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Calls for Transparency on Bad Physicians Grow Louder

 |  By jfellows@healthleadersmedia.com  
   December 10, 2015

Whether physicians who are on probation should be required to disclose their probationary status to patients is a source of debate that's getting hotter in California, where a patient advocacy group is testing the boundaries of transparency.

Two leading patient safety organizations say they support an effort in California to force physicians to disclose their probationary status to patients.

That means California doctors may be a litmus test for a new debate about physician transparency. At issue is whether physicians who are on probation should be required to disclose their probationary status to patients.

The Medical Board of California (MBC) rejected a push from the Safe Patient Project, a patient and policy advocacy group backed by Consumer Union, for new physician disclosure requirements, but the MBC is appointing a task force to explore the current disciplinary system. "We are taking this seriously," says Cassandra Hockenson, MBC spokeswoman. "We could have said, 'we do outreach already, thank you.' But we are serious about patient safety. Our mission is consumer protection."


Tejal Gandhi, MD, MPH, CPPS

The task force will have four members, two from the public and two physicians. The members haven't been publicly named yet, but the group will be appointed by the time of MBC's January board meeting, according to Hockenson. "We had a task force for prescription drug abuse and use and we opened it up to stakeholders, so we will very likely open this up, as well," she says. "It's not going to be in a vacuum."

The disciplinary status of physicians and the details that led to sanctions are available online now through most state medical boards. But it isn't convenient and the burden shouldn't be on patients, says Tejal Gandhi, MD, MPH, CPPS, president and CEO of the National Patient Safety Foundation (NPSF). "Ethically, this is the kind of information patients have a right so see and [should not have to] go hunting for," Gandhi says.

NPSF just released a report on patient safety with eight recommendations that address culture, research, and metrics to improve patient safety. A separate NPSF report on transparency released earlier this year, explicitly called for clinicians to tell patients about their "experience, outcomes, and disciplinary history."

Gandhi says patient safety and transparency are intertwined. "I know there are challenges, but the fact that someone is on probation is something patients should know about," she says. "It's fundamental."

So far, major physicians' groups are mum. The American Medical Association did not comment on the issue. The American College of Physicians issued a statement that said, "We don't have a policy that speaks to this."

Gandhi, who was executive director of quality and safety at Brigham and Women's Hospital in Boston as well as chief quality and safety officer at Partners Healthcare, says one barrier for physicians agreeing to any kind of disclosure requirement is an agreed upon definition for probation.

"It has to be clear what probation means," she says. "There has to be the right way to explain it as well. Is there standard language? It's not the easiest conversation. The board should be providing some standard language and tools."

Guidance Offered
The Safe Patient Project has recommended some guidance on disclosure. It suggests including a paragraph detailing the offense that led to probation, the physician's practice restrictions because of the probation, and directions for contacting MBC for more information about the offense. Safe Patient Project Director Lisa McGiffert applauded MBC's creation of a task force. "We got their attention," she says.

When it comes to whether probationary status at MBC also includes minor physician offenses, such as poor record keeping, McGiffert says that in California, that's likely not the case. "They (MBC) don't hand out probation frivolously," she says. "We think it's disingenuous to claim that doctors are on probation for minor issues. The majority of doctors have no idea how bad these guys are."

McGiffert is no stranger to patient advocacy. She is the consumer liaison to the CDC Healthcare Infection Control Practices Advisory Committee and is a consumer representative on the National Quality Forum's Healthcare-associated Infections Steering Committee.

As of September 2015, about 500 doctors in California were on probation, which is less than 1%. And McGiffert is right. A quick spot check on reveals that the doctors on the list are linked to egregious errors ranging from sexual assault to failing to follow up on patients who eventually died.

'Patients Deserve to Know'
What isn't known, and what the MBC task force can do, says McGiffert, is determine if there are minor offenses among the physicians who are on probation and narrow down the determination of which offenses are so bad that patients should be notified.

The Federation of State Medical Boards does not know if a requirement to disclose probationary status of physicians to patients exists in other states. McGiffert says it does not. "This would set a precedent," she says.

The Leapfrog Group, which monitors hospital safety and transparency for patients, says consumers want this kind of information, and they should get it. "Patients deserve to know," says Erica Mobley, the group's director of communications. "We should never underestimate the intelligence of a consumer. There's no reason why they shouldn't be able use that information to make an informed decision."

The move to disclose errors to patients isn't groundbreaking. The information is online, some organizations, such as Cleveland Clinic, post reports on their quality—both the good and the bad. But telling a patient personally, whether on a form they sign at check-in or in a notice posted on the practice's physical and online site is unprecedented.

Todd Johnson, CEO of HealthLoop, a patient engagement platform provider, says physicians could look to the disclosure rules that govern IT.

"When there's a data breach, we have to report it," Johnson says. "Transparency is a double-edged sword for physicians, but the train has left the station. Medicine is an interesting place to explore this issue of transparency because people are literally putting their lives in someone else's hands."

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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