We’ve all heard about the blue wall of silence that
describes a belief that law enforcement personnel will refrain from reporting
misconduct of their colleagues to the proper authorities. Physicians had similarly been accused of
hiding behind a white coat wall of silence, as I have on this blog. This describes the belief that physicians do
not reliably turn in colleagues who are incompetent and impaired. Personally, I have never knowingly
participated in the care of a patient with an impaired colleague. Competency is a murkier issue and is, of
course, variable in the medical profession.
In addition, it’s not easy to define or to measure. It is this very fact that has made me so
hostile to the Pay-for-Performance schemes that claims to be a quality metric,
but is truly used as a cost cutting tool.
'I Know Nothing'
I am aware of physicians in my community who do not have a strong
reputation of medical skill. Yet, many
of these physicians are beloved by their patients. Clearly, they are delivering something of
great value that may not be included in our traditional definition of medical
competence. In addition, if physicians
of lower medical skill levels, consult specialists more liberally to assist in
the care of their patients, then the patients receive good medical care, albeit
at higher cost.
What obligations to physicians have to come clean to
patients about other doctors and health care facilities? Weigh in on the following.
- A patient asks you if her primary care doctor is any good. The primary care physician is a strong referrer to the practice, but is not highly regarded among colleagues. How would you respond if you were the doctor?
- A private practice surgeon operates at only one hospital. His patient asks if another hospital would be a better choice. The doctor is aware that the post-operative infection rate in his hospital is 5% higher than in area hospitals. How would you respond if you were the surgeon?
- A hospitalized patient is medically ready to be sent home. Every additional day in the hospital consumes time and resources. More importantly, it exposes the patient to risks of hospital life including infections and other complications. The admitting doctor intends to discharge the patient home at the end of the week. If you are a physician consultant on the case, what would you do?
Of course, I know what the correct answers should be. But, my profession, and probably yours, are
not as pure as we would like them to be.
While integrity may be absolute
and impeccable, alas, we are not.
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