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.