The recent news about the two Northwest Airlines pilots whose licenses were revoked, less than a week after they let their plane wander 150 miles off course, raises the question: Where are the firing offenses in medicine?
The pilots injured no passengers, and the event didn't even qualify as a "near miss." But because they egregiously violated safety rules by working on their flight schedules on a laptop in the cockpit, the aviation authorities did not hesitate to pull their licenses.
In the medical industry, by contrast, it is well known that a doctor will lose his or her license for only flagrant patterns of drug or alcohol abuse or other criminal behavior, with a trail of dead and injured patients usually lasting years before the practitioner is finally put out of business.
Medicine's big safety emphasis in recent years has been to create a "no blame" culture that encourages reporting of errors, injuries and "near-misses" by promises of confidentiality and non-punitive action. The idea has been to bring systemic problems out into the open so they can be corrected by implementing "systems" changes, such as checklists to make sure all appropriate steps are taken to prevent infections when inserting catheters into blood vessels.
But what about a doctor who repeatedly puts patients in jeopardy, in small or big ways, by ignoring the rules? Many don't wash their hands routinely when they enter a patient's hospital room, and deadly infections sometimes get spread from patient to patient. Others don't "sign out" their patients at the end of a shift by a person-to-person encounter with the provider taking over.
Some surgeons still won't follow the now routine practice of "signing the site" to prevent wrong-site surgery. If the surgeon is a prominent "feeder" of patients to the hospital, such transgressions can easily be overlooked by administrators who don't want to lose the business. That helps explain why an estimated 4,000 wrong-site surgeries still are performed every year in the United States, more than a decade after the "sign your site" campaign by orthopedic and other surgical specialties.
The good news is that medical safety leaders are starting to call for accountability for rules violations. Dr. Robert Wachter of UC-San Francisco and Dr. Peter Pronovost of Johns Hopkins recently wrote about this in the New England Journal of Medicine. Comparing medicine to aviation (the article was published before the Northwest Airlines incident), they noted: "Every safe industry has transgressions that are firing offenses."
They proposed a short list of offenses in the hospital that should call for suspension of the doctor's practice for one or two weeks: failing to perform hand hygiene, skipping the sign-over to a new provider at the end of a shift, not marking the surgical site, and failing to use a checklist at the start of surgery to make sure everyone in the operating room knows the special needs of the patient. These penalties, they suggested, should only apply after the doctor has failed to respond to an initial warning and counseling.
These modest, tentative steps forward are proposed by the authors to their colleagues as a way of fending off intrusive government regulation. But they also say: "The main reason to find the right balance between 'no blame' and individual accountability is that doing so will save lives."
Amen to that.
http://m.naplesnews.com/news/2009/nov/01/former-employee-files-whistle-blowers-lawsuit-lee-/
The sad fact is that doctors who stand up for patients and stand in the way of corporate profits will be "fired"; those that assist corporate profits will be protected.
BLAKE MOORE, MD FACS CIME
President Semmelweis Society
I have worked in health care for quite some time. And just as there are some elders who are no longer competent to drive, there are elderly doctors who are no longer competant to practice. I have seen elderly doctors using out of date, less efficient drugs or techniques to treat a patient because "that's how they did it in my day." In other times, the doctor's memory and motor skills are significantly impaired. I have also personally had my former PCP, who was elderly, give me advice that I knew from my own health care experience to be very outdated and unsound.
Which isn't to say all elderly doctors aren't capable, just as there are elderly drivers who are still good drivers. But I do think this is a problem which needs to be addressed.
In most states, the highest court of appeals of the state has power to revoke attorney licenses. Some do a better job than others. But unlike medicine, everything happens out in the open, for the public to observe.
For patient advocates like me, the frustrating part of the medical discipline system is its secrecy and unresponsiveness. I filed a formal licensing complaint about a Maryland plastic surgeon who put a healthy patient into a permanent coma with a gross overdose of local anesthetic; two years later, I received a one-paragraph response from the state board that he had received a "private reprimand." No details available, because, after all, it's "private."
In another recent case, I complained to the Florida nursing board about a nurse-midwife whose overuse of the uterine-stimulating drug oxytocin caused the uterus to rupture and the baby to suffer terrible cerebral palsy. More than a year later, I received a one-sentence reply that the board had "failed to find probable cause."
In the law world, comparable incidents would have received at least a detailed explanation of why the licensing body was or was not taking action. That's what we should demand of any professional disciplinary system that respects the public's right to know.
Peer review *used* to be quite effective, but in institutions, when the bean-counters call the shots, that method has declined.
Since we are on the topic, may I ask what should be the firing offense for an attorney?
We need systems changes to reduce preventable errors and improve patient care. Those are making a difference now and as developed will do even more to save lives and lessen suffering.
But there is still a huge problem of incompetent or just plain sloppy doctors and other providers that contributes to the approximately 198,000 deaths/year from preventable medical error in hospitals alone. There are even more cases of errors that merely maim, disfigure or cause pain.
In one hospital in 2007 there were three surgeries where the doctors were drilling into the wrong side of the patient's head! Three times? Something is wrong here.
Malpractice insurers know that the biggest predictor of a claim was having had a previous claim. Studies show it's just a few doctors making a lot of mistakes that cause the problem. One study of CA ob/gyns found that just 7% of the doctors caused 93% of the claims. If they could get rid of the 7% the health of the patients would be improved and well as tremendous savings of money.
There are more ways to get rid of a bad lawyer if they are practicing law. Wall Street is different.