Court Case Weakening Peer Review

[miacomet]

Sorry, Gamer, but PA is a medmal hellhole. Wondered if everyone has read this, and what your opinions are:

Lessons Learned from Court Case that Weakened Peer-Review Protection - ACEP Now

I'm employed and work in a state with great protections. Others may not be so lucky....

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[southerndoc]

I saw this a few weeks ago. State laws will dictate how peer review is protected in each state.

 

[NYEMMED]

This is a bad precedent.
Nobody will investigate and form solutions through peer review if if can be used against you

 

[namethatsmell]

Yeah this makes sense.

Why let the spirit of the law prevail over a technicality?

Just some more proof that our med-mal system is about money and not justice.

 

[Mr.S]

peer review is different from performance evals is diff from Morbidity and mortality conference

 

[deleted497653]

peer review is different from performance evals is diff from Morbidity and mortality conference

None of them should be accessible to plaintiff lawyers during a lawsuit.

 

[southerndoc]

None of them should be accessible to plaintiff lawyers during a lawsuit.

M&M presentations have been held as not protected in court before.

 

[deleted497653]

M&M presentations have been held as not protected in court before.

I didn’t know that.

Outside of academic settings, such as residency, are M&M conferences required for hospitals? At my non academic location, they are held monthly.

Also wanted to add from personal experience and unrelated. My only peer review was originated by someone who didn’t like me. My site director for the most part acted like peer reviews are harmless but this thread is making me think I was right, peer reviews are sometimes used for unintended consequences.
I’m also surprised at how quickly people suggest you submit something for peer review, like it’s something to utilize whenever you don’t like how a case went.

 

[southerndoc]

As someone who sits on a peer review committee and who does peer review for a state medical board, submitting for a peer review isn't in itself a bad thing. Most cases are deemed appropriate. Some have letters send for opportunities for improvement. Some are deemed by the committee to be inappropriate. Some are aggregious, some are grossly negligent. Most of what a peer review committee is for is to tease out patterns. If every doc is having a case peer reviewed because they are missing vital signs at discharge, then clearly that is a system issue that needs improvement. Without reporting it, it will never get addressed.

Most states recognize M&M conferences as continuing education conferences. Most hospitals even open them to outside attendance. Regardless, because it's usually involving CME, then it's usually not protected from the courts.

 

[MechEDoc]

Outside of academic settings, such as residency, are M&M conferences required for hospitals?

M & M conferences do not appear to be required. In 2+ years of working in firefighter positions, locums, and a permanent position only one facility had M&M conferences. That one appear to be largely dysfunctional and was opportunity to review any and all complaints. Approximately 90% of them were garbage that should've been addressed with a simple email from the medical director. Not sure what was up with it, however it seemed to be the local culture.

My only peer review was originated by someone who didn’t like me. My site director for the most part acted like peer reviews are harmless but this thread is making me think I was right, peer reviews are sometimes used for unintended consequences.

All of my colleagues that have been subjected to peer reviews (at least those that I know of) have been for for pretty suspect reasons. In the first, a nasty consultant made false allegations and referred someone to peer review. The ED physician was rather annoyed because in her view the consultant was blatantly lying. Other physicians had similar encounters with the consultant, however as he brought in a significant amount of money to the hospital and has significant political capital within the institution there never seemed to be blowback to the individual. The next two peer reviews I know of involved upset individuals trying to cast blame on another physician by preemptively sending a case to peer review and an attempt direct the narrative from the beginning and to deflect their involvement (and failings).

Via hearsay I only know of one peer review that seemed legitimate. Your mileage may vary, however I have a pretty jaundiced view of the peer review process.

Peer reviews are not a benign process, can easily be used for vendettas, and can affect your career.

 

[namethatsmell]

M & M conferences do not appear to be required. In 2+ years of working in firefighter positions, locums, and a permanent position only one facility had M&M conferences. That one appear to be largely dysfunctional and was opportunity to review any and all complaints. Approximately 90% of them were garbage that should've been addressed with a simple email from the medical director. Not sure what was up with it, however it seemed to be the local culture.



All of my colleagues that have been subjected to peer reviews (at least those that I know of) have been for for pretty suspect reasons. In the first, a nasty consultant made false allegations and referred someone to peer review. The ED physician was rather annoyed because in her view the consultant was blatantly lying. Other physicians had similar encounters with the consultant, however as he brought in a significant amount of money to the hospital and has significant political capital within the institution there never seemed to be blowback to the individual. The next two peer reviews I know of involved upset individuals trying to cast blame on another physician by preemptively sending a case to peer review and an attempt direct the narrative from the beginning and to deflect their involvement (and failings).

Via hearsay I only know of one peer review that seemed legitimate. Your mileage may vary, however I have a pretty jaundiced view of the peer review process.

Peer reviews are not a benign process, can easily be used for vendettas, and can affect your career.

If a case is presented solely because a specialist feels butthurt but has no real learning points for the group or a case is picked that involves one doc not recognizing something very obvious (ie clear stemi) then discussing those cases in a large group format is a waste of everybody's time and not a good way to deal with the actual issues at hand in those cases.

From my experience helping run peer review at a few places, a couple things increase the likelihood that something useful comes out of the process rather than have it serve as a witch hunt: the person running it reaches out to the doc involved to get their perspective and helps present that during the meeting, docs' identities remain anonymous when cases are discussed, and there's discussion and/or voting occurring before the outcome of the case is revealed.
The other big component is how the learning points of a case are framed. Useful approaches include a) helping to improve everbody's knowledge on rare but morbid/deadly things or treatment updates b) fostering discussion on how the group wants to handle/dispo common presentations or c) focus on the system issues at play and how they can be improved. If the learning point is "doc x is dumb and should read more"...you might as well hand out torches and pitchforks.