What Can External Peer Review Do for You?
Case 1: Supporting a physician whose practice is questioned.
Who:In question, a well-respected, senior surgeon with an outstanding reputation, decades of successful practice in a major metropolitan area, and a wide base of referrals.
What: A complaint filed by a junior member of the surgeon’s department. The complaint alleged that the surgeon in question was performing surgeries that were unnecessarily aggressive and not clinically indicated.
Why: Faced with the question of how to respond to the serious concern, the Department Chair needed to determine if in fact the surgeon was practicing ‘cowboy medicine’ in his operating room, or whether the concerns were unfounded. Was the complaint the action of a competitor who made unjust accusations for his own interests? Was patient safety in jeopardy? Did any educational or corrective steps need to be taken by the department to ensure it was adhering to standards of care?
In this case, there was another similarly qualified surgeon within the department, but given this doctor’s professional partnership with the surgeon in question, conflict of interest would be unavoidable.
How: The Department Chair enlisted the help of MDReview to determine whether care was in fact inappropriate in any way, and if the hospital had a problem it would need to address. This would be done by providing case records to an independent, third party reviewer for the purposes of thorough, unbiased evaluation.
What happened? MDReview chose an experienced, Board Certified reviewer with equivalent training and experience, who performs the same procedures as the surgeon in question, but who is located in another region of the country and has no ties or conflicts of interest with the hospital or surgeon in question.
The reviewer was provided with complete medical records and imaging for two cases identified in the original complaint. The reviewer, also considered an expert in this surgical specialty, wrote a very detailed report that was supported by current association guidelines in this specialty. Her review found that the surgeon’s choice of procedures was fully appropriate and clinically indicated – and provided clear education as to why the procedures were in fact clinically indicated for those patients. In short, nothing was wrong with the surgeon’s management: not only was the care clinically indicated, but it was performed with a high level of quality and skill.
According to Don Lefkowits, MD, Medical Director at MDReview, “In the past, in the absence of a reliable, objective way to evaluate a physician’s practice, a department chair might have swept similar concerns under the rug. Now, with the availability of external peer review, hospital departments can take steps to objectively determine whether concerns about a physician are valid or not. In this case, the findings both exonerated the surgeon and reinforced that the department was providing excellent care to its patients with this particular surgical problem.”
When a hospital invests in external peer review, the rewards are clear. In this case, the department chair could confidently report that it had done due diligence and found the surgeon’s care to be impeccable. But regardless of the findings, the investment in external peer review arms the hospital with the information it needs to proceed — whether that means fully supporting a person under review, or recommending changes toward specific, identifiable improvements.
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