Ask the expert: What is the downside of prospective focused review?

No focused professional practice evaluation (FPPE) is perfect, and prospective FPPE has its weaknesses as well. Foremost among them is that a prospective focused review process cannot account for all potential variations or unexpected factors. For example, patients’ circumstances often change, and a proposed plan of care established in advance of the treatment may not work. Consequently, no intervention by the medical staff reviewer is possible in situations where the circumstances change, and when the treatment must change to fit the situation, the patient may be exposed to the kind of risk that FPPE is intended to avoid. In addition, there may be a disconnect between the proposed treatment plan and the one actually implemented. This is of greater concern in the procedural area, but it could have ramifications on the cognitive side as well.

Finally, the hands-on application of treatment by the physician is not possible with the prospective method. Certainly, we all know that some people can talk a much better game than they play. If the particular game in question is bridge or golf, the consequences are more humorous than important. In the area of patient care, however, this weakness of the prospective method may be the most serious defect of all.

This week’s question and answer are from Proctoring and FPPE: Strategies for Verifying Physician Competence,Second Edition, by Robert J. Marder, MD, CMSL, and Mark A. Smith, MD, MBA, CMSL.