Wednesday, December 05, 2007

Policing Medicine

By now, nearly everyone has heard the question; “What do they call the person who graduated at the bottom of his medical school class?” and the answer; “Doctor.”

In other words, not all doctors are of equal competence and, being human beings, a few of them are incompetent – even dangerous. Because of the power they have over the lives of their patients, it is important that there be some protection against them.

Historically, that has been considered a part of medicine’s professional responsibility. It was expected that doctors as a group would identify those among them whose performance was unacceptable and do something about it.

That expectation took a hard hit in a survey recently reported in the Annals of Internal Medicine (The Boston Globe, December 4). Of the physicians who responded to the survey, 45% “Had direct personal knowledge of a physician in your hospital, group, or practice who was impaired or incompetent, and did not always report the physician.”

Dr. David Bates, chief of general internal medicine at Brigham and Women’s Hospital was quoted as saying he was surprised by the result. He shouldn’t have been. Every hospital administrator knows better than to count on medical staff support when dealing with a problem physician.

It has been that way for as long as I can remember. What is new is public concern about safety in health care and recognition of the important role of physicians.

Which raises the question; if the medical profession cannot police itself, who should do it?

I can imagine only two candidates. One is the medical licensure agency of the state and the other is hospitals.

Most state licensure agencies are trying, but their procedures, being legal in nature, are time-consuming and cumbersome. Dangerous physicians need to be dealt with now, not at the end of a tedious legal procedure.

Which leaves hospitals.

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