08/15/2008 12:04 am ET Updated Nov 17, 2011

Who is Practicing Medicine?

This is not a silly or trivial question. Practicing medicine without a license is dangerous, costly and illegal. Yet people do it thousands of time every day without getting caught.

Yesterday at our clinical conference, the big problem was Baby X. We had done our research and found an out of state Hospital (A) had the highest success rate (98%) with the heart procedure that the baby needed. The insurance company refused to authorize payment to Hospital A and was demanding that Baby X go to Hospital B. The Medical Director of the insurance company said that Hospital B had an excellent success rate (91%) and was considerably cheaper. They planned to schedule surgery for Baby X at Hospital B.

What if our baby is one of the seven -- 98 minus 91 -- who die at Hospital B but would have survived at Hospital A? Who is responsible? Who is accountable? What will the family think? Should they sue and if so, whom? Who is practicing medicine (and doing it badly)?

HIPAA (Health Insurance Portability and Accountability Act) was passed by Congress and implemented by several regulatory agencies. It makes it difficult to share medical information. Coupled with the medical malpractice litigation statutes interpreted by each Hospital Counsel, wide dissemination of medical information, especially about adverse outcomes, is virtually impossible. But isn't that the way we learn how to avoid mistakes? So, mistakes continue -- patients suffer, and whose fault is that? Who is practicing medicine here, and doing it badly?

Examples are endless. The fact is that medicine is a complex team sport. Financial, managerial, legal, and operational decisions impact patient outcomes at least as much as strictly medical decisions but only those with MD after their names are held responsible.

How many people practice medicine without a license?
What should we do about it?