I think it is revealing about what type of people doctors truly are that this poster will no longer "speak frankly" if such true statements are admitted into a court of law.

It is the obligation of every citizen to speak frankly in a court of law. That this doctor believes it is "chilling" to do so is further evidence that doctors are arrogant, societal enemies who must be brought under ever closer regulatory and legal scrutiny.

Speaking of unloved. We are now "arrogant, societal enemies". Perhaps anon 7:54, you see a reflection of yourself in your physician(s). Of whom I can only say, my condolences.

O Good Lord. This kind of development is not "chilling", it's far past the time. The process of medical peer review has been SCREAMING for serious reform FOR YEARS.

The AMA and state medical societies are not going to initiate it. They're all too afraid of the lawyers. And the medical boards are run by them.

All of this legal cloak & dagger crap, shielding the process from ANY kind of accountability has made it ripe for abuse - by doctors and hospital executives alike. Most of the legal protections to encourage physicians to "speak frankly" (1) assume doctors always act in a beneficent way (HAH!), and (2) are really designed to protect the institution from liability. Can you say, "risk management"?

If you want an impaired physician to "speak frankly", see to it that he/she gets to a physician (were a privilege exists), have the appropriate releases signed and let the examining physician make a condensed/professional report to whatever disciplinary panel is involved. If the doctor under review wants to be "frank" and testify on his/her behalf . . . he/she can . . . but it can be held against him/her . . . JUST LIKE ANYBODY ELSE IN A COURT PROCEEDING.

These days with nebulous JCAHO-approved psychiatric terms like "disruptive doctor" . . . not to mention the fact that initiating a BAD FAITH or "SHAM" peer review action is a VERY EASY way to economically destroy a competitor (or whistle-blower) . .. the peer review process is often akin to a modern-day witch-hunt.

Falsely accused doctors have NO WAY to fight back. They have less rights than your average ax-murderer. And the doctors who sit on these committees have absolute power.

There's an old saying about absolute power . . .

Moreover, a lot gets lost in the translation of disciplinary action . . . and patients (victims and potential victims of bad care) are ALWAYS the losers there.

Reform the process nationwide - with federal legislation. Open it up to more scrutiny. The truth remains absolute protection in a court of law and doctors are entitled to their professional opinions (key word, professional).

I've never submitted (or said) anything in a peer review setting that I would not say on the stand. Bad care is bad care. Bad behavior is bad behavior. We, as doctors, are supposed to be patient advocates. We are human and can have FEELINGS as we advocate.

Hell, enact REAL, enforceable whistle-blower protection (and when I say real, I mean protection where if you sign your name and you're telling the truth, you're protected from retaliation - not this chicken-poop, ripe-for-back-stabbing anonymous call-in stuff so prominent today).

If doctors in the USA really want tort reform - or to fix medicine in general - they have got to be willing the pull back that veil.

Right now patients don't trust us. And (based on what I've been through myself - fired for intervening in medical badness and defying the threats of clueless/greedy administrators to report it to peer review) they have GOOD REASON not to.

And please do not get me started on "obligations" in a court-of-law. In my case (where perjury/contempt/fraud remains unprosecuted) those obligations apparently did not apply to anyone but me.

Move to Texas? The Texas Medical Board has an awful reputation in "sham" peer review circles.

Florida is hardly unique. Crooked lawyers rule everything everywhere. We're truly "over-lawyered".

As for John Edwards (we in North Carolina have felt the pain for years), wake up and smell the smell. If you support Obama for President, just know there's a fairly good chance that the medical-profession's favorite trial-lawyer could be US Attorney General.

This country became great and rose to great prosperity because of the freedoms set forth by our founding fathers. The role of the government should be minimal - to enforce the law and to enforce contacts. People then work hard, innovate and are put in a position to prosper if they can provide value to better other people's lives. We have insidiously grown into a bloated nanny-state where the government controls over 20% of GDP as opposed to less than 3% 100 years ago. They tell us what to do. They protect us (from ourselves), because they believe they know better what's good for us than we do. It's not going to be better with McCain in office, but it's going to be much much worse with the Dem's in power. It's only through education of the people that we can make positive change. But who controls the educational system? Hmmm. Little wonder that the former "third world" is catching up to us.

What is being lost here is the simple and self-evident reason for shielding peer review from discovery in the first place.

A great deal of mishaps that may, or may not, be due to bad care occur all the time--only a tiny fraction of which result in malpractice litigation.

It is in the interest of everyone who might ever possibly bet sick and need medical care that the profession be encouraged to examine these mishaps, determine what went wrong, and take action to reduce their likelihood of recurrence. That is greatly simplified if people can simply say "I screwed up" without a fear that it will be thrown in their face later in a trial setting. "I screwed up" may not be an admission of malpractice--it may be an admission of an error in judgement but would be seen as such. It is also greatly simplified if everyone doesn't bring his lawyer with him to an M & M conference. That is what a rational person would do if it is all part of the legally accessible record--but then we would never get to the bottom of anything and there would be no internal quality improvement mechanism in our healthcare institutions.

Simply put, the shield is in place to allow meaningful QA involving peer review to occur for the betterment of healthcare for all. Shielding it limits the individual malpractice vicitim's avenues for building a case at the expense of the greater good. The malpractice plaintiff does after all have access to the same record to build their case with that peer review has.

I do a great deal of peer review, and the willingness of docs to say "Gee, you are right, we dropped the ball on that one" enables us to move immediately to discussions of improving the system to reduce that problem. Were we constrained by the considerations that a defendant physician is saddled with, we would be dozens of hundreds of hours in the process before getting to that point.

This has nothing whatsoever to do with the question of how accountable peer reviewers should be when the reviewed physician feels unfairly treated.

"The enemies of clinical care include doctors participating in any review process"

Is such drivel even worth answering? I suppose a brief statement of the self-evident is warranted. But a true fanatic will not bow to reason whether brief or long.

The biggest enemies of clinical care are Doctors who provide substandard care even to the point sometimes of farce. It it peer review that, usually, results in them improving their care or, occasionally, results in their finding something else to do for a living. These enemies of clinical care:

Don't take a history.

Don't examine patients.

Don't look at lethally toxic blood levels while their patients are overtly clinically toxic.

Write fake notes for days they weren't even in the hospital.

Make up history.

Don't see newly admitted hospital patients for 3 or 4 days.

Cut and Paste H & P from a prior admission--not even bothering to change the vital signs.

Having seen all of these behaviors I have to say that the sad fact is that physicians are just like everybody else and a certain number are going to progressively cheat more and more until they realize someone is looking. Many of the rest aren't all that bad but do need someone checking every now and then to stay good. Sad but true. There is not a good screen of morality or character for medical school.

If peer review is to be used in malpractice trials, then peer review needs to be subject to the same legal rules, including protection of the rights of the accused.

Right now, it is so easy to fill peer review with hearsay and downright lies, peer review has no business in malpractice trials.

I have to agree with the post. We instituted "360 degree" review processes at my company last year, and it's an effin' joke.

Nobody will rate each other honestly because everyone knows each other in the small company, and nobody wants to be singled out for giving constructive criticism about a co-worker.

So, in essence, our old review process, which involved being reviewed by your immediate supervisor, and which (IMHO) proferred real insight into your job performance and what the company expected of you, has now turned into a 360degree circle jerk.

-EEJ

If the aim is self-regulation and not oppression nor self-dealing by a corrupt, fossilized hierarchy, immunize the communications, and the remedies. It is not, and there is no immunity, nor even confidentiality, according to this authoritative appellate decision.

Obviously, the aim is plunder by the land pirates, and by their officious, deluded running dogs.

I encourage doctors to bring aggressive lawyers to such reviews. If a tort is committed against the interest of the doctor, set loose merciless litigation on the self-dealing entity and on the self-dealing oppressors. To deter.

The misconduct enumerated by this lawyer running dog warrants informal feedback in the hallway, if the aim is to improve services. They are trivial. They do not warrant a quasi-legal proceeding, unless the aim is to intimidate and to drive out the competition.

Isn't it about time that playtime be over for these self-dealing enemies of clinical care? One may find deficiencies in every record, even those of the lawyer. They serve as lawyer gotcha, are in bad faith, and should not be tolerated without full defense of the legal rights of their victims.