Reporting bad doctors seems like a pretty simple task.
Why then, is physician peer review seemingly inept?
Bob Wachter comes up with some theories, including the fear of litigation. Although doctors who perform peer review are supposed to be legally immune, many hospitals have little faith in these protections. As Dr. Wachter concludes from an analysis of the National Practitioner Data Bank, “these protections must be unambiguously robust,” but in most cases, are not.
Emergency physician Shadowfax, blogging over at MedPage Today, comments that the punishment for infractions, despite the degree of severity, is uniform. In other words, simply being in the Data Bank makes a physician unemployable. “And that’s why it’s shunned – it often seems unjust,” he writes. “There’s no proportionality, no way to indicate the gravity of the transgression, because the full details behind a report are screened from view . . . An isolated mistake or an episode of poor judgment is impossible to distinguish from incompetence, as both are filed as ‘quality of care deficiencies.’ When the only punishment is the ultimate one, it’s no surprise that medical staffs are loathe to invoke it.”
Doctors are often criticized for their inability to self-regulate. I recommend reading these two pieces in their entirety to find out why.
Related posts:
- "A stunning look in to the world of peer review"
- Reader take: Peer review as potential courtroom evidence
- Can a doctor sue a patient for a negative online review?
- Utilization review doctors
- Adopting hospital quality measures too quickly can harm patients
- Medical mistakes
- Restricting resident work hours forces doctors to lie, and other unintended consequences of the 80-hour work week
{ 3 comments }
Kevin, for well over four years, I’ve been blogging about my experience as a public-servant/whistle-blower crap-canned by my hometown hospital for intervening in a bad-baby case (saving the child’s life) . . . and REPORTING it to peer review.
It’s the REASON I’m in the blogosphere!
My practice was decimated, I was black-balled, and I fell into an on-going legal black hole – where wrong is right and down is up – because every law we have favors the hospitals/suits that pull these stunts.
Doctors have little to no recourse. The establishment KNOWS it – and they have turned a deaf ear!
I’ve been treated like dirt for even trying to fight back – called every name in the book – even in the medical blogosphere.
The general public has NO CLUE as to what really going on in medicine. Hell, many doctors don’t. Not really. Most live in their won bubbles. It’s a big part of what’s wrong.
Try the following post on for size. Read the links in it. Then tell me I don’t have the right to be angry & bitter about a system that DOES NOT WORK: http://drjshousecalls.blogspot.com/2009/06/north-carolina-medical-board-needs-to.html
Here’s another link: http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=147405
And another one: http://www.post-gazette.com/pg/03299/234499.stm
The medical blogosphere is LATE to the peer review party.
So NO doctor on the NPDB has a job? Be serious.
And unless you can point to a case showing the immunity has been put aside that’s a weak excuse. And if there is, then have your lobbyists strengthen it.
These are some pretty lame reasons for clamming up when you know a physician shouldn’t be practicing.
Matt, I suggest you go back and READ about my experience on “Housecalls” before you talk about LAME reasons for “clamming up”.
I expect my life & career would have gone a lot smoother if I had done exactly that – if I had rolled over and gone back to sleep. I’m the poster-child for WHY most doctors keep their heads down and their mouths shut.
My enemies were stupid. I was “only” fired when I blew the whistle. So I’m not in the NPDB. But I have spoken to a number of physicians who say they’ve been the victims of “bad-faith peer review” (many targeted by competitors and/or for whistle-blowing). And they ALL say the same thing:
With regards to the NPDB, if you have a job and manage to keep it despite disciplinary action (and it’s actually MORE about being listed because of a hospital’s disciplinary action rather than because you’ve been successfully sued) . . . or you are self-employed . . . and you don’t move . . . there’s not a whole lot to worry about.
BUT (very seriously) if you lose your job, getting another one – anywhere – is a whole nuther story. Being in the NPDB can be the kiss of death.
Peer review is supposed to be about correcting behaviors and rehabilitating doctors – if these things can, in fact, be done. Too often it is used as a weapon to crush and destroy very good people.
And the “immunity” it enjoys often serves to protect the WRONG people.
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