Readers' Responses to the Letter by Chalifoux and the Editorial by Bond in Regard to "Sham Peer Re

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Readers' Responses to the Letter by Chalifoux and the Editorial by Bond in Regard to "Sham Peer Re
	2006-02-10 06:30:30
Readers' Responses to the Letter by Chalifoux and the Editorial by Bond in Regard to "Sham Peer Review" Mark F. McDonnell, MD; Lawrence R. Huntoon, MD, PhD, FAAN; John Majerus; John Wright, MD, FRACS, FACS Medscape General Medicine.  2006;8(1):34.  (c)2006 Medscape Posted 02/02/2006 To the Editor, I read with interest the recent article on sham peer review.[1] I was even more interested in the recent editorial by Mr. Bond on the same topic,[2] because it suggests a very plausible motive for sham peer review to occur, namely, economic domination of the physician community. It is obvious that an independent physician community is the greatest economic threat to the health insurance-hospital industrial complex. Good doctors are especially dangerous to this conglomerate, because they put their patients' interests ahead of the dictates of managed care or of the local hospital's economic success. As Mr. Bond elucidates, this health insurance-hospital industrial complex initially tried to control physicians by purchasing their practices but found that the good doctors cannot be bought. The "final solution" seems to be to eliminate troublesome doctors altogether, with sham peer review as the ultimate weapon. Denying care to our patients apparently was just not profitable enough. I also would strenuously object to this term of "sham" peer review as being much too mild. With the heinous level to which all of this activity has risen, I think that the term "bad faith"; peer review (with all of its legal implications) better describes the situation and should be used exclusively. Victimized physicians need to organize and strike back against the bad faith actions of the health insurance-hospital industrial complex and its minions. Moreover, all physicians must become informed of this latest attempt to dominate medicine and must support their victimized colleagues. Bad faith peer review is a crime against patients, physicians, and medicine itself. Mark F. McDonnell, MD Houston, Texas mfmcdonnellstpsinc.com References Chalifoux R, Jr. So what is a sham peer review? MedGenMed. 2005;7:47. Available at: http://medgenmed.medscape.com/viewarticle/515862 Accessed November 15, 2005. Bond C. Editorial in response to "what is sham peer review?" MedGenMed. 2005;7:48. Available at: http://medgenmed.medscape.com/viewarticle/515869 Accessed November 15, 2006. -------------------------------------------------------------------------------- To the Editor, The article by Dr. Roland Chalifoux, "So What Is a Sham Peer Review?[1]"; highlights a problem that is becoming rampant in our country today.[2] Bad faith peer review has become the "weapon of choice" for unethical hospital administrators and unethical physicians. Hospitals routinely retaliate against physicians who are "too vociferous" in advocating for quality care and patient safety in hospitals. Likewise, jealous competitors are increasingly using sham peer review to eliminate competition. As reimbursements to hospitals and physicians decline, we anticipate that this problem will worsen. Hospitals view it as a means of controlling physicians.[3] The Association of American Physicians and Surgeons (AAPS) has taken the lead in combating this "spreading malignancy" known as sham peer review.[4] We have established a special committee to combat sham peer review and to assist victims of sham peer review. The AAPS has also produced an educational DVD for physicians to increase awareness of this problem and to suggest solutions. Our journal, the Journal of American Physicians and Surgeons has also published numerous articles on sham peer review to educate our colleagues. Sham peer review destroys more than the careers of good physicians. It harms the profession, and most importantly, it harms our patients. If good physicians are afraid of coming forward in the hospital with quality-of-care and patient safety concerns because of retaliation by hospitals, who will advocate for our patients? Lawrence R. Huntoon, MD, PhD, FAAN Editor-in-Chief Journal of American Physicians and Surgeons Editorjpands.org References Chalifoux R, Jr. So what is a sham peer review? MedGenMed. 2005;7:47. Available at: http://medgenmed.medscape.com/viewarticle/515862 Accessed November 15, 2005. The Association of American Physicians and Surgeons (AAPS). Sham peer review rampant. AAPS News. 2004;60. Huntoon L. Abuse of the "disruptive physician" clause. J Am Phys Surg. 2004;9:68. Huntoon L. Sham peer review. Az Med. 2004;(Sept-Oct):15-24. -------------------------------------------------------------------------------- To the Editor, I read with great interest the article by Dr. Roland F. Chalifoux Jr., "So What Is a Sham Peer Review?[1]" and the accompanying editorial by Charles Bond.[2] Although I did not see it mentioned as such, it appears that what is described here could fall under the more general category of "workplace mobbing," a phenomenon identified by the late Dr. Heinz Leymann in the 1980s. The pejorative label of "disruptive doctor" bears much resemblance to that of "difficult professor," as outlined by Ken Westhues[3,4] in his online essay, "'The Difficult Professor': a Pernicious Concept." Although the factors described show a doctor's career to be uniquely at risk, I think that the lessons pointed to here may give all of us pause, doctor and allied health professional alike. In the case of the allied health professional, the "annual performance review" is what may similarly come into play as a mobbing instrument, with potentially devastating results to those who have an established history, as Westhues points out, of typically above-average performance. The management guru W. Edwards Deming,[5] although he has been criticized as being naive in this regard, may have had it right when he advocated the abolishment of the individual annual performance review altogether. I particularly like the following take on Deming's view of performance appraisals given by Harry Goldstein[6] in the IEEE Spectrum: Deming viewed all performance appraisals -- starting with grades in elementary school and moving up to merit systems for rewarding and punishing employees -- as a continuum of pain meted out over a lifetime. He believed that people are born intrinsically motivated with high self-esteem and tend to enjoy learning and cooperating with others. These attributes are gradually eroded by the extrinsic motivators employed by educators and businesses, until the only thing left is a desiccated husk ready for the trash heap -- or retirement. Deming taught that problems can be best addressed by looking for systemic causes rather than trying to affix blame on individual culprits. James Hoopes,[7] while critical of some of Deming's beliefs, still praises Deming as someone who "towers over most other gurus in the real good that he did." It is sadly ironic then, Hoopes' description of the final days of Deming's life: With extraordinary energy and dedication, Deming worked up until within a few weeks of his death from kidney failure at the age of ninety-three, giving one of his famous seminars to a large audience while tethered to an oxygen bottle. In the hospital, near the end, he suggested ideas for better care, then lamented the miserable management skills of this doctors, who used his suggestions to correct individual nurses instead of improving the system in which the nurses worked. John Majerus Senior Programmer/Analyst Biomedical Informatics Rochester, Minnesota jmajerusacm.org References Chalifoux R, Jr. So what is a sham peer review? MedGenMed. 2005;7:47. Available at: http://medgenmed.medscape.com/viewarticle/515862 Accessed November 15, 2005. Bond C. Editorial in response to "what is sham peer review?" MedGenMed. 2005;7:48. Available at: http://medgenmed.medscape.com/viewarticle/515869 Accessed November 15, 2006. Westhues K. "The difficult professor": a pernicious concept. Available at: http://mueller.educ.ucalgary.ca/Difficult/default.html Accessed January 12, 2006. Westhues K. Homepage at the University of Waterloo. Available at: http://arts.uwaterloo.ca/~kwesthue/ Accessed January 23, 2006. Deming WE. Out of the Crisis. Cambridge, Mass: Massachusetts Institute of Technology, Center for Advanced Engineering Study; 1986. Goldstein H. Appraising the performance of performance appraisals. IEEE Spectrum. 2006. Available at: http://www.spectrum.ieee.org/careers/careerstemplate.jsp?ArticleId=w110101 Accessed January 12, 2006. Hoopes J. (2003). The Statistician - W. Edwards Deming. False Prophets: The Gurus Who Created Modern Management and Why Their Ideas Are Bad for Business Today. Cambridge, Mass: Perseus; 2003. -------------------------------------------------------------------------------- To the Editor, "Sham reviews[1,2]" take many forms. I have published on the Internet most details of my experience, but a summary may be of interest. After 25 years as head of surgery in a major "public" hospital in Australia, I advised the management of dangerous practices. I was threatened with dismissal, but an internal inquiry found no fault in me. Two years later, I was invited to head a new surgical department in a related hospital. I accepted, but a year later, I again reported unsafe patient management by nonspecialists. I was suspended on grounds of "loss of confidence" in me. None of my critics had any specialist experience in the department that I headed. The 2 most vocal ones falsified their credentials. A senior, independent, truly peer referee was appointed by the hospital to adjudicate at another inquiry. His report was favorable to me but unfavorable to the hospital. It was suppressed until my termination was effected by a committee of whom none was a doctor. At litigation, it was determined that my contract could be terminated at any time without a reason existing. The new job was later described as having never existed, either. The referee's report was lost in the hospital and health department files on 10 occasions in the next 10 years. Finally, the state minister for health sent his personal driver to collect a copy from my home in order to confirm to him that such a report actually existed. He took no action. Of course, at mature age I could never work again in my surgical specialty. There seems absolutely no recourse when such systems are allowed to flourish. "Lay" boards of management are too easily manipulated by antagonistic, threatened medical colleagues who can generate cartels. John Wright, MD, FRACS, FACS References Chalifoux R, Jr. So what is a sham peer review? MedGenMed. 2005;7:47. Available at: http://medgenmed.medscape.com/viewarticle/515862 Accessed November 15, 2005. Bond C. Editorial in response to "what is sham peer review?" MedGenMed. 2005;7:48. Available at: http://medgenmed.medscape.com/viewarticle/515869 Accessed November 15, 2006. -------------------------------------------------------------------------------- -- Regards, Catherine