Unmasking Unsafe Doctors
By: Source: AARP Bulletin Today Date Posted: 2004-08-11 09:49:00-04:00
Knowing your physician's track record could mean the difference between life and death. But consumers can get more information on the effectiveness of their home appliances than on the people they entrust with the care of their health.
That's what the family of the late Tillis James Churchill discovered after the Gainesville, Fla., high school football coach underwent botched stomach surgery. Churchill's doctor had assured him he'd have no problem. But the mismanaged surgery led to multi-organ failure, and Churchill died in pain weeks later on his 49th birthday.
Churchill's family later learned the doctor had lost nine patients and repeatedly been held liable for malpractice. Churchill's son, T.J., says if they had known of this record, "I think that my dad and others would still be alive."
The tragic case demonstrates how important it is for consumers to know about unsafe doctors. It resembles numerous medical mishaps across the country that have sparked demands for greater disclosure of physician information and led many states to launch physician-profile systems.
Yet despite some advances, Charles Inlander, president of the People's Medical Society, a consumer group based in Allentown, Pa., says, "Health care is the last bastion of nondisclosure to consumers in the U.S."
| Photo by Laughing Stock |
The basic facts about your doctor—for example, where he or she studied —are usually easy to obtain. Going beyond that, however, is another story.
"Ideally," says Sidney Wolfe, M.D., director of the Public Citizen Health Research Group, a Washington consumer advocacy organization, "you'd like outcome data on physicians"—information on the results of treatments. But such information, he says, is rarely available.
In its absence, he and others advise that the best alternative is to check whether your doctor has a disciplinary record—although here, too, the task isn't easy and the result could be a false sense of security, if information is incomplete.
While most doctors have never been professionally disciplined, some have. Such action can take many forms—from revoking or restricting hospital privileges to yanking a physician's license to practice medicine. And a large number of malpractice payments can be another tip-off of possible trouble.
While state medical boards have broad powers, including the ability to lift a physician's license to practice, Wolfe says "far too many" doctors only get their wrists slapped even for serious offenses.
Dale Austin, interim CEO of the Federation of State Medical Boards, admits that state boards rarely penalize a physician for a single mistake, generally acting only when hospitals or professional peers cite patterns of problem behavior.
While researching the issue, however, Public Citizen found over 5,000 doctors nationwide who had been excluded from Medicare or had their federal narcotics license restricted or revoked, with hundreds not disciplined by their state boards.
Responding to growing calls for disclosure of physician misdeeds, some 28 states now make information on physicians public, according to the National Conference of State Legislatures.
The leader in this effort is Massachusetts, which set up the first public system in 1996. By calling a toll-free number or visiting a special website, consumers can access a physician profile that, in addition to basic facts, tells about any malpractice payments, criminal convictions and hospital or medical board disciplinary action in the last decade. Following the death of Gainesville football coach Tillis Churchill, Florida established a similar and highly regarded information service in 1997.
But consumer advocates say most state systems leave much to be desired. They point to Virginia, which launched its service last summer, as more typical. The information it makes available to the public is furnished by doctors and not independently verified. The Washington Post reported that, as a result, the public has been kept in the dark in some important instances. In one case, for example, an anesthesiologist failed to report that he had been disciplined by medical boards in seven states.
The Federation of State Medical Boards earlier this year opened a "DocInfo" database that lists disciplinary actions taken by all state medical boards, which consumers can access for a fee. But critics of state practices say that such information does not tell the full story.
FEDERAL SOURCE OFF-LIMITS
A far greater repository of disciplinary information—more than a quarter of a million records gathered from various sources on almost 150,000 health professionals—exists at the federal level in the U.S. Department of Health and Human Services. It's contained in the National Practitioner Data Bank (NPDB), which is open to hospitals and other medical organizations but closed to the public.
Efforts to allow public access to this data bank have met stiff resistance, especially from the American Medical Association (AMA), which argues that NPDB data is "raw and unsynthesized" and could mislead consumers. It particularly objects to releasing malpractice information, maintaining that certain specialists doing high-risk procedures get sued more often than others.
Donald Palmisano, M.D., a New Orleans surgeon and AMA trustee, tells the AARP Bulletin, "We believe the patient should have relevant information." But he says state medical boards should decide what to release.
Inlander of the People's Medical Society pooh-poohs that approach. "That's the fox guarding the chicken coop," he says.
Even Medicare fails to offer beneficiaries information on physicians, other than whether a doctor participates in Medicare.
So what's a consumer to do to gauge the competence of a physician?
• USE EXISTING SOURCES.
Although in most instances it's likely to be incomplete, consumer advocates say patients should make full use of available public information. For example, an important fact to know about a specialist is whether he or she is board certified—that is, vigorously trained and certified by peers to be skilled in a particular area of medicine—and this fact can readily be checked. (See Sites to See.)
• BE AN ASSERTIVE PATIENT.
Experts say that beyond checking available information, the consumer's best course is personal directness.
"It's essential for you to trust your physician," says the AMA's Palmisano. And he advises patients to do whatever it takes to gain that trust, whether it's talking to their doctors or to others about a doctor's skill.
But Inlander notes that doctors "are not consumer-oriented [and] not even trained to think that way." And he believes the best way to overcome this deficiency is for the consumer or an advocate to speak up forcefully.
"The key thing to remember," he says, "is that your health is at stake ... you should not be afraid to ask questions or to challenge physicians. You don't have to be obnoxious about it. But the more you do it, the better your health care is going to be."
As proof, he cites studies that show that consumers who ask the fewest questions and are the least assertive tend to have the worst medical outcomes.
"I've seen people hold up a line at a supermarket," he continues, "because they think they got overcharged 50 cents, but they won't ask their doctor how many times he's done a certain procedure when [the answer] could be the reason they live or die."
If, for example, your doctor recommends you for a particular procedure, Inlander and others say you should first find out about the physician's training in the procedure. If the doctor graduated from medical school in 1960, and the procedure has been used for only five years, it's important to know how he or she learned the technique. (For other key questions to ask your physician, see Questions to Ask Your Doctor.)
And consumer advocates say that if a physician does not want to address such issues candidly, that may be a sign you would be better off "shopping" elsewhere for medical treatment.
preview