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
Guelph General Hospital,
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