BECAUSE OF PRIVACY LAWS, WHEN A PATIENT anonymously posts a scathing review of a physician on a Website such as or, the physician has little recourse. Jeffrey Segal—along with Medical Justice, his firm in Greensboro, N.C. sees this as a problem to be fought with a waiver that limits how and where patients can take aim at their caregivers.

Segal, who left his neurosurgery practice to found Medical Justice in 2002 after a patient sued him for what Segal considered frivolous reasons (the case was dropped), describes the waiver as part of his firm’s mission to protect physicians from unjust attacks. He predicts that the waiver will help lead to more accurate assessment of care, but Medical Justice hasn’t escaped charges of censorship.

Q: How do you know anonymous posts are doing harm to physicians’ reputations?
A: We know that physician review sites are as likely to misinform as they are to inform. If a patient complains that his wound opened two days after an operation, how do we know the patient followed instructions not to lift heavy objects? Are the reviewers really patients? In one case, a dentist was accused of inappropriately touching child patients. The “reviewer” turned out to be a competitor. On the other hand, laudatory reviews could be written by the physician himself.

Q: What inspired the idea of waivers?
A: Our main focus is frivolous lawsuits. We educate physicians about ways to deter them, and we offer guidance if they are sued. We’ve introduced a contract that physicians can ask patients to sign, stipulating that if a dispute over care arises, the patient agrees to use as witnesses only physicians who belong to medical societies within the relevant specialty and who are governed by established ethical codes. Three years ago, when a surgeon told us he was being anonymously attacked online, we began to wonder whether a similar contract might help bring fairness to online reviews.

Q: How many physicians use the waivers, and how many patients have signed them?
A: We have about 2,200 members, and we estimate that half use waivers consistently—and that hundreds of thousands of patients have signed them.

Q: How can anonymous reviewers be held accountable?
A: Websites operating as platforms for outside commentary aren’t liable for defamation suits—but they are subject to copyright laws. Waivers assign copyright to the physician, so if the physician has asked all of her patients to sign, she can claim ownership of any anonymous review of her practice and ask that it be removed.

Q: How often have physicians persuaded sites to take down reviews?
A: We don’t release specific numbers, but many physicians have had success. In a recent case, a post grossly misrepresented the care a surgeon had given a patient. The site was alerted, and the post was taken down.

Q: What if a patient refuses to sign?
A: If a patient is in need of emergency care, obviously physicians shouldn’t worry about the waiver. With long-standing patients there’s usually a level of trust, and physicians have told us that most patients are very willing to sign. If a new patient refuses, it’s up to the physician to decide what to do.

Q: How do you respond to charges that waivers are essentially gag orders?
A: Patients are free to speak with family, friends, other physicians, lawyers, hospital peer review committees or credentialing committees. There’s a wide range of appropriate places where patients can make themselves heard besides review sites. Also, we have recently amended the waivers to encourage patients to post reviews at some sites, such as and, that we believe take a much more balanced and fair approach than others.

Q: How would you like to see physician review sites change?
A: Barring anonymous reviews would be a start. Sites should at least have a way to verify that the reviewer is in fact a patient of the physician he or she is discussing. And to prevent an extreme opinion—positive or negative—from skewing impressions, the sites should hold off on posting reviews until they have a representative sampling of, say, 10 or more. Finally, we’d like to see reviews focus on areas patients can speak knowledgeably about. There’s a big difference between commenting on the parking, how long you waited or whether you were treated rudely and making specific comments about, say, the technique the physician used in performing a catheter ablation of cardiac arrhythmia.

What’s Your Take? Is Medical Justice’s waiver system a welcome form of protection or a type of censorship? Weigh in here.