For an introduction to SPR, click here. For a history of SPR, click here. To learn how to distinguish real vs. sham peer review, click here.

We don’t hear about SPR as often as it occurs because those who have experienced it have likely signed nondisclosure agreements or self-isolated in shame after being ostracized by an institution built upon helping others. Victims commonly blame themselves when it’s often their own excellence that led to the experience. 

If it wasn’t made clear already, the fallout of SPR is brutal. Victims discuss being extremely emotionally and psychologically destabilized as the culmination of lies and gaslighting makes them question their own identities and competency. Effects can be long-lasting through post-traumatic stress disorder. Materially, SPR is often career-ending, contributing to the massive doctor shortage by eliminating competent medical practitioners for non-medical reasons.

What’s most disturbing is that rather than facing differences of opinion, philosophy, or strategy head-on or telling the truth about budget cuts, competition, or feelings of scarcity, undermining another’s character is chosen as an “easier” route to banishing a colleague from a work environment, or medicine altogether. Yet it is precisely a lack of character, integrity, dignity, and respect for human life that empowers individuals to make false claims against another colleague in good standing. It is physicians’ lack of emotional intelligence and conflict resolution skills that leads to unethical practices that degrade the lives of humans who have dedicated their lives to improving those of others. The qualities of perfectionism and dogged competitiveness, which we are encouraged to embody to break into the medical field, end up destroying us. 

We must revamp the medical selection process, as well as medical education and training, to include content that incorporates trust-building, boundary-setting, empathy, and shame resilience to overcome the lack of psychological safety driving so many unethical practices in medical culture. 

If you suspect you may be a target of SPR, read through these tips:

• Live by the Golden Rule: Treat others as you’d like to be treated. If you step out of line, own it, apologize, and repair it. This means being accountable for your behavior and taking steps to rebuild trust with the person you hurt when you were acting out of your integrity.
• However, being acquiescent and trusting within a suspected SPR can lead to self-sabotage rather than a peaceful resolution.
• If you sense you may be in an SPR, believe yourself. Even if you’re being paranoid, it’s important you protect yourself. 
• Don’t go to human resources or the Medical Executive Committee (MEC). They protect patients and the institution, not you. On the contrary, they often retaliate against those who report to them for support. Instead, read and learn medical staff bylaws. Know that the MEC can change them, so stay on top of them. Know the members of the MEC, remembering that even members of the MEC have been victims of SPR by their own committees.
• If you’re told you don’t need an attorney or one won’t be allowed at a peer review proceeding, consider this a sign that you must consult and retain an independent lawyer knowledgeable about SPR who can protect your rights. 
• Hire a lawyer early in the process to grant you perspective and help you maintain truth in the face of profoundly destabilizing gaslighting. You may be conditioned not to trust lawyers, but in these cases, they are often more trustworthy than the medical system you’re working in.
• Specifically, hire a health care lawyer, not a malpractice lawyer. Consult the bylaws, but know your legal civil rights as they matter, even in a health care setting.
• Record all meetings with your phone or an AI device and save them.
• Should your case end up in court, have a court reporter keep a record of any peer review hearings.
• Make copies of all emails and text correspondences before, during, and after SPR.
• Under no circumstances should you resign while there’s an open or ongoing investigation. This is because you may be reported to the National Practitioner Data Bank (NPDB) even after you leave. If you’re reported to the NPDB, the only person who can remove the report is the person who submitted it. Ensure any legal action taken includes provisions to keep you from being reported. Though not always, many who have been reported have been blacklisted from practicing medicine in the US.
• Contact Physician Just Equity (PJE), a collaborative organization providing confidential peer support for physicians/surgeons navigating workplace conflicts while also advocating for optimal patient care and necessary institutional change through education, research, empowerment, and advocacy—”Championing a Balanced Resolution”—mitigating injustices through the collective wisdom of those who’ve personally experienced injustice.
• The Association of American Physicians and Surgeons (AAPS) is the only national medical association helping physicians fight back against sham peer review. They can be contacted by phone at 1-800-635-1196 and also have a hotline for sham peer review: 719-627-7759.
• Dr. Lawrence Huntoon of the AAPS recently wrote about filing a lawsuit for intentional or negligent fraud. A physician cannot obtain punitive damages on a breach of contract claim but can obtain punitive damages on a fraud claim. 
• Read Aysun Alagoz’s memoir, The Medical Matrix: One Physician’s Story Maneuvering the Minefields of Medicine. It chronicles her lived experience and provides in-depth assistance and survival strategies for those navigating SPR and its consequences.
• Seek support and advice from others outside of your practice or institution. Unbiased, not-for-profit organizations such as PJE provide emotional support, wisdom, and non-legal advice in a psychologically safe way. Confidential support from peers who have been through SPR is invaluable. 

Currently, no reliable methods exist to protect anyone from SPR other than going outside the medical system, on your own time and dime, to seek counsel. It’s up to you to protect your own integrity, sanity, and self-respect. It’s on all of us as physicians to do the work, challenging and vulnerable as it may be, to reach a future where SPR is no more.  

Tracey O’Connell is an educator and coach who fosters positive self-worth, psychological safety, emotional intelligence, and shame resilience among physicians, teens, and LGBTQ+ individuals. She is a certified facilitator of expressive writing programs and Brené Brown’s research. Her change of direction came after many years of feeling “not enough” as a person, physician, parent, or partner. Tracey has found that expressive writing allows us to access our true selves, helps us gain self-trust and self-compassion, and ultimately leads to a more authentic and wholehearted way of belonging in the world. She is also an advocate for universal, affordable, fair, safe, and equitable medical access, education, and practice. Since 1992, she has lived in Durham/Chapel Hill, NC, where she began her medical career in radiology and musculoskeletal imaging, training at UNC-Chapel Hill and Duke University.

She can be reached on her website, LinkedIn, Facebook, Instagram @fertile__soul, and YouTube.