While I squawk about medical weblogs providing trancparency into the practice of medicine, most people at last week's conference agreed that there is such a thing as too much transparency. Where is the line between too much transparency and just enough? I'm not sure. Today's entry may tread the line …. hmmm ..
The New York's department of Professional Misconduct and Physician Discipline is New York's attempt to insure that physicians practicing in this state are well trained and well behaved. Sometimes I help review the cases of physicians who are – for some reason – being scrutinized by this department. While I sometime know why the physician is being reviewed, I usually make an effort to be blind to this – I think that it makes my review more objective.
It's always awkward. I feel uncomfortable challenging another physician's judgement, decksionmaking skill, or personality. The process usually involves reviewing a videotape of the physician interacting with one of the "standardized patients" we have in the medical school. (A "standardized patient" is an actor – someone employed and trained by our faculty to act out a particular problem. We use these "patients" in the training of our students, and it gives us insight into the students' ability to interact with patients, and their physical exam skills.)
After I review the videotape, I usually review a few real charts from the physician's practice, and then there is an interview during which I ask questions about the progress notes and the videotape. This often the most awkward part, but of course reveals the most about their thought processes. Here's the sad news: some physicians simply should not be practicing medicine. They're humans too – so physicians are sometimes in a position that makes them unable to properly do their jobs. The trouble is that their livelihood depends on their practice – and most physicians have enormous debt that remains from medical school and residency - even as many as ten or fifteen years later.
LIke the bus driver who can't see very well – it's a sad situation, but it's clearly unsafe. The tricky ones are where it's not so obvious as the vision impaired bus driver.
Hence the need for reviews such as that described above. In the end – I make no decision, thankfully. Rather – I provide feedback to the State, and they are empowere to take corrective action based on my assessment and several others.
I find the process to be remarkably appropriate. The situations are alwayds delicate, but I think that the process is thorough enough to identify problems if they exist – yet with enough "due process" to provide respect and some presumption of "innocence."
Want to see if a physician in New York has been disciplined in any way? New York has made that easy too … just go to the New York State Physician Finder and look up the physician. Once you've found the physician, click on "Legal Actions" and you can see any current or previous actions against that physician. Now there's transparency, eh?