The Incompetent Doctor, And How to Protect Yourself

Two nurses who lost their hospital jobs and endured criminal prosecution after reporting a physician to the Texas Medical Board over patient safety concerns will receive $375,000 each in a settlement of a federal lawsuit they had filed against their former employer, the physician, and other parties [Lowes, 2010].

Every physician in California has a recurring nightmare of finding their name on the monthly "discipline" list of the California medical board, the regulator of doctors in the state. The report includes a brief description of the offense, and the punishment. Of the 30 or so actions reported, about 90% are related to alcohol or drugs, usually resulting in probation and rehabilitation. A few offenses are related to fraud, with the remaining punishments due to incompetence, usually so egregious as to be frightening.

In reality, these problems are the tip of an iceberg. For every action taken, who knows how many are not reported, or don't rise to the level of discipline? Some result in malpractice suits, but these rarely result in physician suspension or retraining.

The article quoted above illustrates how difficult it can be to report and discipline even one bad physician. Two nurses risked their careers by complaining about what appears to be clear incompetence. That doctor used his friendship and influence with the hospital administrator and local officials to both avoid the charges and to get the nurses fired from their jobs.

Although the nurses eventually prevailed in court, the doctor has remained in practice, although he under investigation.

How can society in general, and your family in particular, make sure your physician is doing a good job?

Physician groups and hospital staffs do a much better job policing themselves than state medical boards. In large groups, physicians have substantial ethical, financial, and legal incentives to monitor, evaluate and improve the care they are giving. Excluding the impaired or incompetent doctor makes very good sense.

One of the few beneficial aspects of Obamacare is that it contains financial incentives to force physicians to form groups, which will be far more effective than bureaucracies and review boards in improving quality.

In the meantime, you can probably protect yourself and your family by using doctors who are affiliated with larger groups and larger hospitals. Although there are exceptions, it is far less likely an impaired or incompetent doctor will be practicing with others. Counter-intuitive as it might seem, avoiding the local "Marcus Welby" practitioner may be the key to insuring good care. Nurses in Texas Whistleblower Case Settle for $750,000.

Reference:

Robert Lowes, "Nurses in Texas Whistleblower Case Settle for $750,000," Medscape Medical News, August 12, 2010.