Tucson, Ariz. Not so long ago, hospitals were primarily workshops for physicians, and both hospital administrators and physicians were working for a single purpose: healing the sick. But now many hospitals—whether tax-exempt (“nonprofit”) or not—have become big businesses. Their first priority is bringing in more revenue from government and insurers, and decreasing their expenses. Physicians who care about their patients may stand in the way of the business plan.
Physicians, of course, are needed, and some are good “team players.“ They bring in patients, do profitable procedures, and follow the administration’s orders. Increasingly, they are hospital employees, or partners in business ventures.
Others, mostly independent physicians who are paid by their patients, may be “disruptive” of the hospital’s agenda. They might object to exclusive contracts with certain physician groups. They might put patients before rules or guidelines, causing harm to the bottom line. Or they might speak out against unsafe or shoddy patient care.
Many Americans like television’s “Dr. House,” and his white board. A real doctor, Robert Peraino, M.D., tried setting one up at his hospital, to facilitate discussion of difficult cases. Only one discussion occurred—because most doctors didn’t care much about learning. Dr. Peraino—highly regarded for diagnostic skills and teaching ability while he was doing locum tenens work at the hospital—was not hired as a hospitalist. The reason: he was “non-affable.” That is, he chastised nurses who were trying to countermand his orders to stop medications that were harming a patient.
“Affability means accepting mediocrity,” Peraino writes in the spring 2011 issue of the Journal of American Physicians and Surgeons (http://www.jpands.org/vol16no1/peraino.pdf).
Peraino just lost a job opportunity. Other physicians lose their career and livelihood because of attacks by unscrupulous hospitals. The Chinese general Sun Tzu’s famous treatise, The Art of War, is cited by John Dale Dunn, M.D., J.D., as a guide to how physicians can defend their professional lives against a hospital’s attempt to destroy them (http://www.jpands.org/vol16no1/dunn.pdf).
Hospitals sometimes abuse the peer review process, which was intended to protect patients. Physicians can be subject to sham peer review under the pretext of quality concerns, writes Dr. Lawrence Huntoon, chairman of the Association of American Physicians and Surgeons (AAPS) Committee to Combat Sham Peer Review. In the spring issue of the Journal (http://www.jpands.org/vol16no1/huntoon.pdf) and in workshops for physicians (http://www.youtube.com/watch?v=Kj5T8UR_ugU) he provides a disaster preparedness and defense guide for physicians
If physicians lose in a rigged “fair hearing,” they get reported to the National Practitioner Data Bank (NPDB) and may never be able to work in medicine again. The same federal law that created the NPDB—the Health Care Quality Improvement Act (HCQIA)—is being used to keep wrongfully accused physicians from recovering damages in court, even if they can prove malice and outright fabrication of the “evidence” against them.
HCQIA was never intended to protect abuses of peer review, writes Nicholas Kadar, M.D., J.D., LL.M., in an extensive review of the legislative history and important court cases (http://www.jpands.org/vol16no1/kadar.pdf). Courts, however, have misinterpreted the Act and created virtually absolute immunity for the most egregious unwarranted hospital attacks on good physicians.
“With the most ethical physicians driven out of the hospital, if not entirely out of medicine, who will protect patients if the hospital becomes their enemy also?” asks Jane M. Orient, M.D., Executive Director of AAPS.