Tuesday, September 1, 2015

Physician, police thyself!

OK, I can’t possibly let this one go.

New York Times, today, the Opinion Pages: When Bad Doctors Happen to Good Patients (http://nyti.ms/1JvPsyX). These two guys, Thomas Moore and Steve Cohen… well, maybe they were dropped at birth or beaten by the nuns at catholic school or didn’t get vaccinated, I don’t know, but they are not purveyors of peace and love between all beings. Here is a sampling of the things they say:

“Doctors and hospitals are doing a poor job of policing themselves, yet they have been successful at keeping anyone else from doing it.”

“When juries do award large pain-and-suffering amounts, it is because that is the only way our system allows people who have been grievously harmed to recoup some measure of what they have lost.”

“Don’t limit what injured people may collect, and don’t make it more difficult for victims to get their cases heard.”

“As long as hospitals and doctors block legislation and fight regulation, patients will remain in peril.”

“The greater shame is that hospitals don’t put more emphasis on patient safety.”

You get the gist. The comments section pretty much says everything I would say about all this, except for one thing, one sentence of reason in a sea of nonsense:

“Even better for all concerned, keep the negligent act from ever happening in the first place.”

Let’s forget for a moment the most salient part of this statement from Moore and Cohen’s viewpoint, which is that it would most definitely not be better for THEM. The truth is that it would, in fact, be better if we could prevent medical errors from happening. Very rarely is an error the result of one “negligent act”. Virtually nothing that happens in hospitals is the result of the unilateral action of one person. Let the comments on the OP-Ed piece tell that story.

But let’s imagine, just for now, that patients are harmed by the individual negligent acts of doctors, so-called Bad Doctors. There are Bad Doctors out there. They’re generally not evil, just incompetent. They exist. Everyone who works with them knows who they are. And the medical profession hasn’t been great at preventing incompetent doctors from practicing. I’ll give the lawyers that one.

The thing is, doctors are not created in a vacuum. Doctors are created from medical students and residents. Medical students and residents are, or are supposed to be, closely watched by senior doctors, whose job is not only to teach them but to evaluate their skills. It is a well-known trope among young students that medical school is hard to get into but once you’re in it’s virtually impossible to get kicked out. The same goes for residency. Residency directors will go to great lengths to get poorly-performing residents through their program of training. It is, of course, very hard to tell a young person who has invested so many years of their lives that they have to go find some other line of work. In sports the natural process of sorting out incompetence happens all the time: If you win you’re in, if you lose you find another job. It’s true in business as well. In medicine, once you’re in you’re pretty much in.

Once that under-performing resident is released into the world, they can’t be taken back. They’re launched. They’re doctors.

Suing more doctors for more money will not prevent incompetence. It hasn’t yet and people have been suing doctors for a couple hundred years. If there needs to be a weeding-out process, or a “policing” process, perhaps we need to focus our efforts earlier on in the educational process.

Courtesy of  http://www.medpagetoday.com/PracticeManagement/Medicolegal/53341?isalert=1&uun=g906366d4491R5793688u&xid=NL_breakingnews_2015-09-01


  1. The bill is named after Lavern Wilkinson, a Brooklyn woman whose curable form of lung cancer went untreated when doctors at Kings County Hospital failed to alert her to a suspicious mass noted on an X-ray taken three years earlier. Ms. Wilkinson died, and her daughter was barred from bringing a lawsuit against the negligent hospital because in New York a victim has only two and a half years from the time of the medical mistake in which to bring an action, not from the time the error was discovered or should have been discovered. The latter standard is the law in 44 states, and Lavern’s Law would have adopted the provision in New York.

    Hospitals are dangerous places. In 1999 the Institute of Medicine at the National Academy of Sciences published a study, “To Err is Human,” which concluded that at least 44,000 patients were killed (and many more injured) in hospitals each year because of medical errors...

    The opposition to Lavern’s Law came from the hospital and health care lobby, apparently concerned that the bill might result in more medical malpractice lawsuits. It very well might, but the actual number would probably be minuscule: Of the hundreds of possible cases we evaluate every year, only a handful are outside the statute of limitations. But it is still hard to tell those victims that neither we nor the judicial system can help them.

    Surprisingly, despite the frequency of avoidable errors, very few wind up as medical malpractice lawsuits. A 2013 study concluded that about 1 percent of medical errors resulted in a claim. Only a tiny percentage of malpractice cases result in doctors’ hospital privileges being curtailed...

    And even if a victim wins a medical malpractice lawsuit, awards are generally modest. Thirty-three states restrict the amount of compensation for the pain and suffering victims have endured...

    Doctors and hospitals must do a better job of policing themselves. Six percent of all doctors were estimated to be responsible for 58 percent of all malpractice payments between 1991 and 2005. State licensing agencies must do a much better job of keeping those worst of the worst out of hospitals. The threshold for state medical licensing agencies to initiate reviews should be reduced; in New York it takes six malpractice judgments or settlements. It should be three at most.


  2. Tort reform is a huge issue among healthcare professionals, particularly physicians. It could ease the costs associated with medical practice and unnecessary tests. But if medical liability is reformed, who will police physicians? Can surgeons police surgeons? ...

    There are efforts to improve quality and reduce deaths and injury to patients, but are those efforts really making an impact on every-day decisions?

    A separate study in 2013 concluded that only 1 percent of medical errors result in claims and only a small percentage of malpractice cases result in curtailing physicians' privileges at hospitals. Medical societies don't always take away the physician's license; according to the report, in New York, less than 4 percent of the complaints filed resulted in serious sanctions like losing or suspending the physician's license in a state that requires six malpractice judgments or settlements before the state medical licensing agencies initiate license reviews.

    There have been multiple high-profile cases of spine surgeons who lost their licenses, but only after their records became egregious. Even then, some were allowed to continue.

    Neurosurgeon Aria Sabit, MD, for example, was forced to surrender his license in California after a patient he operated on died from postoperative complications. However, he moved to Michigan and continued practicing until he was accused of billing for spinal fusions he didn't actually perform and performing medically unnecessary procedures.

    In another case, Atiq Durrani, MD, who practiced in Ohio, had his licensed suspended after multiple complaints from his patients that were "buried by the hospital for financial concerns," according to a WCPO report. He performed surgery in Butler County from 2010 to 2013 and now has 285 lawsuits filed against him...

    Can surgeons and healthcare providers effectively police their colleagues? Can medical societies take the reins and revoke licenses before horror stories commence? With more data collected in healthcare about complications and malpractice — and that data being published and used in payment decisions — it will be harder to slip through the cracks.

    But for now, who's watching?