How much should patients know about their doctors?
How much should patients know about their doctors?
Physician profiles can be misleading, inaccurate
For physicians practicing in Massachusetts and Florida, public disclosure of their malpractice history is a reality. Both states have adopted physician profiling laws that give consumers easy access to information about their training, education, and malpractice and disciplinary history. And doctors in New York, California, and Wisconsin face similar laws in the near future.
While this is nothing to worry about for many physicians, for those doctors who have been sued particularly those in high risk specialties such publicity can have a potentially damaging effect especially if profiles are inaccurate or misleading.
Since Massachusetts became the first state to implement a physician profiling law in November, inaccuracy has been an ongoing problem. National outcomes expert David Nash, MD, of Philadelphia’s Thomas Jefferson University, referred to Massachusetts’ public disclosure of malpractice data as a venture by "the people’s Republic of Massachusetts" in a speech during the recent National Managed Care Congress in Washington, DC.
According to the Massachusetts Medical Society (MMS) in Boston, there have been 32,000 calls to the line since November and 51,000 profiles sent out. But there also have been more than 25,000 requests by physicians for profiles to be amended, says Joe Heyman, MD, FACOG, president of the MMS.
One of the biggest critics of the system, Barbara Rockett, MD, a surgeon in Brookline, MA, says that 4,500 doctors called about profile mistakes on the first day the profiling line was operational.
The profiling system as a whole is misleading, argues another vocal Massachusetts critic, Leonard Morse, MD, chief medical officer at the Greater New Bedford (MA) Community Health Center. He notes that 92% of Massachusetts physicians have no liability claims at all.
That information, compiled by the Massachusetts Board of Registration and Medicine in Boston, indicates that of the 27,000 physicians in Massachusetts, only 1,800 have had malpractice suits, only 400 have had any board disciplinary action, and only five have had criminal convictions.
Rockett says you also have to consider that much of the litigation was against people who were in high risk specialties, such as obstetrics or orthopedic surgery.
The information on the disciplinary actions is also inadequate, Morse says, pointing out that it only says action was taken, not why. "And information on them is already available to the public through the board of medicine’s published disciplinary actions," adds the former MMS president.
So what can your physicians do about profiling? That depends on whether your state has a profiling system or is just considering one, says Richard Bagby, MD, FACR, the president of the Florida Medical Association (FMA) in Tallahassee and a radiologist practicing in Winter Park, FL.
Physicians must take an active role
If your state is considering profiling legislation, then Bagby says your physicians have to get involved from the start with medical societies drafting legislation (see story about the FMA’s input into legislation, p. 80.); in practices, by educating patients and staff; in communities, by writing letters to the local newspaper editor; and in legislatures, through phone calls and letters.
Massachusetts’ experience has been a guide for Bagby and the FMA, he says. Its critics helped galvanize the FMA membership into being an integral part of the proposed legislation.
Once legislation is passed, it is up to doctors to make sure that their profiles are accurate and representative, he adds.
Aside from checking their profile, Bagby says physicians can take other action to ameliorate any adverse effects from a specific profiling law. Educating the public about the incidence of malpractice is one such action.
Information on the profiles’ limitations is vital for the public, says Morse. Physicians must encourage their medical society to educate the public, Morse says. "All of its promotional material should focus on letting the public know what is being proposed and what it means to them."
Even Bagby, who believes in the profiling system, notes that information provided in profiles can be misleading. For example, recent reports published in Florida newspapers noted the names of physicians who had disciplinary or malpractice histories. "Many of the issues were trivial," he says. "If someone was late in sending in their license renewal application, their name appeared on the list."
Also on the list were many physicians who work in specialities that have very high litigation rates, Bagby says. "Eighty to 90% of the neurosurgeons in our state have been sued at least once."
The reports in Florida were based on information gleaned by the Agency for Health Care Administration (AHCA) in Tallahassee, says AHCA spokeswoman Colleen David. Last fall, the agency decided to put together in one location information already available to the public. It was limited to a five-year disciplinary and malpractice history, and physicians who had three or more claims of $25,000 or more in that time period.
"We found that the public was demanding credible information to make health care choices," David says. "We receive calls daily for this kind of information."
She defends the report and the way most newspapers treated the information. "Only 2% of Florida doctors were listed," says David. "I think that it was a fair presentation."
If profiling is already a reality in your state, there is little your physicians can do aside from ensuring their patients have accurate information about them, says Bagby. Physicians must be ready, willing, and able to explain to patients anything untoward that appears on their profile. "Often, they don’t understand the realities of malpractice litigation," he says.
Heyman agrees. Physicians should "explain what happened and that medicine isn’t a guarantee of good results." In Massachusetts, doctors can avail themselves of the services of the MMS patient/physician advocate who can intercede if communication on this subject is difficult. The society also offers seminars to physicians on effective doctor/patient communication.
Heyman contends that whatever the critics say, profiling benefits patients and has little long-term impact on physicians. "I have possibly the most published profile in the state," Heyman says, noting that he has a suit and two settlements on his record. "I still have a waiting list for patients."
"Just because your malpractice history is included doesn’t mean the whole profile has to be negative," Bagby adds. "People are more interested in whether you are board certified, what HMOs you work with, and where you trained." Bagby notes that in 25 years of practice in Florida, he has never been asked about his malpractice history.
Neither has Rockett, who says her patients are more interested in how often she has done a procedure and what the outcomes have been.
Saying that profiling is a bad thing won’t change things, according to Heyman. "This is the real world. Doctors are being held accountable, and consumers want information. It is not if they should have it, but how they should see it. This may not be the best thing, but it is the law that was passed, and now we have to live with it."
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