What You Don't Know About Peer Review Can Hurt You

Neil Chesanow

Disclosures

January 21, 2011

In This Article

Introduction

Peer review contains inherent problems, and the way hospitals typically conduct the process only makes the situation worse. Not only is peer review often unfair to a doctor under evaluation, but it's also ineffective at what peer review is actually intended to do -- protect patients.

"One reason doctors are so paranoid about peer review is the emphasis on punishment over education," says Skip Freedman, MD, an emergency physician and medical director at AllMed Healthcare Management, a Portland, Oregon-based firm that conducts independent physician reviews for hospitals and other healthcare organizations.

"The idea should be to improve care, not take the doctors out back and shoot them," Freedman says. "It's that anxiety which prevents peer review from being done properly and done better. There are occasional incurable cases of doctor arrogance or ignorance in which privileges may be suspended. Those are extremely rare. That's not where peer review should be thought to reside."

Peer review is typically "well-intentioned but dismal," Freedman admits. Peer review is typically done reactively rather than proactively, he says. It's usually done on an ad hoc basis rather than systematically. Doctors who sit on peer review panels are typically untrained, unpaid volunteers -- amateurs -- for whom conducting peer reviews isn't a priority and whose terms of service generally aren't long enough to for them to gain the necessary experience. And peer review panels are riven by bias, with doctors often judging other doctors who are their partners or competitors, calling their impartiality into doubt.

"Most physicians have no idea of how the peer review process works until they're actually in the middle of it," says Mark Smith, MD, MBA, a vascular surgeon in Palm Springs, California, and a consultant at HG Healthcare Consultants in Salem, Wisconsin, which redesigns peer review at the behest of hospitals and medical staffs. "Right now, many doctors aren't happy when they become involved in a peer review."

For many doctors, peer review is perceived to be inquisitional and shaming. It may also threaten the loss of hospital privileges, which can be disastrous for a medical career.

For many other doctors, however, peer review doesn't inspire dread; it inspires indifference. That's problematic, too. "Hospitals do a lot of ineffective peer reviews where they don't find much of anything," says Robert J. Marder, MD, a Chicago-based a pathologist, author of several books on peer review, and a vice president at the Greeley Company, a consulting firm in Marblehead, Massachusetts, that performs peer review redesign. "This is more of a concern than peer review turning into a witch hunt."

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