Saturday, November 6, 2010

Some Thoughts Re: Essentials of a Good Peer Review Process

This posting will only be appreciated by those who believe in the necessity of a good-faith and healthy peer review process in order to improve the medical care of the patients and the community.  That is what every conscientious physician supports.  Physicians and surgeons should be more assertive in seeking constructive peer review practices in their hospitals.  Before engaging with a hospital, physicians ideally need to know how the peer review process works.  Asking for a copy of the Bylaws early on may give a hint.  I wish there were an on-line resource that identifies hospitals that have an on-going healthy educational peer review processes .  One should probably avoid hospitals that do not employ the peer review process under any circumstance other than punishing or eliminating a physician.  

In my opinion, a good peer review process should be:

1.  On-going and continuous.
2.  Applying the same level of chart reviews and scrutiny to all physicians in an institution, fairly.  Initiating chart reviews against only one physicians based on some triggering statistical analysis is discriminatory.
3.  Used to educate, and to prevent recurrence of problems
4.  Transparent and involving all clinicians/providers.  All providers should be both active participants of reviews as well as being reviewed.  Every surgeon's problem cases should be reviewed.  Every surgeon/physician should be treated with the same level of collegiality.  The goal should be to improve the care of patients by all providers.

If need to, for cases where the staff may not reach a conclusion in a particular case, it may be a great idea to selectively use the services of a reputable external review service, or approach the nearest University Medical Center to see if they have staff that is willing to perform an external review.  Such a service should be used primarily for education, rather than to make a case against an individual provider.

Hospitals whose only application of the peer review process is to restrict or revoke the privileges of  select physicians should be identified and be known to the public.  Physicians should avoid seeking privileges in, practicing in, or being employed by, those hospitals.  Those are not quality-seeking institutions, but, rather, physician-victimizing and punishment systems that could be unfair and probably should be avoided.

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