Regarding the Joint Commissions alert on unprofessional behavior:
This is long-overdue action that should have, and would have, been unnecessary if hospitals were individually capable of monitoring and controlling the behavior of staff locally either through social pressure or formal policy. In my experience, staff members who are permitted to act out are staff members who provide an important source of revenue for the institution. Hopefully this external backbone will provide the necessary motivation for hospital administrators and medical staffs that have been reluctant to confront these immature golden geese where needed.
The question that immediately occurs to me, however, is, however objectionable and potentially harmful the rude and hostile behavior in question is, it pales beside the issue of the practice of medicine by conspiracy, of which sham peer review is one facet. This issue is of profound importance because of its direct impact on patient safety, since it prevents reporting of inadequate care, and because of its indirect effects which include its devastating impact on the lives of a wide range of healthcare providers. The latter is responsible not only for the loss of caregivers who are both talented and conscientious, but may also be responsible for what could be called a conspiracy to deny the existence of inadequate care, and labeling those who call attention to inadequate care as engaging in rude and/or hostile behavior. Such subjective criterion, applied by a self-selected judge and jury, has been used often in the past as a weapon to fight patient advocacy; now this tactic will have the imprimatur of the Joint Commission, yet the issue of the practice of medicine by conspiracy, including sham peer review goes unaddressedin fact strengthened by this action. The net effect for patient safety and patient care in my view is, unfortunately, a negative one.
W. Harry Horner, Ph.D., M.D.Waynesboro, Va.
Its about time
Forrest Calico, M.D.Stanford, Ky.,
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