Peer Review: The dirty little secret of medicine.

Via Rangle MD: The problem with peer review.

Chris Rangle is an Internist practicing in Texas. His blog at Rangle MD is one of the older physician blogs on the web. The block quote below is from a post of his on how peer review works in Americas hospitals.

The majority of the time physician concerns about quality and patient safety are properly addressed without the administration going after the whistleblower but increasingly the system put in place by the 1986 law is being used to silence the messenger. According to the Pittsburgh Post-Gazette a 2001 report by the University of Baltimore found a serious potential for abuse by the hospital peer review system.

The report found that whistleblower physicians who alienate hospital officials are vulnerable to having their admitting privileges taken away, with devastating effects on their practices. Because the federal Health Care Quality Improvement Act protects peer review panels if they are sued, it also can have the effect of protecting a malicious peer-review group motivated by spite, prejudice or a desire to cripple a competitor's practice, the authors said.

What's more is that these peer review committees tend to operate in their own little worlds being only loosely governed by the hospital's bylaws. They are not courts of law, the committee members usually have no experience with legal procedure, and a such there is the potential for them to become the closest thing to a legalized "Kangaroo Court" in this country as you can get. A physician reader let me know about his own devastating experiences with these committees.

"In these proceedings, it is a trial. But it is unlike any 'trial', you have ever imagined. It is a chapter out of 'Alice in Wonderland'. The emphasis is all on 'procedure'. There is NO due process. There are NO rules of evidence. Hearsay, opinion, rumors, innuendo, and outright lies are completely acceptable as testimony. Truth, facts, and evidence are irrelevant. All that matters is procedure. The board can decide that a physician improperly performed a hysterectomy on a MAN, and it cannot be challenged in court as long as 'proper procedure' was followed in making the determination. I am not kidding. If this were not so serious, it would be hilarious."