Are you LISTENING to yourself? There is a theory in law (and where medical peer review is concerned, it’s apparently just a theory) that it’s better to let a 100 guilty men go free than convict one innocent man.

If you were the one man/woman facing a corrupt hospital review committee – or medical board – you’d probably feel a tad differently about the process. But since it’s not you, let ‘em all swing . . . for self-review in Medicine ahs been a time-honored tradition since the days of the ancient Greeks.

That defines the biggest problem with medicine (and law) right now. Never mind that it’s 2008, and the sneaky, devious Greeks climbed out of their Trojan horse long ago.

Supremacy Claus, I appreciate what you’re saying about fighting back with agressive lawyers and “merciless litigation” against abusive/corrupt institutions, but GET REAL. The way the laws are written now (well, excepting those in Florida), that is virutally impossible. How many doctors can afford to do that – especially if the very process they’re fighting keeps them from making a living?

As I said, the medical peer reveiw process SCREAMS for comprehensive legislative reform and standardization. Yet everyone everywhere (except the state of Florida) is sitting on their hands.

That is how Florida happened. Medical apathy, neglect and hyper-self-interest. Doctors did not do the job the way it’s supposed to be done . . . victimized patients had enough and the Supremes/legislature listened.

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.

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

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

You defend your own left wing oppression of the innocent doctor by the use of pretextual gotchas, false trials to get rid of competitors out performing the entrenched incompetents, and a complete waste of time by doctors without enough patients to stay busy and productive. These doctors doing pretextual, self-serving oversight always seem to be decrepit incompetents judging dynamic, cutting edge, creative people. They destroy good careers with ruinous legal fees, at no risk to themselves. Doctors should always strive to deter these officious intermeddlers by litigation aimed at personal assets.

How old are you Anon?

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.

Short of that, collaboration with the enemies of clinical care is treason to patients. The enemies of clinical care include doctors participating in any review process.

The sole aim of this pretextual regulatory oversight is plunder of the $2 tril budget. The extreme over-regulation of medicine is in bad faith. No one has an obligation of honesty to land pirates. There is a moral obligation to resist the land pirates to the utmost.

Self-criticism comes from Stalin. He promoted it among journalists. Those stupid enough to believe him, got summarily shot. It is an old tyrant trick.

Naturally, the land pirates on the Florida court will never allow their deliberations to get televised, nor accessed for appeals to higher courts. The favor trading, the hopeless conflicts of interests, the biased rent seeking rationales for most of their decisions will never see the light of day.

Doctors should start a legislative movement to end all confidentiality privileges of judges and lawyer, including the lie promoting client-lawyer privilege. The judges are public officials. Their discussions are paid for by the public. The public is retrieving its own property from the land pirates.

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.