Healthcare Quarterly

Healthcare Quarterly 2(2) December 1998 : 8-8.doi:10.12927/hcq..17135

Quarterly Letters: Process Not Litigation

J. Squires


I would like to submit some reaction to the article "Process Not Litigation: Dealing with Physician Impairment in a Hospital" which appeared in the Summer 1998 issue (Vol. 1 No. 4). Let me say that the process described [by the authors] makes inherent sense, and is one consistent with the spirit of medical self-governance and shared accountability between administration and the medical staff.
However, I have some difficulties with the proposal. First, to define explicit standards of care/utilization that would be acceptable to all members of a department is a very difficult undertaking - although I do agree it is a necessary step to identify outliers. What is more difficult in practical terms is for department chiefs (who in many cases are performing this duty for a short term and perhaps on a rotational basis) to confront their colleagues on issues such as a breach of standards. It is all too easy to ignore the problem of a colleague who does not use hospital resources responsibly (or how administration would like to see them used) or whose behavior is inappropriate. The challenge in this era of limited financial resources is to create a culture where chiefs are committed to carrying out their mandated roles and afforded the opportunity to do so.

About the Author(s)

J. Squires, MD, FRCPC
Emergency Room Physician
and Member Senior
Management Team,
Guelph General Hospital,
Guelph, ON


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