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| Patient safety leaders seek solution to “problem doctors” |
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January 18, 2006 - In an article written for the January edition of the Annals of Internal Medicine, Doctors Lucian L. Leape and John A. Fromson issue a call for a national effort to develop “better methods of measuring physician performance and an expansion of programs for helping practitioners who are deficient” in one or more of three fields. Dr. Leape, is a leading expert in patient safety with the Harvard School of Public Health, and Dr. Fromson, a physician at Metrowest Medical Center in Natick, is director of the Massachusetts Physician Health Services program of the Massachusetts Medical Society. The measures are needed, they write, to deal with doctors who may be “dyscompetent,” or lacking in various professional behaviors such as “communication skills, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.” They use the term “dyscompetent” since the term refers to a deficiency in certain professional behaviors, but not someone who is totally incompetent. A second type of deficiency that results in a “problem doctor” is physician with “mental or behavioral problems such as depression, anxiety, substance abuse, afflicted with a personality disorder such as antisocial behavior, or disruptive with colleagues, patients, and subordinates.” The article notes that the term “disruptive physician” has been applied to “physicians who exhibit abusive behavior that interferes with patient care or could reasonable be expected to interfere with the process of delivering quality care.” The third type of deficiency that needs attention is with a physician who is “impaired,” with a disability from psychiatric illness, alcoholism, or drug dependence. Doctors Leape and Fromson call upon state medical boards (represented by the Federation of State Medical Boards), the medical specialty boards (represented by the American Board of Medical Specialties), and the Joint Commission on Accreditation of Healthcare Organizations for a national effort to develop the systems and measures for monitoring and assuring acceptable physician performance. On Beacon Hill, legislation has already been introduced to establish a commission within the Executive Office of Health and Human Services, to make recommendations on the establishment of performance standards for physicians that will improve patient outcomes and provide the means of measuring professional performance. Senate Bill No. 1289, sponsored by Senator Richard T. Moore (D-Uxbridge) who chairs the Joint Committee on Health Care Financing, had a public hearing on November 30, 2005 by the Committee on Public Health. Senator Moore believes that his legislation could put Massachusetts in the forefront of a national effort to establish physician performance measures that would improve the quality and safety of health care in the Bay State. For more information on Senator Moore’s work in the Senate, visit his web site at senatormoore.com |
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By Lucian L.
Leape, MD, and John A. Fromson, MD, January Edition of the Annals of Internal Medicine