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Medicine Privacy The Internet

The Other Exam Room: When Doctors 'Google' Their Patients 231

Posted by Soulskill
from the like-dr.-house-but-lazier dept.
theodp writes "Writing in the NY Times, Dr. Haider Javed Warraich shares a dirty little medical secret: doctors do 'Google' their patients, and the practice is likely to only become more common. And while he personally feels the practice should be restricted to situations where there's a genuine safety issue, an anecdote Warraich shares illustrates how patient search could provide insight into what otherwise might be unsolved mysteries — or lead to a snap misdiagnosis: 'I was once taking care of a frail, older patient who came to the hospital feeling very short of breath. It wasn't immediately clear why, but her breathing was getting worse. To look for accidental ingestions, I sent for a drug screen and, to my great surprise, it came back positive for cocaine. It didn't make sense to me, given her age and the person lying before me, and I was concerned she had been the victim of some sort of abuse. She told me she had no idea why there was cocaine in her system. When I walked out of the room, a nurse called me over to her computer. There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.'"
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The Other Exam Room: When Doctors 'Google' Their Patients

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  • by Anonymous Coward on Wednesday January 08, 2014 @09:23AM (#45896881)

    I don't care if my doctor Google's me. They'll have to weed through millions of results for Anonymous Coward.

  • by Cornwallis (1188489) on Wednesday January 08, 2014 @09:25AM (#45896891)

    "Everybody lies."

  • by MindPrison (864299) on Wednesday January 08, 2014 @09:26AM (#45896899) Journal
    Everyone google everyone. When someone is asking for employment, seek a job, seek a position, ask for marriage, new neighbors etc...you'll get googled. This isn't good, in fact - it's very bad, for everyone, including yourself. Because at some point, you'll have no privacy anymore. Sure - the one who GETS the information will be empowered by what he or she THINKS is facts, because it's out there - in plain text for everyone to see. But what you DON'T see, is the context, context as in "the other information", we're talking the "real" story here...not what someone PUT out there for everyone to see. I have a friend that have done nothing wrong afaik. His son is a police officer, and one day this police officer happen to catch "the wrong guy to mess with", the one he caught is still a criminal, but now the cop has been targeted by this criminal. The criminal happen to own a "BLOG" about his hate towards law enforcement, and he got really angry with my friends son. He decided to make my friend suffer, his wife, his daughter and his son suffer. So he went public with ALL their information and put it up on his blog. One day, when my friend needs to talk to officials, they too will google him, and they will see his name and details on the criminals page, except...they probably won't investigate the fact that the page with the information, comes from a criminal that has a hen to pluck with my friends son. This is why, this is a bad thing.
    • by Anonymous Coward on Wednesday January 08, 2014 @09:30AM (#45896927)
      You know what a good thing is? Paragraphs, dude. Paragraphs.
      • by MindPrison (864299) on Wednesday January 08, 2014 @09:39AM (#45896971) Journal

        You know what a good thing is? Paragraphs, dude. Paragraphs.

        I was momentarily autistic when I wrote that, you insensitive clod!

        • Autism is not an acute illness

          • Re: (Score:2, Offtopic)

            by MindPrison (864299)

            Autism is not an acute illness

            I know...it was sort of a joke ;) But point taken, autism is no joke, no joke at all. In fact, some of my best friends are autistic, and very intelligent btw.

    • by KingOfBLASH (620432) on Wednesday January 08, 2014 @09:52AM (#45897059) Journal

      Google is like a knife: neither inherently good nor inherently evil.

      Some people will do the equivalent of SEO and actually create lies about themselves that people will find. Literally, if you're smart about it when people google your name all they will see is that you are some sort of awesome human being. Link to press releases of you donating a kidney to some poor schmuck who couldn't afford it. Link to how Jesus washed your feet. Link to positive stuff.

      Other people won't get it and the picture your ex girlfriend posted of you pissing yourself will make the front page of google.

    • Everyone google everyone. When someone is asking for employment, seek a job, seek a position, ask for marriage, new neighbors etc...you'll get googled. This isn't good, in fact - it's very bad, for everyone, including yourself...

      That implies everyone has loads of information about them online for all to see. If you google my name (and I imagine it's the same for most people) you'll get links to a few moderatly famous people with the same or similar names. The usual batch of profile sites with a few people with the same name none of which are actually me. I looked through the first few pages of images and I'm not there either.

      • by boristdog (133725)

        Yeah, but those of us with fairly unique names are boned if we have anything bad online, real or manufactured.

        This is why I have to have a facebook account, a linked-in account, etc. that I do NOTHING with except maintain a vanilla profile. I don't want someone setting up an account in my name. 15 years ago someone sent a stupid, highly ungrammatical "letter to the editor" of a local paper (which maintains an online presence) using my name as a joke. They printed it in the online edition and the damn thin

    • Would your friends son have found out about that blog without Google? Would he have been able to take any actions against that blog?

    • by mark-t (151149) <markt@@@lynx...bc...ca> on Wednesday January 08, 2014 @11:16AM (#45897685) Journal
      The interesting thing is, however, as that sort of situation becomes increasingly common in our society, most people are going to eventually learn that they shouldn't be making judgmental decisions about somebody based only on what they find online any more than they should be making such decisions based on other superficial factors.... like race, age, et al. It will never be perfect, of course... but to be honest, you can still find racist jerks too, even in places which are very culturally diverse.
    • by cayenne8 (626475)

      Everyone google everyone. When someone is asking for employment, seek a job, seek a position, ask for marriage, new neighbors etc...you'll get googled. This isn't good, in fact - it's very bad, for everyone, including yourself. Because at some point, you'll have no privacy anymore.

      Well, there's good reason to not put information about yourself on the internet. I've been on since about '92, and thankfully googling myself comes up very little pointing to me. I don't do FB or twitter, etc.

      You don't have to

  • Patients Lie (Score:5, Insightful)

    by jamesl (106902) on Wednesday January 08, 2014 @09:29AM (#45896911)

    And it could kill them.

    • And it can harm doctors. With the spread of viral diseases like hepatitis, patient deception can lead to infection of medical personnel.
      • Re: (Score:3, Informative)

        by gweihir (88907)

        Only if the doctors and nurses are incompetent. Unless they are sure, they have to assume HIV and the like anyways and be careful.

      • And it can harm doctors. With the spread of viral diseases like hepatitis, patient deception can lead to infection of medical personnel.

        Doctors should always wear gloves. The patient himself might not even know yet that he has an infection.

        Or the patient may actually have told it to the secretary, who marked it on the form, but the doctor didn't take time to read the form.

        • The doctor almost certainly looked at the form. But the form relates facts; it doesn't tell a story. Part of the process of making a diagnosis is getting people to talk about their problem as a story - it lets us know what the patient thinks is important and why they came, which may or may not have much to do with what is really wrong with them.
    • Re:Patients Lie (Score:5, Insightful)

      by KingOfBLASH (620432) on Wednesday January 08, 2014 @09:54AM (#45897075) Journal

      Patients don't lie. They just don't have a medical professional's understanding of what is and isn't important.

      • She told the doctor she had no idea why there was coke in her system. If she's telling the truth (doubt it), ok, fine. But if she lied or is in denial, that's totally on her.

        • Re: (Score:2, Interesting)

          by Anonymous Coward

          If she tells her doctor, the topic may end in his records, and be mentioned on the phone. State authorities steal medical records and break into confident communication. She'll likely not survive getting "busted".

          Why the fuck should she put the rest of her life on the line to make her doctor happy? It's probably bad enough as it is with the tests being on medical record.

        • by gstoddart (321705)

          She told the doctor she had no idea why there was coke in her system. If she's telling the truth (doubt it), ok, fine. But if she lied or is in denial, that's totally on her.

          Or, you know, maybe she has been clean for 30 years, doesn't touch the stuff any more, and literally has NO IDEA of why it's in her system.

          Reading that I almost got the impression the doctor realized there could be residual cocaine, and that it was likely a false hit.

          • by Qzukk (229616)

            and literally has NO IDEA of why it's in her system

            All she did was bake some cookies using the baggie of sugar she found in the sugar jar.

          • Can't be detected past about three days. It was fresh. I don't know why this gentleman was given the great pulpit of the NYTimes to say he felt bad about when a nurse Googled a patient, but he wasn't looking at an ex-user of cocaine.
      • by CaptSlaq (1491233)

        Patients don't lie. They just don't have a medical professional's understanding of what is and isn't important.

        I have a bridge I'd like to sell you...

        Everyone lies, even when it's to their detriment. Shame (among others) is a very powerful emotion.

        • Bollocks. I don't do coke. I don't do drugs. I don't do anything I'm ashamed of.

          If my doctor asks me something, I tell him truthfully. Sometimes though what I tell him is not what he wanted to ask. That's not due to my lying. It's due to my not understanding the question asked, or at least, not understanding what is important in regards to the question.

      • Re:Patients Lie (Score:5, Interesting)

        by demonlapin (527802) on Wednesday January 08, 2014 @10:32AM (#45897361) Homepage Journal
        MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.
        • by Rich0 (548339)

          MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.

          The patients pretend not to lie, and the doctors pretend that they don't know.

          Honestly, I think half of that problem would go away if we didn't treat doctors like gatekeepers. If somebody wants a prescription for anything other than an antibiotic they should be able to just go to the store and buy it. I could see not forcing insurers to cover it, but I think that if we treated doctors less like gatekeepers we'd see fewer adversarial relationships.

          If people went to the doctor solely because they wanted the

        • by mjwx (966435)

          MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.

          This.

          I'm not a doctor, but the last time I went to one I got the weirdest look after a brief examination. I asked him what the problem was and all he said was he doesn't get many patients who tell him the truth. I've worked in tech support, so I know when a user lies to me it just makes the whole thing longer and more painful for everyone. So I dont lie to people who I'd like to help me (especially when I'm in pain).

        • by CODiNE (27417)

          And sometimes doctors assume the patient is lying when their moral judgement of the person conflicts with what they're being told by them.

          Such as the non-sexual transition of chlamydia. But no let's take kids away for their parents and throw the pervs in jail, it's statistically not likely they're telling the truth so they must be lying.

      • Patients don't lie. They just don't have a medical professional's understanding of what is and isn't important.

        A little bit like computer users then, hehe... How possible can a noob know that having rebooted the computer is somehow important to the analysis to the problem?

  • So.... (Score:5, Insightful)

    by MitchDev (2526834) on Wednesday January 08, 2014 @09:29AM (#45896921)

    ... adoctor will fondle and touch and examine your most intimate body parts, yet they shouldn't look at publicly available information? STUPID.

    Yes, they shouldn't jump to conclusions based on what they find, but otherwise, fair game.

    • Re:So.... (Score:5, Interesting)

      by Vitriol+Angst (458300) on Wednesday January 08, 2014 @09:42AM (#45896989)

      I feel more confident in a Doctor having more information than a for-profit insurance company -- which already KNOWS MORE than the doctor in many cases.

    • Re:So.... (Score:5, Interesting)

      by gstoddart (321705) on Wednesday January 08, 2014 @09:54AM (#45897073) Homepage

      ... adoctor will fondle and touch and examine your most intimate body parts, yet they shouldn't look at publicly available information? STUPID.

      Except when doctors look at this publicly available information, the fact that they looked at it also becomes information which, while not publicly available, is still available to Google and, by extension, the government. Because the search engine knows who did the search (possibly exactly who if you're logged in) and where it came from.

      The simple act of the search allows someone to say "this doctor's office looked for this person, and they also looked at this information". You don't think big data can't then determine that "this person has that condition and is being treated by that doctor"?

      And then you've violated HIPAA laws and your obligation to patient confidentiality.

      Unless you can prove no 3rd party could glean information from you doing that search (and I assure you, the doctors can't), you pretty much have to assume that someone actually could.

      Which means the default position here has to be "no, you can't do that". Because it has more potential to cause harm than people realize.

      • I'm more concerned with doctors being able to find medical records from other doctors. You see one quack and get a misdiagnosis, and it can haunt you for years to come. With electronic records, almost all of the hospitals are linked here, and a simple search turns up everything. Its impossible to correct things in your medical files as well. All you can do is add a statement to them.

      • Re: (Score:3, Interesting)

        by sharkette66 (256044)

        Uh, no. This is a feeble understanding of HIPAA. HIPAA would only be involved with the information in the medical record, and violations occur when information in the medical record is shared in a way that HIPAA does not allow. There are many exemptions.

        Googles records of a person's search, even a doctor's search, would not constitute sharing a patient's personal medical information(PMO) in a way prohibited by HIPAA.

        The idea that google knows something has been searched, then by extension 'the government kn

      • by MitchDev (2526834)

        That's idiotic. First, Google doesn't know who the doctor is, second, he's only looking you up, not putting your medical records out there.

        This HIPPA shit goes too far if there's any way a HIPPA-cryte case could be made from a Doctor Googling info ANYONE could Google...

        Really, you people need to change your tinfoil hats, I think your brains rotted clean through...

  • by east coast (590680) on Wednesday January 08, 2014 @09:35AM (#45896957)
    Why would he feel that way?

    To me, if a doctor can find something about a patient without going to crazy lengths to do it then he shouldn't feel bad about it. It would be like me telling my doctor I've given up smoking and he sees me smoking in front of my local Starbucks a month later. On my next visit should he really ignore that I'm smoking again or should he ask about it or come outright and say "I caught you in the act."

    Granted, I'm an adult and I can decide but for medical guidance to be accurate and worthwhile you have to be honest with your doctor and his pointing out the embarrassing truth might be what it takes to get a patient to straighten up and fly right.
    • by schlachter (862210) on Wednesday January 08, 2014 @09:41AM (#45896983)

      It's public info, and it could help the doc make a decision, so let them use it.

      BUT, make them spell out the patient what data they used to make their diagnosis if it was not provided directly by the patient.

      • by drinkypoo (153816)

        Well, look at the current case. The medical test was used to make the diagnosis, the social networking data was only used to determine whether the person had likely been drugged without their knowledge. In this case, it suggested that she probably hadn't been (since she had a history of cocaine use) in spite of her protestations to the contrary.

    • Granted, I'm an adult and I can decide but for medical guidance to be accurate and worthwhile you have to be honest with your doctor and his pointing out the embarrassing truth might be what it takes to get a patient to straighten up and fly right.

      This is probably accurate in many cases.

      The geriatric coke addict in the summary not withstanding.

    • Just remember as you say things like that, the doctor doesn't work for you. He works for the insurance company, the one who is paying him and with whose policies he either complies or goes unpaid. It's been a long time since the doctor was really in charge of his practice.
      • by thoromyr (673646)

        +1

        My doctor is now refusing to continue issuing a prescription (innocuous [not a substance restricted by anything other than requiring a prescription], but moderately expensive) because the insurance company has instructed otherwise. The problem (for me) is that the alternatives either don't work or have bad side effects. This is all documented as the insurance company has kept changing the prescription to anything else under the sun. The doctor now refuses to write the script at all and was plainly afraid

    • by MozeeToby (1163751) on Wednesday January 08, 2014 @10:13AM (#45897207)

      Wait, so this doctor now knows that his patient has a decades old history of drug abuse, at least one near overdose, and the rest of her stay was uneventful and he never brought it up... Am I the only one who says "WTF" to that? That seems like a much, much larger failure on the part of the doctor than googling a patient.

      • It's bad storytelling. I strongly suspect that he expected to find out she was positive for benzodiazepines or opioids, if anything, which is why cocaine was irrelevant to her treatment.
    • by Nikker (749551)
      I don't think the result of your doctor finding out health concerns should result in a "gotchya" moment and why should it? Your doctor knows you very well in most circumstances in a medical and a social way, cornering his/her patient is always the least fruitful way of resolving an issue or helping someone.
  • It's only fair (Score:3, Insightful)

    by Anonymous Coward on Wednesday January 08, 2014 @09:40AM (#45896973)

    After all patients google the doctors too.

  • by Nutria (679911) on Wednesday January 08, 2014 @09:44AM (#45896997)

    tests can detect cocaine many, many years later. How is this so?

    • by sandytaru (1158959) on Wednesday January 08, 2014 @09:48AM (#45897019) Journal
      I thought the implication was that she lied about having no idea how coke was in her system because she was still an addict and still taking it?
      • by Nutria (679911)

        I thought of that too. The summary implies, though, that the doctor dismissed that possibility (patient too old).

        • And that is a major failing on the doctor's part. Old people can be addicts too.

          • by Stickerboy (61554)

            And that is a major failing on the doctor's part. Old people can be addicts too.

            I replied about this above this thread, too.

            The doctor responded the way that they did, because the rest of the medical picture falls into place once it becomes known that the patient is still abusing cocaine. The doctor didn't dismiss the possibility, treating cocaine addicts for their health issues is commonplace.

            The question that was nagging the doctor was, how did the drugs get into the patient's system in the first place? Elder abuse takes many different forms.

    • tests can detect cocaine many, many years later. How is this so?

      Old story but true:

      http://en.wikipedia.org/wiki/Contaminated_currency [wikipedia.org]

      • by Luckyo (1726890)

        We're talking human body here. Unlike pieces of paper or plastic, human bodies have metabolism that removes various toxins from the body with time.

        • by mjwx (966435)

          We're talking human body here. Unlike pieces of paper or plastic, human bodies have metabolism that removes various toxins from the body with time.

          Not all the trace chemicals are metabolized. In the case of THC it can be detected years later when it's released from body fat. Also drugs can be detected from other trace chemicals that aren't toxins and can stay in the body much longer.

  • Hmmmm ... (Score:5, Interesting)

    by gstoddart (321705) on Wednesday January 08, 2014 @09:48AM (#45897023) Homepage

    Wouldn't doctors googling their patients essentially violate HIPAA rules?

    Because you've now let the fact that you are a doctor treating a specific patient bleed out around the corners, and since Google is keeping track of who you are and what you searched for, they know it too.

    Unless you are doing this in such a way that you can guarantee you're not causing patient confidentiality to be breached (which Google sure as hell isn't), I'm of the opinion you've demonstrated a lapse in ethics, and a breech of the law.

    And, even if you search in a manner you know was anonymous, if those searches come from something which is identifiable as being the anonymous search of doctors, the content of those searches can still leak information out.

    Because when Google see that Dr. Joe Quack has searched for Bob Skippy Smith followed by a quick refresher on the symptoms of herpes .... Google knows (or can infer) that Bob Smith has Herpes.

    Doctors are not information theorists, and quite possibly not well educated enough about this technology to be using it in conjunction with their medical practice. Because clearly, if they understood this a little better, they'd realize they've more or less violated their ethics (and possibly the law) by doing this.

    Doctors Googling their patients is a terrible idea, and has every possibility of violating the privacy of the patient, as well as the laws meant to protect it.

    • by drinkypoo (153816)

      Wouldn't doctors googling their patients essentially violate HIPAA rules?

      They have a legal expectation of privacy that the search metadata won't be used for illegal purposes. The illegal acts of others are not their responsibility unless they had reason to believe that they would be committed. If they were googling the information of a political refugee, there would perhaps be more grey area.

    • Re:Hmmmm ... (Score:5, Insightful)

      by Stickerboy (61554) on Wednesday January 08, 2014 @12:25PM (#45898431) Homepage

      I am a doctor.

      Wouldn't doctors googling their patients essentially violate HIPAA rules?

      No.

      Because you've now let the fact that you are a doctor treating a specific patient bleed out around the corners, and since Google is keeping track of who you are and what you searched for, they know it too.

      Unless you are doing this in such a way that you can guarantee you're not causing patient confidentiality to be breached (which Google sure as hell isn't), I'm of the opinion you've demonstrated a lapse in ethics, and a breech of the law.

      Violating HIPAA takes intent. And you're taking the doctor's responsibility to protect patient information way too far.

      For example, Doctor X discusses Patient Y's case with Friend Z, with specific identifying information. HIPAA violation.

      Doctor X discusses Patient Y's case with consulting Doctor A in a suitably private conversation over the telephone. Unknown to the parties, the NSA / and/or the phone company is wiretapping the line, and just learned all about Patient Y. Not a HIPAA violation on either Doctor's part. Doctors have to take reasonable precautions to protect their patient's privacy. Guarding against every possible outlet that snooping intelligence agencies and snooping internet companies could use is too much, and we'd never get anything productive done.

      And, even if you search in a manner you know was anonymous, if those searches come from something which is identifiable as being the anonymous search of doctors, the content of those searches can still leak information out.

      Because when Google see that Dr. Joe Quack has searched for Bob Skippy Smith followed by a quick refresher on the symptoms of herpes .... Google knows (or can infer) that Bob Smith has Herpes.

      Doctors are not information theorists, and quite possibly not well educated enough about this technology to be using it in conjunction with their medical practice. Because clearly, if they understood this a little better, they'd realize they've more or less violated their ethics (and possibly the law) by doing this.

      Doctors Googling their patients is a terrible idea, and has every possibility of violating the privacy of the patient, as well as the laws meant to protect it.

      This would be an incredibly bad idea on Google's part to try to gather accurate information this way on patients. Because I assure you, doctors are neither linear nor subject related in their internet searching. Just because I google "gstoddart" and then a few minutes later "UpToDate: complications of inserting foreign objects in anus" does not mean the two are anywhere related, despite what you're thinking. I may have 20 different patients on my service at any given time, and I frequently have to be thinking about multiple cases at any given time during a workday. Hell, just to make things more confusing for google, maybe I googled "best place to order roses nearby" in between those two google searches, because I'm taking my girlfriend out to dinner after work.

      Sorry, while I hate it, no one, not me, not you, has privacy anymore online or electronically. While we can fight against it, get used to it.

    • by Stickerboy (61554)

      Further examples of HIPAA violations and nonviolations and why.

      Doctor X discusses Patient Y's case with Doctor Z, also involved in the case, at the supermarket. This is a HIPAA violation, as long as there are bystanders and he used specific identifying information. The Doctor intended to have the conversation in a place where he could have reasonably assumed there were unrelated people overhearing.

      Now, Doctor X discussing Patient Y as a generic stroke case in public that could be one of a million just like

  • by Joe_Dragon (2206452) on Wednesday January 08, 2014 @09:48AM (#45897033)

    They better get the right person or bad stuff may happen like (up to death with big law suits)

  • by willy_me (212994) on Wednesday January 08, 2014 @09:53AM (#45897067)

    This will only work on a few people. When I google myself, William Douglas, I get a pile of hits and none of them are for me. Additionally, people can still change their name if they want to distance themselves from their past. Will not hide you from government agencies but will be good enough for everyone else.

    On a side note, a question to the grammar Nazis. When using the word "Google" as a verb, should the first character be capitalized? And as a website that supposedly stays neutral, should it even be used as a verb within headlines?

    Now if you would please forgive me, I must go monitor Bing to see if their is a sudden spike in searches for "William Douglas".

    • by telchine (719345)

      On a side note, a question to the grammar Nazis. When using the word "Google" as a verb, should the first character be capitalized?

      Not usually. However in the title it's correct to capitalize each word.

    • On a side note, a question to the grammar Nazis. When using the word "Google" as a verb, should the first character be capitalized?

      Seems to me capitalization in current English is used for proper nouns.
      I don't know that we've ever Had proper verbs.

      To google or not to Google, that is the question.
      Whether 'tis nobler to suffer the slings and arrows of outrageous liars or search for info about them on the web (because we know everything on the web is absolutely true.)

    • Additionally, people can still change their name if they want to distance themselves from their past.

      ...including their education and work history, making it much harder to find a job.

  • I figured the Doctors were googling patients info to see how much they could overcharge for their service.

  • Everyone realizes that googling names can frequently come up with false hits from the wrong person with the same name. Employers do this, boyfriends and girlfriends do it. Even though everyone knows how unreliable it is, they still keep googling names and using the results.
    In a world constantly screaming for "moar" information it's a shame there's not enough reflection on how valuable or correct it is.
    • Yup! When I self-googled, I got a whole page of MyRealName, none of which was me. The first real "me" I found was some dumb question I asked on a mailing list 15 years ago, and I have plausible deniability for that one.

  • i think doctors should be permitted to use the search to decide whether they want to treat a patient at all, based on certain criteria. For instance, if you find the patient ranting about three other doctors and claiming to be in litigation with hospitals over various perceived slights... maybe they want to steer clear. Maybe the person really has a terrible track record of bad doctors and hospitals, but I fear the loss of physicians because of false accusations and public airings of disagreements.

    However,

Make headway at work. Continue to let things deteriorate at home.

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