The Tricky Business of Policing Ourselves II

This is a continuation of the prior post.

Picking a good physician is one thing. Identifying the less competent ones is much more challenging. As a whole, physicians like regulating ourselves. With requirements like continuing medical education, board recertification, and institutional bylaws, we try to identify and remediate physicians who fall outside the normal standard of care. Those who are grossly negligent, clearly unprofessional, or overtly irresponsible are easy to identify. But there's a big gray zone that's very scary. If the average surgeon takes an hour for a particular procedure, but one surgeon averages two hours, is that a problem? What if he averages four hours? If an average radiologist misses 2% of a particular finding, is a radiologist who misses 4% a problem? Most physicians participate in active learning even in practice, going to conferences and reading journals; would you find a physician problematic if he did no continuing medical education? What about the physician who has no knowledge or skill deficiencies, but who is rude to other staff? How do you approach doctors in the "gray zone?" They are colleagues, and it can be a challenging interpersonal interaction to confront one. Historically, we do very poorly in policing ourselves. But as public scrutiny falls upon substandard physicians, we need to do a better job in making our professional expectations explicit and follow through with working with the doctors that don't meet the minimum standards.