Monday, May 23, 2011

Peer Review Reform (1) - Need objective criteria for Career Capital Punishment

All the discussions everywhere indicate that we have a very flawed medical peer review system that lacks so much that it could be more harmful than beneficial.  Coupled with the National Practitioner Data Bank, the combination draws the picture of an unpredictable monster.  Let's start thinking of reforming the process, and finally having a set of guidelines that can be promoted for a proposed solution.

First of all, I do not know if there is anyway any set of hospital bylaws, policies and procedures can strike the right balance between the interests of the public in being protected from the rare dangerous provider, and being fair and impartial to the provider.  In fact, I do not think that any set of bylaws can be ganging-up proof.  Let's face it, even when a hospital clearly breaches its own bylaws, it takes so much litigation, resources and time to seek remedy that the victim may become exhausted or ruined while justice is taking its slow-paced process time.  The victim may succumb before any remedy.  Then there will be appeals, counter-appeals.  Essentially, even winning entails so much loss.

Therefore, my biggest idea for today is that a reform should set rules as to the exact conditions under which the extreme measure of restricting or diminishing a physician's privileges should be considered.  That is my one focused idea for today.  The subjective criteria do not work too well.  For example, what could be not acceptable by the one medical staff in small hospital A (eg, for financial or reputation reasons) and portrayed as being a danger to the patients, may be very well a reasonable expectation of the average practice in hospital B.  Hospital A may be essentially protecting its financial bottom-line by discouraging its providers from treating sicker patients (who normally would have higher incidence of complications by nature of their disease) under the disguise of quality and avoiding complications.  So, hospital B should really not be bound by an adversarial decision against a physician whose privileges are revoked or reduced in Hospital A.  Hospital B should be willing to accept that physician to practice, particularly he/she is willing to and is experienced in treating more complicated medical problems .  But, the reality is that once Hospital A made their decision, and that is reported to the National Practioner Data Bank (NPDB), the regulators in Hospital B system (not the professionals aka physicians) may not even give that physician a chance to be considered.  In essence, a physician's fault may not be what she/he did, but where that physician practiced.  This is because really there are no critera as to when to apply the death penalty (career capital punishment) to a physician's career.

So, my plea is that the major career-destroying disciplinary actions must be considered as serious decisions and therefore there has to be clear and objective (not subjective) criteria before applying them to a certain physician as a last resort.

1 comment:

  1. Icompletley agree. But a statute is like a strict recipe to a lawyer. It it is not there then it is not there.
    HCQIA is everything. There is an abosence of any statutory requirement for objetivity. If their was a legistaltive wish to apply an obkecctive test, it would be specified. Apparently the lobby that wrote the law did not want to be restricted by objectivity.