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Why Are These Doctors So Mad? What It Means for You

The public has the biggest stake in the outcome of whether physicians should be expected to have independent assessment of their knowledge and performance in practice. We have been left out of the debate.
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A vocal group of doctors is thumping mad. Is your doctor one of them?

Here's the backstory. If you live in Colorado, Indiana, Montana, New York or South Dakota, your doctor could be practicing for 30 years and never be required to keep up-to-date as a condition of renewing his or her medical license every few years. Just fill out a form and send a check.

It's not much better if you live elsewhere. Other states require licensed doctors to do as little as 20 hours of self-study a year.

To raise the standard in a high-stakes profession, most doctors choose to become certified by a board of their peers in their specialty, say family medicine or surgery.

Maintaining this certification requires passing a knowledge exam every 10 years and demonstrating continuous learning and improvement in the care provided to patients.

A group of doctors has circulated a petition to do away with independent examinations of doctors' medical knowledge and requirements to improve their practice, saying it is too burdensome and not relevant to what they do every day.

Their solution? Continuing medical education, shorthand for no independent determination of whether a physician is keeping up-to-date.

Taking a page from Hillary Clinton's "Trust me" attitude in deciding which emails should be made public from her private account while Secretary of State, the doctors' stance is a "Trust me" too.

It doesn't fly. Here's why. First, the public wants to trust their doctor but also wants independent verification that their doctor meets a higher standard: "Trust, but verify."

Second, if the certification process is not well-tailored to physician practice and too costly, don't throw it out, fix it. Make it relevant. Make it better. Test competence as well as knowledge.

Here's an example. A University of Michigan study of physicians who perform bariatric surgery were videotaped while performing surgery. Their surgical skill was independently assessed by their peers who were unaware of who was performing the procedure. Not surprising, patients whose surgeons had better skills fared better. Independent assessment pinpoints where a physician's competence can be improved.

Most people probably think this type of testing is already being done. It isn't. It should be. Raise the bar. Don't lower the floor.

Third, the public expects that doctors stay abreast of emerging health threats such as antibiotic-resistant superbugs and how to diagnose and treat them.

A gentleman I know in the Washington, D.C. area who had surgery noticed that the wound had become red and swollen. His doctor did not follow the standard protocol developed by physicians that has reduced these infections. The result? Months of painful and costly treatment of an antibiotic-resistant infection.

Doctors are like the rest of us. We don't know what we don't know. Fully free choice of continuing education is not a solution.

Take patient safety. Most doctors never learned patient safety in medical school. It was never taught, although that it beginning to change. Fortunately, future doctors in training are expected to learn how to identify common medical errors and unsafe situations, and how to reduce the chance of patient harm.

Physicians in 2015 should not practice cardiology or surgery as if it were the 1990s. Nor should they practice as if it were the 1990s when it comes to safety.

A cadre of dedicated physicians have been learning and applying safety science in patient care -- on top of their heavy workloads -- with promising results.

To bring more practicing doctors up to speed, the certification process has given greater emphasis to patient safety. Remarkably, opponents of certification have characterized patient safety as "busy work" in an article in the well-known New England Journal of Medicine.

There is a saying among professionals who go to work every day to ensure public safety whether on airplanes, in space flight, in nuclear power plants, on America's highways or in the doctor's office or hospital: anyone who is not trained to see how mistakes can happen, nor equipped to avoid them, is the most dangerous person in the room.

The public has the biggest stake in the outcome of whether physicians should be expected to have independent assessment of their knowledge and performance in practice. We have been left out of the debate.

The media should invite the public into the dialogue. Hopefully it will be without some of the vitriol that has surfaced. Perhaps it is indicative of physician burnout, fueled by unrealistic demands by their employers and insurance companies to see too many patients in too little time in a system filled with opportunities for error. Whatever the etiology, a constructive tone would be consistent with the professionalism the public expects.

In the interest of full disclosure, three years ago I agreed to be an unpaid, independent public member of the public policy committee of the American Board of Medical Specialties. It works in collaboration with the 24 specialty boards that offer certification to physicians. My purpose has been to encourage patient safety as an integral part of ongoing assessment of physicians, an interest sparked 15 years ago while writing Wall of Silence, the first book to tell the human story behind the Institute of Medicine report, To Err is Human.

Recent estimates suggest that more than 400,000 Americans die from preventable health care harm annually. All hands on deck are needed to stem the mayhem. The patient on the gurney is counting on it. "Trust me" doesn't work.

Rosemary Gibson is the author of Wall of Silence and is the 2014 recipient of the American Medical Writers Association award for her writing on health care in the public interest. She is a founding member of the Consumers Union Safe Patient Network and is senior advisor at The Hastings Center.

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