What if this practioner’s rate is 3 times the average? shouldn’t peers be looking at that and determining if their is a sound reason for that such as higher risk patients? How will the patient even know that this person has a higher incident of poor outcome? How will his professional peers know if he practices in isolation?

What some docs want is to keep their practice in secret, to not have their work examined with any depth or regularity by their professional peers, leave patients left with a lawsuit as the only means of holding them accountable or even subject to scrutiny, and then deny that as well.

We will have a leg to stand on complaining about the unfair malpractice claims when we do a better job of self-regulation.

He is necessarily dependent on licensing boards and hospital staffs for his protection.

Restricting malpractice to most severe injuries is not the answer. In fact, the vast majority of malpractice occurs without any accountability already, and that is a problem. Granted that many, perhaps most claims that are pursued are in turn not malpractice.

I am embarrassed at how much more energy we devote to one side of the problem (inappropriate claims) in comparison to how little is devoted to improving the quality of care.

I review charts regularly and see ridiculous incidents of neglect at levels that shock. Dangerously toxic therapeutic drug levels that aren’t acknowledged or addressed for days in the face of overt toxicity, lack of communication (lack of effort-not communication error) between care providers resulting in serious problems not being followed up, and most aggravating of all–failure to take histories or even review what is right in the chart with the result of serious adverse therapeutic neglect.

Most of the harm that I have seen was caused not by lack of practitioner skill but lack of conscientious effort to attend that patient–failure to read the chart, listen to and look at the patient, and talk to the family.

And save the crap about not being paid enough to do those things. That is practicing medicine and that is what you are paid to do. You are not entitled to a certain amount of money just because you are in the medical profession. The fortunes of the medical profession have gone up and down for 2500 years. If they are down for now, that doesn’t change your professional obligation to actually practice medicine when you accept a patient–not to just pretend to in order to churn revenue. If the payment rate isn’t acceptable to you, do something else for a living. If you stay in it anyway, it can’t be so bad.

Is $20 million your breakpoint?

That’s a risk you chose to take when you hired me, therefore it is your responsibility.