Friday, October 1, 2010

Eliminating Experienced Surgeons Utilizing Hospital Peer Review Processes

Good doctors are sorely needed. Experienced surgeons are needed by so many communities. Unfortunately, some of those who can serve you very well are being eliminated from practice by peers, for varying reasons. Often times the reasons are political or economical, and the easier (though malicious) way is to use the hospital peer review process to eliminate them.

Here is how it works.  Almost always, those physicians/surgeons who are willing to take sicker patients and, therefore become experienced in treating higher risk patients, will have a higher incidence of complications than those who choose to treat only less complicated cases.  Bingo! This applies to surgeons in particular.  In a hospital environment that is hostile to a certain surgeon, such a higher rate of complications comes quite handy to trigger a peer review. They may even use fancy (but not totally reliable) statistical models to show that they stratified for the higher risk, and found that the particular surgeon's rate of complications is "unacceptably" higher than the norm.  Notice that treating sicker patients can cost a hospital more money, particularly if the patient is uninsured or has an insurance that does not pay well.  So, a peer review would be initiated to address "concerns" about the practice of that particular doctor. The final outcome of the peer review process cannot be simply letting the physician/surgeon go to look for practice elsewhere.

The way the punitive quality assurance system in the US is set up mandates reporting adversarial and disciplinary actions to the National Practitioners Data Band. The regulations in the US, do not require whatsoever any constructive peer review process, which is not fair to the patients nor their doctors.  Anyway, if a hospital administration or the powerful staff of a hospital gang up to eliminate a doctor, and they play the sham peer review game right, they probably have no choice but to destroy the career of that physician and remove the shammed doctor from practicing altogether. That surgeon cannot practice almost anywhere.  As a result, the community at large is deprived from the services of a surgeon/physician who has more experience, and whose services are therefore more valuable, than the peers. When such experienced surgeons are eliminated, you are left with the newbies or those who evade doing surgery on difficult cases.

Dear patient, there is a pressure in some hospital environments that doctors avoid treating your complicated issues and sending you elsewhere. Even if there is an experienced physician/surgeon on staff, such an expertise will not be appreciated and may very well be harshly punished in a sham quest for "quality".

Monday, September 27, 2010

The National Practitioner Data Bank - Information Could Be More Damaging Than Reliable

The National Practitioner Data Bank (NPDB) is like an amplification system to announce to the world, without checking the fairness or integrity of the source, that a physician has a problem and that a disciplinary action has been inflicted.  Have you heard of guilty till proven innocent?  Here, there is even no chance to prove innocence.  Guilty, period!   The problem is that the peer review process in the hospitals is so flawed that it does not measure up to a proper “due process”.   You may very well be denied the right to the equivalent of an impartial jury.   As mentioned in another post, it is quite possible to manipulate this process and to end up in an unfair disciplinary action even though a physician or a surgeon might be completely competent or even better than the rest. I call it, voting someone out in an elimination game.  Despite the shaky standards of the process, the results are considered valid and the law obligates a hospital to report the damaging information to the National Practitioner Data Bank. Essentially, any hospital or competitors who have the power and lack of integrity as to inflict an adversarial action against you as a physician, will also have the ability (actually by law, the obligation) to report you to the National Practitioner Data Bank, which would make such damaging information available to other health authorities, hospitals, etc.  No one would second-guess the reasons of the damaging information or disciplinary action, and to be on the safe side, everyone will avoid you like the plague.  You cannot be hired or employed anywhere else unless someone is willing to stand up for you against the odds. All that started as a result of a process that can easily be abused against anyone who practices medicine, particularly invasive procedures like surgery, cardiology, radiology, etc.  To provide an efficient mechanism of  spreading damaging information about physicians (that is, NPDB) while having loop-holes and loose criteria of incriminating a doctor in a hospital peer review is nothing short of defaming. When quality improvement means carrying a whip or assassinating a career rather than creating an environment of transparency, openness and constructive auditing, I hope you all realize that we, in the US, have a serious problem.  This is a harsh punitive and potentially vindictive environment, not a constructive one.

Physician Suicide -Is It More Common Than the General Population?

I came across an article by Drs. Randy Sansone and Lori Sansone on that addresses the question, whether suicide rates among physicians are any higher than the general population.  It appears that, in general, suicide rates among physicians are higher than the population at large. They have also given some insight as to the possible reasons, although it is difficult to know for sure the exact predisposing factors. 

Physician Suicide: A Fleeting Moment of Despair
By Randy A. Sansone, MD, and Lori A. Sansone, MD
Psychiatry (Edgemont) January 2009;6(1):18–22
Dr. R. Sansone is a professor in the Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, Ohio, and Director of Psychiatry Education at Kettering Medical Center in Kettering, Ohio; Dr. L. Sansone is a family medicine physician (government service) and Medical Director of the Primary Care Clinic at Wright-Patterson Air Force Base. 

On another note, a physician has mentioned that suicide rates are also higher among physicians subjected to disciplinary actions out of the dreadful peer review processes. My comment:  If that is true, then the peer review may not result in the death sentence to a physician's career and means of living, but may even lead some to end their own lives. Unfortunately, a punitive culture is more prevalent than a constructive-minded culture.  Despite that burden, the process is very much flawed and is very much open to exploitation and abuse.