Dr. Bob took the call from a colleague. Someone he had worked with for years.
"Bob, it's me. Sorry to bother you but we had a meeting of the department peer review committee and your name got flagged. Listen, this is nothing, it's no big deal. But the nurses think you have higher than average complications on the interventional procedures you've done in the past 6 months. Like I said, it's nothing. I know what a good doctor you are. Would you mind dropping by the medical staff office tomorrow for a quick review of this with the chief and the hospital's medical director?"
At this point, Dr. Bob should:
- Say "Yes, I'll be there."
- Get angry and deny any problem.
- Ask for a list of the procedures and the complications that have been documented.
- Wonder what his rights are.
- Call his lawyer.
Sitting in the doctors' lounge, I commonly hear doctors, when they're not watching Fox TV and yelling that they're going to law school, complaining about letters they get from hospital peer review committees about this or that case. They invariably proclaim that they have "rights" and are entitled to their day in court.
They somehow think that the U.S. Bill of Rights applies to any conflict they might have with a hospital peer review committee.
But what most doctors do not understand is that in most cases the only due process rights they are entitled to are those outlined in the hospital's bylaws and fair hearing manual. And those can be pretty slim and usually biased in favor of the hospital.
Such issues can come up with quality issues, like a doctor who the hospital thinks has more complications for a certain procedure or surgery than his/her peers or for a doctor who has been deemed "disruptive."
Or an older doctor who has been flagged by nurses as being cognitively impaired.
If Bob, the doctor in the example above, asks his attorney what the hospital is entitled to review, he will likely hear something that is pretty broad -- like "anything that has any reasonable relationship to quality." And that's as defined by the hospital, not by Bob.
Under both state and federal law hospitals have broad powers to investigate any medical staff physician for quality problems, including the broad and feared "disruptive" behavior.
In deciding what to do, Bob and every other doctor confronted with such a call should remember one thing: Peer review committees have enormous power over your career.
They can make or break you. Take them seriously.
But, you don't have to fold and do everything they want right away.
The best approach is to be cooperative -- to a point. And to do that you have to know your rights.
Most doctors probably don't know where to find the current copy of the hospital's bylaws. For most, they are probably posted on the hospital's password-protected website or the physicians' portal.
For Bob, a good start would be to tell his buddy that he would love to attend but he has a busy office schedule or a procedure to do that cannot be easily canceled. Buy some time. And use that time to determine his actual rights and the hospital's actual procedures for peer review investigations.
The most important thing is to not attack the committee verbally or in writing. Don't fire off an email to your buddy on the committee or to the hospital's medical director saying how long you've been on the staff and how much revenue you've brought to the hospital.
Do assume that if you're under review, there are actually some problematic complications with your cases or the hospital has decided to bring in a younger competitor and is using quality issues to oust you. Either way, you need to take this seriously and not attack the process yourself.
Doctors always seem to want to "fix" these problems quickly and by themselves, and in doing so usually make the problem worse.
, has been a cardiologist in private practice in San Antonio for the past four decades and has a litigation practice in healthcare law.