Retaliation Rules ... Without Rules

Hopefully, none of you have been replaced since the last go around, unless it was for something better. I know a few of those who reached out have actually upgraded their places either in work or life or both, and maybe those who tried to replace them saw some light.

One of the reasons I wanted the boys to watch the hockey playoffs (sorry, Canada) was the sportsmanship that is lacking in other sports; the penalties and fighting are rough, but the game is overall a team sport and less about one player, none of them except the captains address the referees, and most importantly, they line up and shake hands at the end of the series. The diva show, taunting, showboating, and whining are not great influences on young kids, but as Sir Charles once said, athletes are not role models, which makes us wonder: Who are the role models?

Retaliation, and who eventually gets called for the foul, is often prevalent in sports, especially as athletes spend more time working referees instead of actually playing. The retaliation fouls in basketball and football are two of the most common, and most preventable, penalties that origi- nate from the moment of rage and loss of sportsmanship and discipline.

So, has retaliation become a part of the fabric of the contempt patients have for their physicians? We see it in the corporate world, where supervisors who are strict and focused on the best outcomes for the team end up getting reported to HR for yelling and being “too mean.” And the result: the rise of the one-star reviews, further eroding trust and how we approach difficult conversations. Patients now complain that the dermatologists are too mean and insensitive in telling them about wearing sunscreens to reduce skin cancer risks, to disagree with an internet search when patients convinced themselves of a diagnosis, and to simply not miss their shots or pills, as that might actually slow down their progress. Of course, we now live in a world where patients in their 20s ask us, “Are you sure?” and “How do you know?” but they trust influencers and those without degrees instead.

From challenging the treatment plan and diagnosis to billing issues to trusting the internet more, the movement for patient retaliation against their doctors is becoming more perilous for those who are not walking on eggshells. Catch them on a bad day, say too much, or say something the wrong way, and patients want to find a way to get you

back. Like many dermatologists out there, I had a young patient who had horrible acne and scarring and had not done anything yet, and she came to see an “acne expert” from the online search. Yet after hearing about “purging” and “retention” and multiple other influencer terms, and discussing antibiotics, topicals, and isotretinoin, the patient insisted on some natural treatments with multiple questions of my training and experience. Eventually, she didn’t fill any of the prescriptions we “suggested” (suggestion pad back in action), but within two hours did take the time to slam our clinic and damage our reputation online for being “uncaring” and “too out of touch” with patients ... a healthy way of handling things.

The even angrier, or just more entitled, patient has figured out that as painful as a bad review can be, going after a physician’s license can strike a deeper blow; and, as the movement goes, state medical boards are becoming the new Yelp, making filing complaints easier on their websites as patients now pursue revenge or to fortify lawsuits, and the Federation of State Medical Boards (FSMB) provides very specific guidance to patients on when, and how, to file complaints against physicians. The goal initially was to identify impaired physicians to protect patient safety, but what was once defense has become a source for offense. And as stated, “Any disciplinary action imposed by the board is entered into public record. It is then part of the physician’s permanent professional record and is available nationally through the FSMB Physician Data Center. Patients can access this info through their state’s medical board or by accessing docinfo.org.” So as the trends continue to empower patients, so have the avenues for filing complaints, and retaliation means sabotaging careers, not just reputations.

Medical board complaint legal defense costs are not always covered by medical malpractice insurance, and for the most part, reports to medical boards are still more serious than just trivial complaints. Some common standard-of-care complaints include: failure to diagnose, also a leading cause of medical malpractice claims; inappropriately prescribing medications and monitoring opioids or other controlled substances; actionable violations of physician-patient confidentiality; and inappropriate behavior that interferes with patient care, including interactions with others in the chain of care.¹ It was bad enough between the years of 2020-2022, in the heat of the pandemic, when disagreements about vaccinations and opinions vs facts became a source for medical board actions. Ironically, there was no oversight as to who decided the difference between what is inaccurate, incomplete, and ever-changing information, aside from who decided which complaints were based on political disagreements.