Ongoing and Focused Professional Practice Evaluation-A Complex Joint Commission Standard

Dr. Scalpel weighs in on a physician’s view of the new Joint Commission requirements for Ongoing and Focused Professional Practice Evaluation, a thorny issue in the world of medical staff administration:


Dear Dr. Scalpel:

In accordance with Joint Commission regulations, we are required to request an evaluation of your clinical performance. The Credentialling Committee now requires the completion of an evaluation form by a peer in your specialty who is not a member of your group practice.

Attached, you will find a letter and accompanying evaluation form which you should forward to a peer of your choice for completion. In order to proceed with the processing of your reappointment application, it is necessary that you ensure that the required evaluation form is forwarded to a peer and returned to us in a timely manner.

How did we let this happen?

Read the rest of Dr. Scalpel’s comments:


Joint Commission’s stated goal with these new requirements is to improve the objectivity and validity of the credentialing/privileging process.  Historically most hospitals have relied heavily on peer references, often from peers with a financial interest in the outcome, when determining whether or not a physician should be granted initial or ongoing privileges. 

In fifteen years of reading professional evaluations I doubt that I’ve read more than ten that said anything other than "recommended."  In general, no one wants to be the cause of a colleague’s loss of clinical privileges, particularly not when the practitioner is part of the writer’s professional practice group.

My best advice to the medical profession, which understandably feels put out by these additional requirements, is get involved and help your organization’s administration and medical staff office develop the best possible tools for objective, valid review of professional practice. 

In today’s world, good or bad, it’s all about data.

Nurses Recommend Doctors

was renamed and relaunched earlier this month by CareSeek. “We are excited to see that our vision of ‘getting better- together’ is more than just a tag line, stated Gale Wilson-Steele, CareSeek’s founder and CEO.”

Kim McAllister, a veteran emergency room registered nurse in San Francisco, (and famous blogger by the way) praised the change. “The new name showcases the sites focus on “recommending” rather than just rating physicians. Nurses are always asked, Do you know a good doctor? Well, now they can post their opinions about the doctors they work with and refer people to the site.”

I visited the site and noted that there are a large number of physicians listed, but as of this time, few are rated.  There is also no way to tell by looking at the list whether or not a physician has been rated by a nurse member, or if he or she has, what type of rating was entered. As more data is collected the site will become more valuable to visitors seeking information about physician providers.

Under Posting Guidelines, the site states:

Regarding Ratings and Reviews

“It is our underlying premise that physicians and caregivers practice under a professional code of ethics, and that inherently they are in the healthcare business to help their patients.  There are certain styles of practice, however, that vary between care providers.  We know that reports from patients and others who work closely with physicians provide valuable information when choosing a health professional.  This personal feedback helps to manage patient expectations, allows physicians to improve patient and employee satisfaction, and can be used to improve the quality of care.”

The proliferation of physician rating sites that have sprung up on the web in the past couple of years clearly demonstrate that patients want more information than has historically been available to them.  Time will tell whether or not these sites, which provide interesting, but often biased feedback, will continue to be attractive to those seeking information about potential care providers.

What are you, stupid? Dealing with the jerk at work

“What are you, stupid?”

Such was a physician’s loud and unhappy response to a medical records employee who would not release the patient record he wanted.  (This incident happened a few years ago, so I don’t remember whether the issue was that the record was not for one of his patients, or whether he wanted to take it home with him to review.)

This incident became well-known around the hospital, and when the medical records employee left for another job sometime later (hmm, wonder why??) we organized a going-away party complete with fortune cookies – with the same message in each of them – “What are you, stupid?”

When doctors behave like bullies the issues tend to escalate because of their position of power on the healthcare team.  Docs however, are not alone in this behavior. Nurses, administrators, and other healthcare providers can and do also act in unprofessional, unkind, and abusive ways.

It’s no surprise that the issue of workplace bullying strikes a cord with most of us. 

According to Stanford University professor Robert I. Sutton, who recently wrote a book on the subject,  workplace jerks are everywhere, and most people will encounter one (or more) of these people over the course of their professional life., in an article entitled “Dealing with the jerk at work” notes that the characters in question are typically the people often referred to as bullies, creeps, jerks, tormentors, despots, backstabbers, egomaniacs and the like.

For Sutton, their behavior in so many of today’s workplaces can be damaging to not only fellow workers and the companies that employ them, but themselves as well.

“If you display contempt,” he writes in chapter four, “others will respond in much the same way, igniting a vicious circle that can turn everyone around you into a mean-spirited monster just like you.”

Unfortunately, many workplaces today ignore, forgive or even encourage nastiness.

Read Dealing with the jerk at work

Turn About is Fair Play – Doctors Rate Insurers

For years, doctors have chafed at new ways insurers are rating them and tying
bonus payments to those ratings.

The Minnesota Star Tribune reports that the Minnesota Medical Association is fighting back by issuing pay for performance plan ratings.  The Association also has issued a report regarding the unnecessarily heavy administrative
burden created by multiple criteria sets used by various health plans.

In their most confrontational move yet, the association turned the tables on
insurers by ranking nine of the so-called pay-for-performance programs.
Centers for Medicare and Medicaid Services ranked at the top while Bridges to
Excellence, a program used by large, self-insured employers, was at the bottom.
Programs by Blue Cross Blue Shield of Minnesota, UCare, PreferredOne,
HealthPartners and Medica fell somewhere in between.


Financial Security Hard-Earned For Most Medical Residents

Meet Chris and Meg – medical residents in the Chicago area.  CNN Money gives us a glimpse into their lives, at least from a financial perspective:

Financial security won’t come guaranteed with their medical licenses. As health-care economics squeeze physician salaries, rising college and med school tuitions are putting young doctors ever deeper in the hole.

By the spring of 2006, as med school was drawing to a close, Meg and Chris had a total of more than $450,000 in debt. The couple’s work is rewarding, but not in the monetary sense. Their combined earnings are around $88,000 which, given their exhausting schedules, averages out to about $12 an hour.

Money Magazine set Chris and Meg up with Donald Duncan, a Chicago-area planner and investment adviser.

Read the full text of Young Doctors In Debt

Moving Day

Clinical Risk Management is part of the Cleveland Clinic’s Quality & Patient Safety Institute.  QPSI (made up of several departments) is moving to a new building on the main campus today. 

In preparation we’ve all been packing, and thus rummaging through boxes, for the past week.  “Now where did I put that notebook?” There are sticky tags with names and new locations everywhere.  It looks like a post-it notepad exploded in the vicinity.

Moving is, to say the least, disruptive.  On the positive side however, it does force us to throw away things that should never have been kept in the first place.  Pity the poor housekeepers in our area. 

Because I just can’t bear to part with them, I am lugging along my heavy three ring binders of past issues of Synergy.  I sent NAMSS Executive office a request that they consider putting past issues on CD and selling them.  Having moved my office several times over the past few years, I’d be first in line to purchase a copy.  Any other takers?

The new building has two interior rows of conference rooms, which are all glass fronted – no secret meetings here!  It will be interesting to see whether we simply get used to meeting like schools of fish, or whether being on display will tend to make meetings shorter, and perhaps friendlier?

At any rate, think of me today – I’ll be the one eying a stack of boxes trying to remember where I packed the stapler…

Physician Drug Addiction – Are Patients Protected?

Dr. Jennifer Zampogna showed many signs of having a drug addiction that could endanger patients.

Pharmacists noticed. Her staff noticed. So did the state attorney general’s office, local police and federal authorities.

Yet the Pennsylvania Board of Medicine, which is supposed to protect the public from addicted doctors, didn’t act decisively until after Zampogna had been investigated for seven months and arrested.

So opens an article from the Pennsylvania Cumberland County News.

The article examines the difficult balance between acting swiftly to protect patients and waiting until enough information has been gathered and investigated to ensure that physicians are appropriately protected as well.

Enabling doctors to obtain help without destroying their careers makes it more likely doctors will address, not hide, an addiction. As a result, the public is safer.

A conservative estimate is that about 7 percent of doctors are addicted to drugs or alcohol. Pennsylvania, with about 35,800 licensed doctors, would have at least 2,500 addicted doctors.

In 2006, the (Pennsylvania) medical board disciplined six doctors for situations involving addiction. It’s monitoring about 73 doctors dealing with substance abuse, with 24 more waiting to enter the program.

Read the full text of Medical Board Moves Slowly Against Addicted Doctors

I love you forever

It made me smile.  Parents sitting with a young girl, probably around 4; she is drawing on a piece of paper.  Daddy takes out a pen and reaches over to write:

The little girl beams.  I don’t know the family but witnessing this brief interaction makes me smile; a sweet scene to recall some rainy afternoon.

Then Mom leans over, looks at Daddy and says “forever is one word.”  He puts his pen away, looking a bit embarrassed. 

The magic ends.  I sigh.

I post this here as a reminder to us all that love needn’t be perfect to be cherished, and tenderness trumps grammar any day.