COMMENTARY

Should Patients Be Alerted When Doctors Are Disciplined?

Arthur L. Caplan, PhD

Disclosures

October 29, 2018

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU School of Medicine. California just took a big step to empower patients and would-be patients to avoid disciplined doctors. They have worked with the medical board in the state to create an app that you can have on your phone or your iPad and instantaneously get updates on doctors that you may be seeing. I think they allow up to 16 physicians to be tracked, and users receive information from the app about disciplinary actions or license revocation.

We often say to patients, "If you're going to try out a new doctor, check to see their status with the medical board if you're concerned about any license issue that they might have had that led to discipline." However, in most states, it's very difficult for people to find that website, know what to do, or even remember to do it.

I applaud what California is doing. State medical boards are very conservative in revoking licenses and in administering punishments. Some would argue—and I am among them—that they're too lenient and they don't take a "me too" attitude that says, "One conviction of sexual assault, that's it—you lose your license." There may be situations where they allow supervised practice or require someone to be in the room, but that's a topic for another day.

What shouldn't be up for debate is the right of a patient or potential patient to see that physician's status. If you're going to be informed and make choices about your healthcare provider, I think it's relevant. It's important to know whether they have had a license revocation or whether they are practicing with disciplinary administration from the state licensing board.

Historically, I think there's been a little bit too much of an insider club to the licensing board activities in every state. They basically have had heavy physician perspective and peer review; however, it hasn't been oriented toward patient empowerment. Physician to physician, people make decisions [where they] limit an individual's practice or maybe revoke a license, but it doesn't happen often, and these bad guys continue to practice, often costing everyone in medicine a huge chunk of change for their malpractice fees, misconduct activities, etc.

When it comes to disciplinary actions and revocations by state medical boards, I am well aware that many physicians believe that you don't get the full story by having something listed on a website that says "license revoked" or "under disciplinary censure" or "has a letter in their file." I understand that and sometimes the complaints are valid, but the patient or would-be patient [should be able to] ask the doctor about their thoughts concerning the disciplinary action that the medical board took.

It's a subject for discussion, and I understand that it might not be an open-and-shut case in every instance. Nevertheless, if we're going to get patients to trust their doctors and if we are going to have the public supporting the system we put in place for medical licensure, [we need a way] to trigger a discussion. We do not want the accusation to be that we're not sharing this information or that it's kept behind closed doors; I don't think that's the way forward in terms of cementing trust.

Although it isn't comfortable to think that someone at the medical board is watching all the time and will post information about me if I get into trouble and wind up getting penalized, I still believe that's the right thing to do. The way to cement trust between doctors and their patients, and between medicine and the public, is to say, "We do what we can to make sure that you know when someone has been punished or when someone has had their license revoked."

If you choose to discuss that with your doctor or your new doctor, that should be your right. I hope other states emulate what California has done.

I'm Art Caplan, from the Division of Medical Ethics at NYU. Thanks for watching.

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