This week's problem is addressed by Herb Alexander, MD. A prominent orthopaedic surgeon, Dr. Alexander is a retired United States Navy Captain and has held numerous leadership roles throughout his distinguished Navy career and in private practice. Dr. Alexander remains active academically, lecturing nationally and internationally, and is a Founder and Principal of MDReview.
Problem:
"Our medical staff identified several orthopaedic surgical cases
that warrant external peer review. The
preoperative imaging studies were conducted outside the hospital within the
physician's office. Our medical staff is
reluctant to require the physician to provide these images, but the peer
reviewer feels they are integral to an effective, thorough review. The peer reviewer also feels that some of the
office notes are critical to the review process."
Solution:
While orthopaedic surgery is an excellent example of a specialty that
demands that pre- and postoperative studies be included for peer review, it is
not alone. Clinical decisions in the
disciplines of vascular, cardiac, general and other surgical specialties often
hinge on such studies. The fact that
these studies are conducted outside the walls of the hospital is not a
reasonable justification for excluding them from review. Peer reviewers are put
at a significant disadvantage without having access to the very same
information that the physician under study used for patient assessment and
hospital care. By failing to require
that the physician provide the imaging studies that served as a basis for
surgery, the hospital often puts itself in a positioning of commissioning an
external peer review that is based, in part, on speculation. This, in turn,
leads to conclusions that can be difficult to defend.
Can a physician refuse to provide information that is contained within office
records? Such would represent a failure
on the part of the physician to recognize that peer review knows no walls. Care is a continuum, often beginning and
ending in the physician's office but with hospital care in the middle. Physicians have the ethical obligation to
comply with requests for information that is outside the hospital record in
support of the peer review process, even if such compliance is not spelled out
in the medical staff bylaws. Physicians
not inclined to cooperate might be reminded of their obligation. If not already included, the medical staff
might consider incorporating a provision into its bylaws that specifically
articulates the requirements for all medical staff members to fully comply with
the peer review process.
It is important for all involved to remember that peer review knows no walls.
Privileges must be constantly contingent
upon the hospital's complete, unobstructed ability to evaluate patient care for
which the hospital is largely responsible.
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