Black Box in the Operating Room

[PL198]

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That makes zero sense to me. Proportionality would argue that the level of harm inflicted should dictate the level of punishment that results.

Really? So if someone does a tiny amount of negligence but the patient dies, that's worse than if someone was extremely grossly negligent, but someone else caught it and the patient was fine?

 

[Tired]

I'd also like to point out that licensing boards aren't the sum total of our self-policing. We also have specialty boards and hospital privileging, the latter of which typically requires some sort of peer review. Add to that malpractice torts, and we have an additional - albeit extrinsic - layer. So, it's not exactly telling the whole story to just point to a licensing boards actions and point out how weak they typically are. They're not the only cog in the machine. So for all those strongly worded letters, how many of those physicians lost their job? Had their privileges curbed? Now have to be supervised for certain procedures? Were required to undergo additional or re-training? Had to pay out a big malpractice settlement? And while there's some redundancy in the different tiers, I see the licensing board primary functions as 1) provide the public a direct method of accountability that falls short of a tort and 2) to lend legal teeth to sanctions that hospitals/insurance companies cannot provide.

That's fair, and yes, there are other layers of physician-led peer discipline. The difference, of course, is that other than the licensing board these extra layers are not public. The lack of public disclosure may have good reasons behind it, but the end result is a fairly opaque process for our patients and the perception that all we do is cover up each others' mistakes. It also facilitates the phenomenon of bad physicians traveling from one location to another, along the lines of child abusing priests. I'm continually amazed at how many hoops drug or alcohol abusing physicians are made to jump through to keep their license (and rightly so, of course), but how few requirements the boards impose on negligent physicians.

The starting point of this discussion was the off-handed remark by another poster that "all malpractice attorneys are scum" or something along those lines. I continue to believe that they serve an important role, and are a key element for patients to "find out what happened" when something goes wrong. Given how many board and hospital actions are precipitated by malpractice actions, one could almost argue that are necessary to a functioning supervision system of physicians.

 

[Tired]

Really? So if someone does a tiny amount of negligence but the patient dies, that's worse than if someone was extremely grossly negligent, but someone else caught it and the patient was fine?

lurk moar

 

[DermViser]

That's fair, and yes, there are other layers of physician-led peer discipline. The difference, of course, is that other than the licensing board these extra layers are not public. The lack of public disclosure may have good reasons behind it, but the end result is a fairly opaque process for our patients and the perception that all we do is cover up each others' mistakes. It also facilitates the phenomenon of bad physicians traveling from one location to another, along the lines of child abusing priests. I'm continually amazed at how many hoops drug or alcohol abusing physicians are made to jump through to keep their license (and rightly so, of course), but how few requirements the boards impose on negligent physicians.

The starting point of this discussion was the off-handed remark by another poster that "all malpractice attorneys are scum" or something along those lines. I continue to believe that they serve an important role, and are a key element for patients to "find out what happened" when something goes wrong. Given how many board and hospital actions are precipitated by malpractice actions, one could almost argue that are necessary to a functioning supervision system of physicians.

Yeah, except in cases where it's not worth taking on due to states with malpractice caps. "Find out what happened"? You've got to be kidding me.

 

[Tired]

Yeah, except in cases where it's not worth taking on due to states with malpractice caps. "Find out what happened"? You've got to be kidding me.

So you just pretty much form all your opinions based on emotion and GOP press releases, huh?

 

[colbgw02]

That's fair, and yes, there are other layers of physician-led peer discipline. The difference, of course, is that other than the licensing board these extra layers are not public. The lack of public disclosure may have good reasons behind it, but the end result is a fairly opaque process for our patients and the perception that all we do is cover up each others' mistakes. It also facilitates the phenomenon of bad physicians traveling from one location to another, along the lines of child abusing priests. I'm continually amazed at how many hoops drug or alcohol abusing physicians are made to jump through to keep their license (and rightly so, of course), but how few requirements the boards impose on negligent physicians.

All true, and it doesn't help that hospitals frequently consider it safer from a liability standpoint to simply let a bad physician go, rather than initiate the processes to remove him from practice. But overall, as a profession, I think we do a pretty good job. And I'm very hesitant to hand over more power to the State, particularly because we already work in the most highly regulated field there is.

 

[DermViser]

So you just pretty much form all your opinions based on emotion and GOP press releases, huh?

No, when lawyers say they won't take a case bc of a malpractice cap, and would have taken the case before the cap was put in place - that tells me how much they care what happened?

 

[Tired]

All true, and it doesn't help that hospitals frequently consider it safer from a liability standpoint to simply let a bad physician go, rather than initiate the processes to remove him from practice. But overall, as a profession, I think we do a pretty good job. And I'm very hesitant to hand over more power to the State, particularly because we already work in the most highly regulated field there is.

I do really respect the makeup of my state board. Despite it being full of political appointees, the members are all senior respected physicians and highly educated laypeople. All my interactions with them have been very positive, and they seem very responsive to the needs of physicians in our state. They have also taken a very strong stand on requirements for supervising mid-levels, which anecdotally was a big problem when I still lived there. They also started a statewide "high risk prescription users" database, which helped me enormously before I left the state. I have nothing but respect for them.

I just wish they would take some of the issue of substandard care a little more seriously than they seem to do. Every quarter it seems like if you sleep with a patient or get a DUI your license is suspended for 6 months minimum, but if you kill a patient with negligence you get a letter. If it makes me feel uncomfortable, I can only imagine what the general public thinks.

 

[TooMuchResearch]

I wasn't being sarcastic either. It's a serious question. Who defines standard of care - the medical board or the specialty society?

The "expert witness" and "jury of peers" define the standard of care. Specialty society backing of a certain plan of care may give some attorneys pause before taking a case, but it won't stop the standard from being defined in court.