expand on the disclaimer part of any posts, since you are in the state of major lawsuits. You might consider having a stock small paragraph that you simply copy and paste into your medical posts. Asking your malpractice insurer's law department (MILD) for some boilerplate might be a good start.
I don't practice in the area of malpractice law, so I don't know a) how effective such a disclaimer would be, and b) whether or not simply making sure your comments are "advice-free" is enough to keep you out of harm's way. Again, your MILD is likely your best asset.
posted by birdsquared at 11:18 PM on July 15, 2005
I don't practice in the area of malpractice law, so I don't know a) how effective such a disclaimer would be, and b) whether or not simply making sure your comments are "advice-free" is enough to keep you out of harm's way. Again, your MILD is likely your best asset.
posted by birdsquared at 11:18 PM on July 15, 2005
While I don't wish for you to open yourself up to any liability whatsoever, MeFi etal. would be a less intelligent place without your commentary IMHO.
Unfortunately, some do come here to get answers better left for their PCP. Then again, they are probably the same who call our office and get pissed when we won't simply call in an antibiotic for some vague "infection" that "always clears up when I take X."
Do you have that sort of sixth sense with certain patients that tells you "Uh, oh," like this one is here to get pain meds; somatoform disorder v. MS? If you do, then you may want to use that same gut-check here to, at least, keep your concern over posting to tolerable levels.
posted by sillygit at 11:24 PM on July 15, 2005
Unfortunately, some do come here to get answers better left for their PCP. Then again, they are probably the same who call our office and get pissed when we won't simply call in an antibiotic for some vague "infection" that "always clears up when I take X."
Do you have that sort of sixth sense with certain patients that tells you "Uh, oh," like this one is here to get pain meds; somatoform disorder v. MS? If you do, then you may want to use that same gut-check here to, at least, keep your concern over posting to tolerable levels.
posted by sillygit at 11:24 PM on July 15, 2005
This is such a strange issue...
For one thing, part of your professional obligation is to avoid giving away your expertise for free. That certainly isn't something I would consider important if I were to pursue my professional accreditation, but I suspect professional organizations do. Of course the issue isn't talked about... It is moot anyway because of the need for insurance that is so expensive that you couldn't possibly give away much of your time anyway...
Then there is the question of weather you should implicitly trust an expert when you go and see one in real life. I wouldn't! Of course sometimes you have to, but you are always well served to learn as much as you can on your own.
Anyway, when answering a question do you say "Well I am a doctor and I think this"? Personally, I think that is kind of childish. If your advice doesn't stand on it's own merits then you need to write better answers. Also, if the person you are talking to needs to hear your credentials to take you seriously you probably don't want them taking you seriously.
posted by Chuckles at 11:45 PM on July 15, 2005
For one thing, part of your professional obligation is to avoid giving away your expertise for free. That certainly isn't something I would consider important if I were to pursue my professional accreditation, but I suspect professional organizations do. Of course the issue isn't talked about... It is moot anyway because of the need for insurance that is so expensive that you couldn't possibly give away much of your time anyway...
Then there is the question of weather you should implicitly trust an expert when you go and see one in real life. I wouldn't! Of course sometimes you have to, but you are always well served to learn as much as you can on your own.
Anyway, when answering a question do you say "Well I am a doctor and I think this"? Personally, I think that is kind of childish. If your advice doesn't stand on it's own merits then you need to write better answers. Also, if the person you are talking to needs to hear your credentials to take you seriously you probably don't want them taking you seriously.
posted by Chuckles at 11:45 PM on July 15, 2005
Anyway, when answering a question do you say "Well I am a doctor and I think this"? Personally, I think that is kind of childish. If your advice doesn't stand on it's own merits then you need to write better answers.
That's ridiculous, especially when non-experts are posting conflicting comments in the same thread. Do you think the questioner will have enough information to evaluate these answers solely on their merits? If they did, they wouldn't have to ask the damn question in the first place!
posted by grouse at 1:58 AM on July 16, 2005
That's ridiculous, especially when non-experts are posting conflicting comments in the same thread. Do you think the questioner will have enough information to evaluate these answers solely on their merits? If they did, they wouldn't have to ask the damn question in the first place!
posted by grouse at 1:58 AM on July 16, 2005
maybe it would help to look at this from a non-medical angle?
the same problem occurs in other areas as well. maybe all areas. there's a whole pile of crap information, speculation, wild guessing etc in technical/physics threads. it's both frustrating and a fact of life.
i don't post "look you moron i have a first class degree and a phd from cambridge in this" - partly because i don't want to look like a dickhead, partly because i get things wrong anyway, but mainly because i think (despite occasional evidence to the contrary) that if you explain things clearly, it should be relatively obvious who is correct.
so i'd say:
- continue posting
- say what you think clearly and explain why
- don't care if some idiot says otherwise
people know it's just the internet. they also recognise people's names who post here - we build up reputations.
one final thought - maybe the reason doctors get so worried about this is that in real life they rely too much on status? instead of intimidating someone in an office where their word is law, they suddenly have to argue/explain their point. maybe that isn't altogether a bad thing?
posted by andrew cooke at 4:46 AM on July 16, 2005
the same problem occurs in other areas as well. maybe all areas. there's a whole pile of crap information, speculation, wild guessing etc in technical/physics threads. it's both frustrating and a fact of life.
i don't post "look you moron i have a first class degree and a phd from cambridge in this" - partly because i don't want to look like a dickhead, partly because i get things wrong anyway, but mainly because i think (despite occasional evidence to the contrary) that if you explain things clearly, it should be relatively obvious who is correct.
so i'd say:
- continue posting
- say what you think clearly and explain why
- don't care if some idiot says otherwise
people know it's just the internet. they also recognise people's names who post here - we build up reputations.
one final thought - maybe the reason doctors get so worried about this is that in real life they rely too much on status? instead of intimidating someone in an office where their word is law, they suddenly have to argue/explain their point. maybe that isn't altogether a bad thing?
posted by andrew cooke at 4:46 AM on July 16, 2005
hmm. i see i more or less directly contradict grouse.
i guess it depends on the end-user. i like doctors who explain things to me, check their advice against what i find on the net, and will argue with them and even change them if i disagree. i guess others prefer a more structured approach. :o)
i can think of 4 ways to decide this:
- god tells you
- the poster chooses
- the reader chooses
- the cmmunity chooses
ignore the first. the second is whatever you want to do as poster. the third seems difficult - perhaps people should say in their question "please, describe your credentials"? and i guess the last is what we are doing here. i am mixing meta in my meta and should stop for fear of inconsistencies.
everything in this comment is wrong.
posted by andrew cooke at 5:05 AM on July 16, 2005
i guess it depends on the end-user. i like doctors who explain things to me, check their advice against what i find on the net, and will argue with them and even change them if i disagree. i guess others prefer a more structured approach. :o)
i can think of 4 ways to decide this:
- god tells you
- the poster chooses
- the reader chooses
- the cmmunity chooses
ignore the first. the second is whatever you want to do as poster. the third seems difficult - perhaps people should say in their question "please, describe your credentials"? and i guess the last is what we are doing here. i am mixing meta in my meta and should stop for fear of inconsistencies.
everything in this comment is wrong.
posted by andrew cooke at 5:05 AM on July 16, 2005
Surely he can use a disclaimer ("I am giving you this advice as a private citizen and not within my role as a doctor, this is not to be treated as professional advice, consult your physician etc etc etc") to avoid danger?
posted by Pretty_Generic at 5:44 AM on July 16, 2005
posted by Pretty_Generic at 5:44 AM on July 16, 2005
For one thing, part of your professional obligation is to avoid giving away your expertise for free.
posted by Chuckles at 11:45 PM PST on July 15 [!]
I can appreciate the fact that most doctors charge the hell out of people (or their HMO, etc.) for their services, but I have a little difficulty with the idea that not giving away medical advice for free is a professional obligation.
roofus, ikkyu2 - thoughts on this?
posted by NotMyselfRightNow at 5:47 AM on July 16, 2005
posted by Chuckles at 11:45 PM PST on July 15 [!]
I can appreciate the fact that most doctors charge the hell out of people (or their HMO, etc.) for their services, but I have a little difficulty with the idea that not giving away medical advice for free is a professional obligation.
roofus, ikkyu2 - thoughts on this?
posted by NotMyselfRightNow at 5:47 AM on July 16, 2005
I can appreciate the fact that most doctors charge the hell out of people (or their HMO, etc.) for their services, but I have a little difficulty with the idea that not giving away medical advice for free is a professional obligation.
Of course it's not a professional obligation. I can't remember ever being looked down upon by other docs or medical societies for volunteering at a homeless clinic.
Also, I don't know why people keep bringing up sockpuppet accounts. They offer little anonymity what with the whole $5 Paypal thing. Unless #1 is willing to accept envelopes filled with cash, it's a no go.
posted by drpynchon at 7:08 AM on July 16, 2005
Of course it's not a professional obligation. I can't remember ever being looked down upon by other docs or medical societies for volunteering at a homeless clinic.
Also, I don't know why people keep bringing up sockpuppet accounts. They offer little anonymity what with the whole $5 Paypal thing. Unless #1 is willing to accept envelopes filled with cash, it's a no go.
posted by drpynchon at 7:08 AM on July 16, 2005
Should I just can it before I get sued?
No, your contributions are useful and your posts are a lot of signal with very little noise. I think having doctors, lawyers, psychotherapists, accountants and other specialists as a small part of the large panoply of AskMe responders is good news for everyone and it seems to me you've been good with your disclaimers so far.
posted by jessamyn at 7:34 AM on July 16, 2005
No, your contributions are useful and your posts are a lot of signal with very little noise. I think having doctors, lawyers, psychotherapists, accountants and other specialists as a small part of the large panoply of AskMe responders is good news for everyone and it seems to me you've been good with your disclaimers so far.
posted by jessamyn at 7:34 AM on July 16, 2005
As I said in the previous thread, I don't see the problem with providing informed commentary as long as you're not giving specific advice ("Take two of these and call my sockpuppet in the morning") and as long as you provide the standard disclaimer ("This is not to be construed as medical advice"). You can always link to sites you consider reliable to back up your advice rather than relying on "I'm a doctor, so I know." You should certainly jump in to contradict what you know to be erroneous and possibly harmful comments, or so it seems to me.
On preview: jessamyn is, as usual, on the money.
posted by languagehat at 7:38 AM on July 16, 2005
On preview: jessamyn is, as usual, on the money.
posted by languagehat at 7:38 AM on July 16, 2005
Just because you stop answering, doesn't mean people will stop asking.
posted by gimonca at 8:04 AM on July 16, 2005
posted by gimonca at 8:04 AM on July 16, 2005
maybe the reason doctors get so worried about this is that in real life they rely too much on status? instead of intimidating someone in an office where their word is law
Haha! You've not spent much time in a doctor's office.
We get so worried about this because we are sued, early and often, and the lawsuits are costly in terms of money, time, and emotional anguish. I've only been sued in sort of peripheral 'your name was in the chart' ways, and that was annoying enough to convince me that I never want to be sued for real.
As far as For one thing, part of your professional obligation is to avoid giving away your expertise for free. versus not giving away medical advice for free is a professional obligation goes:
Neither one of these is strictly true. I've volunteered in free clinics. Free clinics aren't free; someone has to pay for the malpractice insurance, the electric bill, etc. But they're free to the patient and the doctors don't get paid.
Part of my professional obligation is not giving away medical advice in settings where I have not performed and recorded at least a comprehensive history and physical exam. That is why I do not give medical advice over the internet.
Do you have that sort of sixth sense with certain patients that tells you "Uh, oh," like this one is here to get pain meds; somatoform disorder v. MS? If you do, then you may want to use that same gut-check here to, at least, keep your concern over posting to tolerable levels.
This is a complicated question. The answer is "yes," but I am very distrustful of that sixth sense, not least because manipulative, somatizing, or personality-disordered patients can also be very sick and need treatment at the same time. I pretty much ignore it and try to apply good principles of diagnosis and treatment to all my patients; what it's primarily helpful for is helping me to understand and deal with negative feelings that arise towards such patients, from myself and my staff (nurses, techs, etc.)
I need to interact for a while before I get that feeling, though; so by the time it kicks in here on MeFi, it's already way too late.
sockpuppet Sock puppets are funny!
posted by ikkyu2 at 8:53 AM on July 16, 2005
Haha! You've not spent much time in a doctor's office.
We get so worried about this because we are sued, early and often, and the lawsuits are costly in terms of money, time, and emotional anguish. I've only been sued in sort of peripheral 'your name was in the chart' ways, and that was annoying enough to convince me that I never want to be sued for real.
As far as For one thing, part of your professional obligation is to avoid giving away your expertise for free. versus not giving away medical advice for free is a professional obligation goes:
Neither one of these is strictly true. I've volunteered in free clinics. Free clinics aren't free; someone has to pay for the malpractice insurance, the electric bill, etc. But they're free to the patient and the doctors don't get paid.
Part of my professional obligation is not giving away medical advice in settings where I have not performed and recorded at least a comprehensive history and physical exam. That is why I do not give medical advice over the internet.
Do you have that sort of sixth sense with certain patients that tells you "Uh, oh," like this one is here to get pain meds; somatoform disorder v. MS? If you do, then you may want to use that same gut-check here to, at least, keep your concern over posting to tolerable levels.
This is a complicated question. The answer is "yes," but I am very distrustful of that sixth sense, not least because manipulative, somatizing, or personality-disordered patients can also be very sick and need treatment at the same time. I pretty much ignore it and try to apply good principles of diagnosis and treatment to all my patients; what it's primarily helpful for is helping me to understand and deal with negative feelings that arise towards such patients, from myself and my staff (nurses, techs, etc.)
I need to interact for a while before I get that feeling, though; so by the time it kicks in here on MeFi, it's already way too late.
sockpuppet Sock puppets are funny!
posted by ikkyu2 at 8:53 AM on July 16, 2005
I wonder if it would be useful for mathowie to set up some sort of a disclaimer clause as a condition of using AskMe disclaiming both him and people who answer questions from liability by people who post questions.
posted by gyc at 9:06 AM on July 16, 2005
posted by gyc at 9:06 AM on July 16, 2005
well then ask a lawyer. if you are worried about the law, asking for advice here seems about as sensible as people posting medical questions in the first place.
posted by andrew cooke at 9:28 AM on July 16, 2005
posted by andrew cooke at 9:28 AM on July 16, 2005
monju_botsatsu's link is actually fairly interesting, although very academic/lawyerly sounding.
It seems to deal more with sites that promote themselves as counseling services where there are resident experts that regular people consult. Places that go as far as charging for advice and prescribing medication. To me that is quite different from AskMe, which I take to be more like a group of peers. (I wouldn't count on a court making that distinction though)
The article points out that disclaiming responsibility is a very tricky business:
Courts have long held that professionals cannot contract out of their professional obligations and it would defy that logic to allow cyberprofessionals separate consideration.
While courts and bar regulators have generally looked unfavorably on the use of disclaimers of liability, there may conceivably be some room for their application in particular circumstances. As Professor Lanctot has argued, "Whether a lawyer will be able to rely on a disclaimer will hinge on the nature of the request for advice, the conduct of the lawyer in response to the request, and the factual circumstances surrounding the disclaimer."55 A disclaimer might serve as a particularly successful defense when brought by cyberprofessionals who participate only in providing general legal and medical information to requestors. An example of such a successful attempt at disclaiming liability may be found on AmericasDoctor.com:
A lengthy on-screen disclaimer informs her questioners that the company's Internet doctors -- it employs more than 100 - "will not engage in any conduct that involves the practice of medicine." They will not diagnose illness, prescribe medication, keep a medical record of the conversation or even reveal their identities.56
As long as the doctors on this site adhere to their self-proclaimed policy of only providing general information, such a disclaimer will go far in protecting them from liability under the current trend of the courts.
Ultimately, what all this discussion of disclaimers has led to is an affirmation of the basic principle that courts are unlikely to find liability in the giving of general information but will continue to find a professional-client relationship, and hold parties liable, when specific advice is given.
More importantly, to me at least, is that it is unethical to desire to disclaim responsibility in the first place (not to mention simply false logic):
These problems can lead to a person foregoing a legal claim, incorrectly ingesting certain medications, or even more simply, feeling as though the advice they received was adequate and ending their pursuit for information.
This comes back to my personal ideas about what good AskMeadvice answers look like, and it will help to change the way I write them. I only want to assist people to find their own way, and I am happy to be responsible for the implications of that (of course my exposure is entirely less problematic than a practicing lawyer's or doctor's).
There is another side to the question of an individuals pursuit for information. Because AskMe is a group of peers there is an implication that the advice of one individual doesn't stand alone. To me it can only be judged in the context of the entire thread, with all kinds of complicating factors. For example, what other advice came first or came after you left, did the questioner respond to your requests for clarification, has the questioner begun to follow some of your advice already and returned for further information. This is important to me personally, it will help me to actively whittle down the questions I choose to pursue - as I said, I am only interested in helping people figure things out for themselves (who knows how that kind of argument would fair in a court though... Doh!).
posted by Chuckles at 11:15 AM on July 16, 2005
It seems to deal more with sites that promote themselves as counseling services where there are resident experts that regular people consult. Places that go as far as charging for advice and prescribing medication. To me that is quite different from AskMe, which I take to be more like a group of peers. (I wouldn't count on a court making that distinction though)
The article points out that disclaiming responsibility is a very tricky business:
Courts have long held that professionals cannot contract out of their professional obligations and it would defy that logic to allow cyberprofessionals separate consideration.
While courts and bar regulators have generally looked unfavorably on the use of disclaimers of liability, there may conceivably be some room for their application in particular circumstances. As Professor Lanctot has argued, "Whether a lawyer will be able to rely on a disclaimer will hinge on the nature of the request for advice, the conduct of the lawyer in response to the request, and the factual circumstances surrounding the disclaimer."55 A disclaimer might serve as a particularly successful defense when brought by cyberprofessionals who participate only in providing general legal and medical information to requestors. An example of such a successful attempt at disclaiming liability may be found on AmericasDoctor.com:
A lengthy on-screen disclaimer informs her questioners that the company's Internet doctors -- it employs more than 100 - "will not engage in any conduct that involves the practice of medicine." They will not diagnose illness, prescribe medication, keep a medical record of the conversation or even reveal their identities.56
As long as the doctors on this site adhere to their self-proclaimed policy of only providing general information, such a disclaimer will go far in protecting them from liability under the current trend of the courts.
Ultimately, what all this discussion of disclaimers has led to is an affirmation of the basic principle that courts are unlikely to find liability in the giving of general information but will continue to find a professional-client relationship, and hold parties liable, when specific advice is given.
More importantly, to me at least, is that it is unethical to desire to disclaim responsibility in the first place (not to mention simply false logic):
These problems can lead to a person foregoing a legal claim, incorrectly ingesting certain medications, or even more simply, feeling as though the advice they received was adequate and ending their pursuit for information.
This comes back to my personal ideas about what good AskMe
There is another side to the question of an individuals pursuit for information. Because AskMe is a group of peers there is an implication that the advice of one individual doesn't stand alone. To me it can only be judged in the context of the entire thread, with all kinds of complicating factors. For example, what other advice came first or came after you left, did the questioner respond to your requests for clarification, has the questioner begun to follow some of your advice already and returned for further information. This is important to me personally, it will help me to actively whittle down the questions I choose to pursue - as I said, I am only interested in helping people figure things out for themselves (who knows how that kind of argument would fair in a court though... Doh!).
posted by Chuckles at 11:15 AM on July 16, 2005
This is a very hostile environment for any sort of expert opinion. What happens is somebody will flip out the stale "WTF do you know..." rhetoric and then it all gets tangled up in personal credibility (which the loons and trolls can deny, disparage and defame until the cows come home.)
I don't see any solution other than stand aside if you're liable to be professionally compromised.
This kind of misbehavior is rare face to face and common in the pseudoanonymous internets. Pfffft.
posted by warbaby at 12:01 PM on July 16, 2005
I don't see any solution other than stand aside if you're liable to be professionally compromised.
This kind of misbehavior is rare face to face and common in the pseudoanonymous internets. Pfffft.
posted by warbaby at 12:01 PM on July 16, 2005
I think what gyc said is a good idea. I suppose then there's the problem of have 25,000+ existing members to sign this.
What we hope for is that people will have the common sense to be a bit careful about what's offered on the internet and realize the constraints inherent in such advice. However, some lawsuits are indeed trivial with ulterior motives. You just never know when someone will do something stupid following what they read on the net.
Please don't stop posting commentary. Like what others have said, part of what makes Mefi wonderful is that everyone comes from all walks of life. The community would be poorer without our experts.
posted by state fxn at 12:27 PM on July 16, 2005
What we hope for is that people will have the common sense to be a bit careful about what's offered on the internet and realize the constraints inherent in such advice. However, some lawsuits are indeed trivial with ulterior motives. You just never know when someone will do something stupid following what they read on the net.
Please don't stop posting commentary. Like what others have said, part of what makes Mefi wonderful is that everyone comes from all walks of life. The community would be poorer without our experts.
posted by state fxn at 12:27 PM on July 16, 2005
As a psychologist, I've sometimes refrained from giving specific advice that could be looked upon as a professional recommendation or some kind of treatment. Partly this is from a risk management perspective, but also I think it's an ethical responsibility as well, because it's impossible for me to know the context of the poster's circumstances, so it's hard to know whether something is going to be helpful or not.
posted by jasper411 at 2:31 PM on July 16, 2005
posted by jasper411 at 2:31 PM on July 16, 2005
I think we've all leaned some important lessons here. For one thing, Canada apparently has some rudimentary form of a legal system.
posted by yerfatma at 4:11 PM on July 16, 2005
posted by yerfatma at 4:11 PM on July 16, 2005
Please give us advice you know well. I happen to know a thing or two about PC hardware and I like to give my advice. Granted, it wont kill someone if I give bad advice.
Warn them what your limitations are, do not ask for specifics, and give generalised advice, then advise to speak to someone face to face.
Oh hey Jasper, I get depressed sometimes and I want to stop doing things that would help me like go to work or clean up my apartment... sometimes I just feel like nothing is worth it. This coincided with me not excersizing as much. If I get back into an excersize routine should it go away? What can I try as well to help? Also, I have ADD.
(smile)
posted by Dean Keaton at 5:02 PM on July 16, 2005
Warn them what your limitations are, do not ask for specifics, and give generalised advice, then advise to speak to someone face to face.
Oh hey Jasper, I get depressed sometimes and I want to stop doing things that would help me like go to work or clean up my apartment... sometimes I just feel like nothing is worth it. This coincided with me not excersizing as much. If I get back into an excersize routine should it go away? What can I try as well to help? Also, I have ADD.
(smile)
posted by Dean Keaton at 5:02 PM on July 16, 2005
Because AskMe is a group of peers there is an implication that the advice of one individual doesn't stand alone.
i apologize in advance for the length and specificity of this comment:
all but specifically ikkyu2:
In the earlier stages of ask me, when one user commented on an aspect of a question, often others would add corroboration or supplement the comment with any exceptions or specifics that had not been mentioned (sometimes in response to a naysayer, but it happened nonetheless). In that way, it began to gave a more convivial feel and showcase more of the community aspect of metafilter. Threads now often have more to do with people weighing in on a question whether they have an informed opinion or not, and a wealth of anecdotal commentary. This has been repeatedly mentioned as noise or chatfilter. Before this became the usual state of affairs, i, in one specific case was very glad you spoke up and asserted that you were a doctor, drove home the true gravity of the situation and made them go to the hospital.
Then, i linked you in my profile immediately, in part in gratitude, because before then no one else has asserted that they had more than anecdotal evidence but were proclaiming it with the weight of fact, some so insistently it gave the impression this was board sanctioned wisdom.
But this is not like those e medicine diagnosis this emails. These are people behind whatever the information they provide and may not be properly attuned or receptive to whatever you may tell them, or emotinally removed enough to clearly see what is being expressed.
i have seen some bad information spread but i do not frequent metafilter enough to catch every one and neither is it my job or inclination.
i am not currently licensed in anything to cause myself harm in commenting on a medical or pyschological thread, in fact removed myself from associations that would constrict my own commentary as it would effect anyone else but myself, but in general i do believe it should say on the ask me page or question form that this is a community of peers sharing their opinions and nothing more.
We cannot be held responsible for anyone who misreads or misunderstands anything anyone comments, but i don't think i need to say that the health care situation in the United States right now is dire, and people without health care or the average level of ignorance and neglect to their health and fear of doctors will not be dropping into the hospitl emergency room for a four hour wait or visit a doctor just to make sure or be able to get a second opinion.
The US may be extremely litigious, but this is not a majority of the population because prohibitive legal costs are in part for a reason.
i would rather people refrain from expounding beyond their scope of knowledge or that anecdotal evidence was in a slightly different shade of white, and that is not anything against anecdotal evidence which can often be backed up with like opions from other forums, but some people are seeking "real life tales" and some, like myself, would appreciate more "hard" information.
Despite any clashes we may have had, i have appreciated your input often but even if only for that one incident mentioned. i don't think you should inhibit yourself beyond your own soundness in sounding off, and i believe that jargon is in actuality a good thing if properly used because it dissuades people from involving themselves beyond their depth. It also is an easy catch for somene who knows what you're talking about to speak up and raise opposition or concur.
That is all.
posted by philida at 6:04 PM on July 16, 2005
i apologize in advance for the length and specificity of this comment:
all but specifically ikkyu2:
In the earlier stages of ask me, when one user commented on an aspect of a question, often others would add corroboration or supplement the comment with any exceptions or specifics that had not been mentioned (sometimes in response to a naysayer, but it happened nonetheless). In that way, it began to gave a more convivial feel and showcase more of the community aspect of metafilter. Threads now often have more to do with people weighing in on a question whether they have an informed opinion or not, and a wealth of anecdotal commentary. This has been repeatedly mentioned as noise or chatfilter. Before this became the usual state of affairs, i, in one specific case was very glad you spoke up and asserted that you were a doctor, drove home the true gravity of the situation and made them go to the hospital.
Then, i linked you in my profile immediately, in part in gratitude, because before then no one else has asserted that they had more than anecdotal evidence but were proclaiming it with the weight of fact, some so insistently it gave the impression this was board sanctioned wisdom.
But this is not like those e medicine diagnosis this emails. These are people behind whatever the information they provide and may not be properly attuned or receptive to whatever you may tell them, or emotinally removed enough to clearly see what is being expressed.
i have seen some bad information spread but i do not frequent metafilter enough to catch every one and neither is it my job or inclination.
i am not currently licensed in anything to cause myself harm in commenting on a medical or pyschological thread, in fact removed myself from associations that would constrict my own commentary as it would effect anyone else but myself, but in general i do believe it should say on the ask me page or question form that this is a community of peers sharing their opinions and nothing more.
We cannot be held responsible for anyone who misreads or misunderstands anything anyone comments, but i don't think i need to say that the health care situation in the United States right now is dire, and people without health care or the average level of ignorance and neglect to their health and fear of doctors will not be dropping into the hospitl emergency room for a four hour wait or visit a doctor just to make sure or be able to get a second opinion.
The US may be extremely litigious, but this is not a majority of the population because prohibitive legal costs are in part for a reason.
i would rather people refrain from expounding beyond their scope of knowledge or that anecdotal evidence was in a slightly different shade of white, and that is not anything against anecdotal evidence which can often be backed up with like opions from other forums, but some people are seeking "real life tales" and some, like myself, would appreciate more "hard" information.
Despite any clashes we may have had, i have appreciated your input often but even if only for that one incident mentioned. i don't think you should inhibit yourself beyond your own soundness in sounding off, and i believe that jargon is in actuality a good thing if properly used because it dissuades people from involving themselves beyond their depth. It also is an easy catch for somene who knows what you're talking about to speak up and raise opposition or concur.
That is all.
posted by philida at 6:04 PM on July 16, 2005
Also, if one had to give all and every bit of applicable information to any question asked, you just get really long blocks of unappetizing text.
posted by philida at 6:07 PM on July 16, 2005
posted by philida at 6:07 PM on July 16, 2005
Would it have been too much trouble to have posted that in readable-sized text, philida?
Just wondering.
posted by mr_crash_davis at 7:38 PM on July 16, 2005
Just wondering.
posted by mr_crash_davis at 7:38 PM on July 16, 2005
Even more worth the trouble to shrink it, despite typos, to dissuade the casual reader.
if anyone can enmbiggen the text size to their own greatest convenience, i think it would be you, crash.
then you can embiggen us all by extension.
posted by philida at 7:53 PM on July 16, 2005
if anyone can enmbiggen the text size to their own greatest convenience, i think it would be you, crash.
then you can embiggen us all by extension.
posted by philida at 7:53 PM on July 16, 2005
Please continue to contribute where you think you have something to say, just like all the rest. You might come up with a disclaimer tagline which indicates that this is not medical advice and the reader should consult their own physician. Whatever you choose, thank you for your contributions so far (not just the medical ones either).
posted by caddis at 8:41 PM on July 16, 2005
posted by caddis at 8:41 PM on July 16, 2005
Even more worth the trouble to shrink it, despite typos, to dissuade the casual reader.
Wait, you posted something here that you don't want people to read? Usually people post to communicate, but this is just masturbation.
Of course, it's all masturbation.
posted by grouse at 2:15 AM on July 17, 2005
Wait, you posted something here that you don't want people to read? Usually people post to communicate, but this is just masturbation.
Of course, it's all masturbation.
posted by grouse at 2:15 AM on July 17, 2005
grouse, if you'll visit philida's userpage you'll discover she's the late ethylene (which should be obvious from her style anyway). Communication has never been her primary goal. I vacillate between enjoying her shtick and being irritated by it, but there's no point expecting anything different.
posted by languagehat at 6:14 AM on July 17, 2005
posted by languagehat at 6:14 AM on July 17, 2005
i don't know if i'm the only one...i haven't read through all the posts here, just skimmed..but i don't think medical questions requring any degree of professional-level advice should be posted here at all...i would guess that the info you've given is accurate and useful; however, if you're not able/willing to stand behind that advice with accepting professional responsibility for it, the way you would with any patient face-to-face, then your advice should be given no more weight than someone here without that expertise, or someone here who would pose as a physician offering such advice.
anyone can show up here and say 'i'm a physician'--for you to do so encourages an illusion of legitimacy that could be given to anyone here who pretends to speak on some level of medical expertise.
it's nothing personal, and again, i'm sure you wouldn't hand out information that you did not know to be correct...and it's a noble thing that you would want to offer your expertise to ensure correct information is provided...but if you yourself, or this site, cannot verify the stated expertise of those responding, and cannot monitor all such questions to be sure misinformation is not conveyed, then i would think your primary concern would not be about getting sued, but the well-being of anyone--including people who don't post here, but just read the posts--who might attempt to put the information into practice...there are already sites that provide this service and can certify the qualifications of the experts they employ--i would say leave the service and its liability to them
posted by troybob at 10:17 AM on July 17, 2005
anyone can show up here and say 'i'm a physician'--for you to do so encourages an illusion of legitimacy that could be given to anyone here who pretends to speak on some level of medical expertise.
it's nothing personal, and again, i'm sure you wouldn't hand out information that you did not know to be correct...and it's a noble thing that you would want to offer your expertise to ensure correct information is provided...but if you yourself, or this site, cannot verify the stated expertise of those responding, and cannot monitor all such questions to be sure misinformation is not conveyed, then i would think your primary concern would not be about getting sued, but the well-being of anyone--including people who don't post here, but just read the posts--who might attempt to put the information into practice...there are already sites that provide this service and can certify the qualifications of the experts they employ--i would say leave the service and its liability to them
posted by troybob at 10:17 AM on July 17, 2005
ikkyu2,
While almost all of us know the difference between a mefi user who happens to be an MD and an MD who is in our presence at an appointment, there's possibly some guttersnipe who could lawyer up over a frivolous premise ('he said I should'...etc). Your postings are already very careful so I think such a reaction is highly unlikely.
That said, matthowie should probably review and update terms of service and get the community to respond to them. Anyone stupid and obnoxious enough to attempt to sue you over a response to a posting in a general community is probably enough of an asshole to sue metafilter as a third party...
posted by nj_subgenius at 10:53 AM on July 17, 2005
While almost all of us know the difference between a mefi user who happens to be an MD and an MD who is in our presence at an appointment, there's possibly some guttersnipe who could lawyer up over a frivolous premise ('he said I should'...etc). Your postings are already very careful so I think such a reaction is highly unlikely.
That said, matthowie should probably review and update terms of service and get the community to respond to them. Anyone stupid and obnoxious enough to attempt to sue you over a response to a posting in a general community is probably enough of an asshole to sue metafilter as a third party...
posted by nj_subgenius at 10:53 AM on July 17, 2005
There is already enough nonsense out there without having someone who actually knows what they are talking about drop out over fear of liability. I am sure you have seen the literature showing that a minority of physicians are on the recieving end of the majority of lawsuits, and malpractice is less of a factor in whether a suit is filed than the quality of the doctor-patient relationship (e.g. jerks get sued much more often), concerns about paying for ongoing medical expenses, and whether the doctor/hospital were truthful following a bad outcome. For what it's worth, I practice in one of the most high-risk areas of medicine and have not been sued since finishing my training in 1993. The risk of anything reasonable I say on MeFi pales in comparison to my daily work. Keep commenting; you give good answers to questions that peole may not easily find on their own.
posted by TedW at 3:26 PM on July 17, 2005
posted by TedW at 3:26 PM on July 17, 2005
Wait, you posted something here that you don't want people to read? Usually people post to communicate, but this is just masturbation.
Of course, it's all masturbation.
posted by grouse at 2:15 AM PST on July 17
exactly, in a sense, and your name is grouse
Communication has never been her primary goal. I vacillate between enjoying her shtick and being irritated by it, but there's no point expecting anything different.
posted by languagehat at 6:14 AM PST on July 17
for shame, mr. hat. i thought you knew better.
the point is always communication, but for whose who would actually care what i have to say. otherwise i'd rather stay less assuming and easily skippable.
point illustrated by
i don't know if i'm the only one...i haven't read through all the posts here, just skimmed..
posted by troybob at 10:17 AM PST on July 17
who think no less of for not reading Every Damn Thing everyone writes.
hi, ikkyu2!
posted by philida at 4:36 AM on July 18, 2005
Of course, it's all masturbation.
posted by grouse at 2:15 AM PST on July 17
exactly, in a sense, and your name is grouse
Communication has never been her primary goal. I vacillate between enjoying her shtick and being irritated by it, but there's no point expecting anything different.
posted by languagehat at 6:14 AM PST on July 17
for shame, mr. hat. i thought you knew better.
the point is always communication, but for whose who would actually care what i have to say. otherwise i'd rather stay less assuming and easily skippable.
point illustrated by
i don't know if i'm the only one...i haven't read through all the posts here, just skimmed..
posted by troybob at 10:17 AM PST on July 17
who think no less of for not reading Every Damn Thing everyone writes.
hi, ikkyu2!
posted by philida at 4:36 AM on July 18, 2005
Autopsychography
The poet is an inventor.
She invents so completely
That she succeeds in inventing
That the pain she really feels is pain.
And those who read what she writes
Really feel in the pain they have read,
Not the two which she felt,
But only the one they do not have.
And thus in the wheel ruts
There goes round and round, diverting Reason
That clockwork toy train
Which is called heart.
- Fernando Pessoa
posted by peacay at 5:44 AM on July 18, 2005
The poet is an inventor.
She invents so completely
That she succeeds in inventing
That the pain she really feels is pain.
And those who read what she writes
Really feel in the pain they have read,
Not the two which she felt,
But only the one they do not have.
And thus in the wheel ruts
There goes round and round, diverting Reason
That clockwork toy train
Which is called heart.
- Fernando Pessoa
posted by peacay at 5:44 AM on July 18, 2005
very nice, pk, and thanks, but i am no one one should regard well or much, unlike say madamejujujive
posted by philida at 5:51 AM on July 18, 2005
posted by philida at 5:51 AM on July 18, 2005
Part of the liability thing is that someone might say, "You should exercise more" and then the person goes and exercises and has a heart attack or something. And then the lawyers get involved and it turns out that one of the people who said "You should exercise more" is a credentialed health care professional. And because people who practice health care typically have deep pockets (in the form of malpractice insurance), the lawyer starts licking his/her chops, because it's common knowledge that the insurers may decide it's just cheaper for them to settle for some amount than litigate.
It's infuriating in so many respects that a lot of health care providers have become quite gun-shy about saying anything other than "See a doctor," because something that sounds like prescriptive advice might be construed (typically by lawyers) as being potentially easy money.
and yes, Dean Keaton, you should see a doctor (*and* use spell check) - smile back
posted by jasper411 at 11:21 AM on July 18, 2005
It's infuriating in so many respects that a lot of health care providers have become quite gun-shy about saying anything other than "See a doctor," because something that sounds like prescriptive advice might be construed (typically by lawyers) as being potentially easy money.
and yes, Dean Keaton, you should see a doctor (*and* use spell check) - smile back
posted by jasper411 at 11:21 AM on July 18, 2005
jasper411: It's infuriating in so many respects that a lot of health care providers have become quite gun-shy about saying anything other than "See a doctor," because something that sounds like prescriptive advice might be construed (typically by lawyers) as being potentially easy money.
Agreed! Even more infuriating though, people who are not health care providers who chime in with that line because they think it is what you are supposed to say.
posted by Chuckles at 11:30 AM on July 18, 2005
Agreed! Even more infuriating though, people who are not health care providers who chime in with that line because they think it is what you are supposed to say.
posted by Chuckles at 11:30 AM on July 18, 2005
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posted by mr_crash_davis at 8:35 PM on July 15, 2005