This is unsettling:
If a doctor consistently prescribes the wrong meds or arrives drunk to work, you’d hope that his peers would pipe up.
But the responses of nearly 2,000 doctors to a recent national survey show the professional watchdog system is nowhere near perfect.
More than a third of docs don’t think they’re responsible for reporting those who aren’t fit to practice, according to the results just published in JAMA. And only 69 percent of the docs who knew about an impaired or incompetent colleague reported them.
Summary of the study here.
Omnes Omnibus
So the obvious solution is to limit malpractice suits because they drive up costs and doctors can regulate themselves.
randiego
69% is pretty high if you ask me – I doubt it’s ever been higher.
beltane
The medical profession fails at self-regulation and yet the Republicans keep demanding tort reform. This will not end well.
Dork
OT, but speaking of docs, meds, and unfit for the workplace, anyone see these quotes from Limbaugh against Steinbrenner? Holy wow. Any question now that Rush is not a straight-up racist?
Perhaps one reason docs dont want to report each other is because it would raise everyone’s liability insurance rates if the public (and insurance companies) were aware of the true rate of doctor incompetency.
Bill H
@randiego:
69% is also untrue. The number is far lower. I would guess that fewer than half of physicians who knew of impaired colleagues reported them; probably significantly fewer than half.
jibeaux
I respect doctors, have them in my family, but I heard this guy on the radio yesterday with a Daniel Carlat, a psychiatrist, who wrote a book called “Unhinged”, that scared me silly about the relationship the drug industry has with physicians. Obviously, I’m not so naive I don’t know some of that crap, I’ve seen the drug reps in my doctor’s offices, but did you know that drug companies buy reports from pharmacies showing what doctors, by name, are prescribing, and use them to draw up a personalized report so that they can see exactly what percentage of the time they’re prescribing their drugs and market accordingly? That they provide this information to other doctors who accompany the drug reps to these hard-sell lunch things? It was appalling.
bookcat
My friend had a personal experience of this. She went in for a check up and the doctor was noticeably intoxicated (and late). She couldn’t understand why the staff didn’t prevent him from seeing her given how bad he was. But apparently, she found out, he had a history of this. Why he’s still practicing I don’t know.
gnomedad
@Dork:
Holy crap, Rushbo just can’t help it, can he? Good thing Al Sharpton is on the case to point out the obvious for us.
mellowjohn
who wouldn’t want a prostate exam from the invisible hand of the marketplace?
D. Mason
I know this is simply an anecdote and in no way constitutes proof but I have seen at least one example of this in action.
My mother had high blood pressure and was developing diabetes. Her doc put her on a short term med in an effort to correct her sugar long term without further treatment. When it didn’t work he just left her on the medication which was not meant for long term use. The interactions with the BP medicine she was on caused her to have such irregular BP that over the 1.5 years she was on this medicine she developed heart problems where there had been none. She also managed to get walking pneumonia which he misdiagnosed as allergies and left un-treated for 3 months despite her insisting that the allergy meds didn’t help and that she was sick. She had been going to him for so long she was loathe to switch but one day she went in for the ongoing walking pneumonia and her doc wasn’t there – she ended up having to see his partner instead. The partner told her that she would likely die if she kept taking the meds she was on and recommended she find a new doc ASAP, which she did and is now mostly ok. The other doc, the one who “treated” her originally, is still practicing.
arguingwithsignposts
@Dork:
The sad part is Limbaugh will say it was “satire,” or he was trying to make a joke. And tomorrow, he’ll still have a radio show, and the day after that, and the day after that …
If only the vaunted Yankee Nation would show their colors and demand that fat racist bastard be taken off the air.
beltane
@jibeaux: Several years ago I was mis-diagnosed with Multiple Sclerosis by a doctor who was extremely eager to put me on some very expensive ($1,800 a month), very nasty, new injectable drug along with other drugs to counter some of the side-effects of the injectable. After doing a little bit of research, I got a second opinion which found that my symptoms were caused by an impacted wisdom tooth putting pressure on a facial nerve.
Had I listened to the first doctor, my quality of life would have been completely destroyed by those MS drugs (and I’d still have that wisdom tooth).
I know there are many good doctors out there, but my experience completely demolished my faith in the profession as a whole.
Sheila
What constitutes a “wrong” medication? If unnecessary constitutes part of the equation, don’t most doctors usually prescribe the wrong meds? If a patient demands a medication seen advertised on primetime television and the doctor prescribes it whether or not it is necessary, or even without adverse side effects, is this considered prescribing the wrong medication? If so, then this practice is endemic in the system.
David Hunt
@Dork:
Yeah, that was really bad…and slightly worse than a typical Tuesday for Limbaugh. I read the article and I think the only thing I saw that I haven’t seen before is that I can’t recall Plush Limp Balls calling anyone a race traitor before. He’s usually verbally assaulting black people directly.
ETA: On reflection, I think I should note that I don’t really listen the Limp Balls anymore. He has gotten so bad that the average time for him to say something that offends me enough to change the station is 20 seconds. I now hear what he says from other sources like Media Matters. Still, a barely veiled implication that someone is a race traitor is new.
Waynski
@arguingwithsignposts: We’re the Evil empire (Yankees that is). It’s the Red Sox that claim to have a nation.
Michael
Obviously, the answer is tort reform. Greedy trial lawyers are ruining the practice of medicine.
Waynski
Empire should have been capitalized, but I’m blocked from the editing function. FYWP.
Woodrow L. Goode, IV
The mindset comes out of internship and residency– when an under-trained, overworked and very tired apprentice doctor makes some heinous mistake (or overlooks something obvious) that either kills a patient or puts them through enormous, unnecessary suffering.
Read any memoir written by a doctor and they’ll admit they did it. And they’ll pretty much all say “I never made that mistake again, and I learned. You can say it’s inexcusable and I agree it’s a tragedy when it happens. But doctors aren’t perfect and the errors and lessons are part of the process of becoming a doctor.”
And the “there but for the grace of God go I” syndrome carries over. They say “I can’t destroy someone’s life over an honest error.” They shouldn’t do it when there is a pattern of errors, but it’s hard to break that habit and drop the hammer on a peer.
cleek
what we need here is less regulation, and some tax cuts.
EconWatcher
Maybe unsettling, but not surprising. It’s doubly true of lawyers. Professionals protect their own.
Waynski
@Woodrow L. Goode, IV: This. My brother-in-law is a surgeon and an all around great guy, but I’ve heard similar things if he’s describing a complication he’s treating from another doc’s mistake. He usually says, “I wouldn’t have done it that way…but” So I think you’re right, it’s part of the culture. I can’t imagine he wouldn’t report someone practicing while intoxicated though.
arguingwithsignposts
None of you people watch “House,” obviously. :)
Chris
With the number of lawyers commenting on this site, I wouldn’t hold my breath waiting for posts lamenting rampant legal malpractice.
jibeaux
@beltane:
Yeesh, I’m glad you got it straightened out and I’m glad you don’t have MS.
With doctors and lawyers, I think personal recommendations from people you trust, especially recommendations from other doctors and lawyers you trust, is the best place to start, and never be afraid to get second or third opinions. There’s just no way to put your faith in professional credentials or CVs. In NC some years back, we got this neurosurgeon who moved here from Arizona. He was color blind — which affects your depth perception — in his good eye. I say his good eye because the OTHER ONE DIDN’T WORK AT ALL. He left a string of malpractice lawsuits and injured patients behind in Arizona that apparently there was no requirement to report in NC. I’m all for folks with physical disabilities being productively employed, but maybe if you have a disability which would prohibit you from getting a CDL you should steer clear of NEUROSURGERY?
Maude
@beltane:
Not shocking. I am so glad you found out what was what.
There are websites you can check and make entries on. One is Rate Your MD. It’s good to read these before you make an appointment.
I was damaged by a drug prescribed by a specialist. I ranted for 2 1/2 years.
The Moar You Know
@Chris: “Lamenting” isn’t the word I’d use; I want someone’s blood for what our lawyer did to us.
Problem is, you need a lawyer to sue a lawyer…and good luck finding a lawyer who’s willing to go after one of his own.
Fuckers.
WereBear
This is why you can’t have the profession police itself. Never works, because there’s too many emotions, running too high, and the “ratting out your own” thing is too complicated.
Civilian control of the military. And layman control of the professions. Just getting the freakin’ obvious incompetents out will do wonders.
Lurker
@jibeaux:
I heartily agree with this. I’ve used both personal recommendations and Google to search for reviews of medical professionals.
This site could help, too: HHS has Medicare quality data available for the public. It rates hospitals and not individual doctors, but it’s still good information to have.
West of the Cascades
@The Moar You Know: I’m intrigued at the discussion of lawyers on this string … because most of it is misguided (in my humble opinion as a lawyer). First, there are a fair number of lawyers who are willing to sue other lawyers for malpractice, either because there’s money in it (lawyers generally have deeper pockets than your average Joe the Plumber) or because they feel some responsibility for the integrity of the profession and a sense of justice (e.g. if someone has lost a case or even lost an opportunity to bring a meritorious claim — say a discrimination suit — because the first lawyer fucked up and missed a deadline or didn’t advise the client properly).
Second, here in Oregon (and in most states), the Rules of Professional Conduct explicitly require lawyers to report other lawyers’ violations of the Rules to the Oregon State Bar — there’s wiggle room in the applicable rule (below) but it’s pretty clear:
“A lawyer who knows that another lawyer has
committed a violation of the Rules of Professional
Conduct that raises a substantial question as to that
lawyer’s honesty, trustworthiness or fitness as a lawyer in
other respects shall inform the Oregon State Bar Client
Assistance Office.”
The State Bar has a very easy-to-use website for individuals to submit complaints about attorney conduct — http://www.osbar.org/discipline — and a very active Disciplinary Board.
I’m not sure whether doctors have a similar set of mandatory rules of professional conduct, such that the 31% of doctors who didn’t report their colleagues were not only deficient morally and from a common sense standpoint but also in violation of rules of professional conduct … but whether doctors do or not, I’d wonder whether a similar survey of lawyers would yield a smaller percentage of non-reporting because (most) lawyers take the Rules of Professional Conduct seriously.
Ailuridae
@Dork:
Perhaps one reason docs dont want to report each other is because it would raise everyone’s liability insurance rates if the public (and insurance companies) were aware of the true rate of doctor incompetency.
This is pretty much the sum of it.
As for the doctors versus lawyers comparison it doesn’t really hold, right? Doctors are revered as a class within our society and lawyers reviled. And doctors by and large have guaranteed work that only the most heinous examples of incompetence/malfeasance will take from them, there are fewer doctors produced every year by US medical schools than job openings, etc. Lawyers, especially recent law school graduates exist in a viciously competitive job market and many law school graduates never find work that can pay their law school debts. I can see the value in allowing doctors to either work in a truly free market or allowing them a very high quality of life with some price controls (see Maryland for a great example of this).
Random aside: When I was a kid growing up in upstate NY (town had a population of 25K or so) I had severe breathing difficulties. Now a lot of you are thinking he had asthma. And I did. But my pediatrician never made that diagnosis and it was until I went up to UVT in Burlington at 30 months and saw a specialist (who of course in three minutes told my mom I was asthmatic) that I received the diagnosis. We switched to my hometown’s other pediatrician on the doctor’s recommendation. He was an excellent doctor who also drank a whole lot. So he wasn’t allowed in my hospital because of his drinking. Until the age of about 10 I would probably end up in the ER once a year with two additional extended stays and my doctor gave instructions to the doctors there over the phone.
The point of this is that the specialist who saved my life never reported the first pediatrician to any board despite gross incompetence. And my eventual pediatrican never stood before a board about his drinking despite an entire hospital not letting him work there. And, from everything I have ever seen that holds no less true today.
Woodrow L. Goode, IV
@Waynski: At least in one case, no. I was referred to a guy who was visibly blitzed once. When I told my PCP, he said “Sorry. About a year ago, his wife and daughter were killed in a carjack. I heard he was OK, but I guess he’s slipped again. He really is the best when he’s in control.”
And my guy was really amazed when I fired him for not putting my interests first. He kept pointing out it was a podiatry exam, not a surgical consult– as if that was OK.
Michael
@Chris:
Hell, I’ll admit it. I used to make the mistake of trying to hold other lawyers and judges accountable, but it cost me dearly and took years to undo.
To put it in another way, try and imagine that you may be obligated to have a working relationship with someone for years, particularly in a medium sized or smaller community. Now, imagine siphoning off his wealth or impairing his livelihood his livelihood and what it would mean for that working relationship. Add the factor of the notion that he has business acquaintances, friends and family members in regular contact with you.
I’ll never sue or squeal on another lawyer again unless it means I can retire and move.
CADoc
Lots of issues going on here. In many communities, doctors work essentially independently and there is no mechanism for anyone to monitor them and their work. In larger doctor groups there is much more scrutiny. I get a chart audit and my office inspected routinely. We have committees to investigate patient complaints. Any one not working to the standards of their peers are put on a program of corrective action and fired if they can’t bring themselves up to par. The reputation of our group and our finances are at risk, so we take that very seriously. Hospitals run similar set ups and any cases that fall out of the norm are evaluated.
One problem, especially in hospitals, is that trying to weed out bad operators often is met with an accusation of impeding commerce. In other words the hospital is picking on this person to drive business to someone else on staff they prefer. Sticky and with everyone so worried about lawsuits, I think that inhibits a more robust process.
HyperIon
and when it’s docs and cops, people sometime die.
IMO when it’s lawyers, people die less often.
Joel
I agree with those surprised that the number is as high as 69%.
Imagine what the reporting rate is in professions involving food preparation, auto mechanics, and other things that are basically essential and have little room for error (food poisoning, mechanical failure, etc.).
Chris
Whew! That’s a relief, huh?
Oh well then, nevermind.
Tom Hilton
I just don’t believe it. If that were true, we’d have a massive death toll from medical error–upwards of 100,000 per year. Which we must not, because you never hear about it in the news.
licensed to kill time
@arguingwithsignposts:
I love House, but watching it can make you afraid of going to a hospital, EVER. The patient always almost dies at least three times per episode, is diagnosed and dosed at the drop of a hat with a complete change in both diagnosis and meds each time, and House is usually off in the bathroom doing heroin or LSD (in that episode he tripped for a while and then took MORE stuff that immediately reversed the effects of the acid so I would like to know what the heck THAT stuff was) or jonesing so bad he can’t function. Unless he’s just out of rehab, then he’s all virtuous for a while until he starts popping the Vicodin again. Which he swallows dry even though they are big long fat horse pills.
SO realistic. Still, I watch it because of Hugh Laurie and his big blue eyes.
dollared
Elites. Accountability. Regarding drunk docs, we have to look forward, not backward. After all, they could be sober tomorrow and then everything will be OK.
Bubblegum Tate
@Michael:
And tax cuts!
Omnes Omnibus
@Bubblegum Tate:
Well, duh!
gex
@Omnes Omnibus: And let’s just get rid of the insurance model and go with health care spending accounts. Risk pooling is an unfair redistribution of wealth, you commies.
maus
It’s not for lack of want, but I’m fairly certain a nurse, or doctor-whistleblower would affect his own reputation severely by this :(
There’s plenty of evidence for this ruining careers (and not the right ones…)
Of course, this is INCREDIBLY greater results than you’ll see from Chiros, NDs, “allopathics”, etc.
Tom Hilton
@licensed to kill time:
That’s impressive–Buffy only died twice, and it was in two different episodes.
Comrade Kevin
@HyperIon:
Tell that to someone who gets executed because they had a shitty lawyer.
licensed to kill time
@Tom Hilton:
heh. The patient always “almost-dies”, to be clearerer :)
Nutella
@Tom Hilton:
I can’t tell – is that snark?
“We almost never hear it on the news” doesn’t prove anything. When a news company has a point to make they lie about anything, even the weather.
Nutella
And count me in with the people who think the claim that
is not accurate.
I think 69% is the how many think they ought to report it but a lot less than 69%, probably a lot less than 6%, actually do report it.
sherifffruitfly
There’s a similar issue in common between teachers, doctors, and cops. Each group acts to further their own interests, even above the public’s.
As for doctors specifically, lol @ people who support limiting THEIR OWN RIGHT to sue.
One deserves what one votes for. Damn but that makes it tough on the rest of us though.