Peer Review Monthly: Do you know what I know?

Last Thursday my wife had surgery for a benign ovarian cyst discovered by her primary care doctor during an annual exam. After an ultrasound, her physician referred her to a local area gynecologist whom I happen to have known for many years due to my past position at the medical center at which he practiced. When I heard that he was the physician my wife was referred to, my response was “That’s great. He is a good surgeon and caring physician.” When we met with him and he told us that the surgery would be done at my former hospital, my wife and I felt an additional sense of assurance.

Was this sense of assurance real? As I thought about it, I realized that this assurance was not due to any current data regarding the surgeon or the hospital. I knew of this gynecologist’s abilities 10 years ago, but had they diminished over time? Yes, the hospital had a great reputation, but had it done all it could over the past 10 years to improve the safety of the care it provided patients?

Being a consultant specializing in peer review and physician performance, I felt that I know more than most patients would under these circumstances. However, I was left with a sense that I didn’t know that much.

As a consumer, I thought perhaps I could find out more. I went to Hospital Compare website (www.Medicare.gov) where I could find out about how well the hospital performed on surgical process measures (well above average, but not in the top 10%). Patient satisfaction was just above average even though their advertisements touted their outstanding care. There was no outcome data available for the particular procedure that my wife needed.

And what about the doctor? While a few websites allowed me to buy a “report,” it mainly consisted of general information that I already knew (other than there were no public actions on his license). So I was back basing my opinion on my “insider” knowledge, something not available to most consumers. I put my trust that the hospital’s peer review process would not only detect if the physician had issues, but also help him improve if he was just average. Perhaps as the transparency of healthcare information increases, someday more data may be available on the doctor and the hospital.

I also thought about the airline industry and how I put my life in their hands whenever I fly. Unlike the surgeon, I don’t even know the pilot nor do I have any information about his or her track record. Yet I am willing to place my trust in the airline because they have a strong program of initial and ongoing evaluation of their pilots. 

The same could be true for healthcare. If we as medical staff members and leaders were to really embrace the process of ongoing profession practice evaluation (OPPE), perhaps there will be less of a need for externally available physician data because the public could place its trust in hospitals. But it would take more than a putting a few measures on a profile that we look at every six to eight months. It would require both the investment into information systems to provide accurate physician data and the willingness to use that data effectively to improve physician performance.

Robert Marder, MD, CMSL, is the vice president of The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.