Saturday, October 9, 2010
The US health care system, in general, is fragmented. The way the system addresses concerns regarding a physician/surgeon's competence is no exception. There is actually no mandate to develop a constructive process with the aim of advancing individual providers' knowledge and competence and learning from bad outcomes. In the meanwhile there is a hospital peer review process that allows for arbitrary and capricious termination of a physician/surgeon based on a substandard process, the members of which have (a conditioned) legal immunity. That is the sham peer review as is all very well known among its victims. Finally, there is an obligation that a disciplinary outcome of such a process be reported to the over-rated dreadful National Practitioner Data Bank, which can be the worst defaming system against physicians, even though the intention has been noble. The National Practitioner Data Bank, being simply a reporting mechanism, has data that are subject to the rule "Garbage In, Garbage Out" (aka, GIGO) The integrity of the information any institution obtains from the National Practitioner Data Bank is purely a reflection of the integrity of the process that led to the actions reported to the Bank. Knowing that such a process that leads to reportable decisions is inherently open to corruption (sham peer reviews) makes relying on the National Practitioner Data Bank to eliminate prospective physicians from a position potentially dangerous, since it may very well eliminate an excellent physician that could very well serve an under-served community. The justified concern that bad doctors are not allowed to move from one state to another and from one hospital to another leads to a system that inflicts excessive collateral damage to good doctors, and may very well be eliminating sorely needed good physicians. Even worse, the recent data that bad doctors are generally under-reported highlights how poor the current system is. Since the outcome of reporting a doctor is so harsh, it is probably inflicted more on those who are not well-connected for one reason or another, and the worst doctors may still be protected. An excessively harsh system is certainly counterproductive and creates an environment that does not encourage transparency. As I promised, I will post describing the characteristics that are common among the victims of the sham peer review. I will also look for information as to whether other health care systems are more advanced when dealing with quality concerns and will publish my findings. The Comments section is open to initiate a constructive dialog as to how to improve the quality of the quality improvement system in the US.