This (Commission sees bad behavior as safety risk) 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 administration and medical staffs who have been reluctant to confront these immature golden geese where needed.
The quandary 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 the direct impact it has on patient safety, when it prevents reporting of inadequate care, and because of its indirect effects, which include the devastating impact that it has on the lives of a wide range of healthcare providers.
The latter is responsible for the loss of caregivers who are both talented and conscientious (this loss occurs through multiple avenues: loss of licensure without due process; leaving the medical field hurt and/or in disgust; and, not infrequently, as a result of impaired health subsequent to the strain experienced, including suicide) and may also be responsible for what is perceived, by those involved in a conspiracy to deny the existence of inadequate care, as rude and/or hostile behavior.
Such subjective criteria, applied by a self-selected judge and jury, are an ideal implement for conspirators to wield in their fight against patient advocacyand wield it they have. Now this tactic will have the imprimatur of the Joint Commission, yet the practice of medicine by conspiracy, including sham peer review remains unaddressed and continues unabated despite more than 20 years of earnest effort by individuals and small, but dedicated groups. In fact, it is strengthened by this action. The net effect for patient safety and patient care in my view is, unfortunately, a negative one.
W. Harry Horner, M.D.Waynesboro, Va.