A recent blog and a comment by a colleague stimulated my interest in the concept of "disruptive physician". Googling it quickly lead to this example of what really seems to be the peer review process being used to silence a physician who had the courage to point out a serious patient safety issue at her hospital.
The recent action of the Joint Commission regarding a disruptive hospital personnel policy indicates this issue has gone past the point of just talking about it.
Without the teeth of the Hospital Review committees, talk about the disruptive physician would mean little. However, abuse of the peer review system has been written about for a number of years. Here is a good review of the anatomy and physiology of the legal structure of the peer review world, a world that seems far remote from the usual notions of due process and innocent until proven guilty and meaningful appellate mechanisms. A key point is that federal law gives peer review committees immunity and you do not want to be on the bad side of a group of people who are not restrained by the threat of tort action.
The peer review sword can be used to remove a physician whose actions are in fact placing patients at risk but can be wielded to restrict competitors or to silence or threaten an physician whose comments are "disruptive" to a hospital administration's plan to do what it wants without bothersome input by physicians.
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