Here in the United States MSPs have been hearing about a serial killer named Michael Swango. Author James Stewart reported the Swango case in his book, Blind Eye. This week I learned about another notorious serial killer, Harold Shipman, an English general practitioner who happens to be the only British doctor to be found guilty of murdering his patients. He was convicted January 31, 2000 for 15 murders and sentenced to life imprisonment. Following the trial, an investigation discovered enough evidence to link Shipman to the murders of over 215 people, 80 percent of them females.

As a result of these horrific crimes, a plan to require annual competency evaluations is being implemented and will affect over 150,000 physicians from India who are practicing in the United Kingdom. The details of the plan are explained in Medical Revalidation: Principles and Next Steps by Sir Liam Donaldson, Britain's Chief Medical Officers. Senior physicians appointed to identify poor performers based on patient questionnaires and comments from colleagues will conduct these assessments. These assessments will include physician communication skills, prescribing habits, personal problems (alcohol or drug abuse) and inclusion of patients in decisions regarding their treatment.

Who came up with this idea? According to information from the references listed below, the proposals were developed by the General Medical Council and the Academy of Medical Royal Colleges. The rationale is the scandals over medical incompetence and in particular the case of Dr. Shipman. The focus of this plan is to raise standards, not as a means for disciplinary action for a small number of physicians.

It will be interesting to see how this plan rolls out, how it is perceived by the public, and what impact it may have on the practice of medicine. Think the United States government will be watching?

Carole La Pine, MSA, CPMSM, CPCS



References:
www.business-standard.com/india-Press Trust of India
www.medscape.com - Tim Castle
www.timesonline.co.uk/tol/life and style/health - David Rose
http://en.wikipedia.org/wiki/Harold_Shipman

Many MSPs are familiar with the book Blind Eye by James Stewart about a physician, Michael Swango.  If you have not read this book, you'll want to pick up a copy to learn more about why our jobs are so important to patient safety. 

Mr. Stewart reports the allegations that caused many to believe that Michael Swango may be the most prolific serial killer in American history.  The story is of particular interest to MSPs who investigate applicants for medical staff membership, privileges, and participation in health plans.  Learn how Swango's behavior was not discovered before he committed murder and poisoned coworkers. 

After reading Blind Eye, you'll wonder if you would have uncovered Swango's incompetence, misconduct and criminal behavior. 

Carole  La Pine, MSA, CPMSM, CPCS

We’ve heard about the “secret shoppers” who go into retail stores to evaluate customer service. We even know about the “food critics” who eat out then write reports on their dinning experiences. I must admit to being a little surprised by the latest “mystery patient” methodology. 

It was announced in an article by Dave Gershman published in the Ann Arbor News, Sunday, July 6, 2008 that an outside firm was hired to test patient satisfaction at Saint Joseph Mercy Health System. Although this approach is frequently used by the retail industry to rate customer services, does this really work in a health care setting? One of the down sides of this practice is the additional strain it puts on an already busy office, clinic, and/or practitioner. Dr. Ronald White, President of New Jersey Physicians stated it is “a horrendously bad idea” employing marketing techniques that do not evaluate medical care. Recently the American Medical Association discussed this topic and now is having this type of practice evaluated by its Ethics Committee. 

From the MSP standpoint, testing our procedures with fake applications would significantly impact already limited resources. Before considering such a practice, it is critical to know exactly what goal the exercise would accomplish and then look for other methods to obtain the same information. We know how much time we spend with each application, sometimes looking for what is NOT there, in order to ensure the public that they will get safe care from our practitioners. 

We need to ask: Is the “undercover” approach similar to the practice of pulling a fire alarm to test the response time of the fire department?  

Seems we surely could come up with a more acceptable practice. 

I’m getting ready to do a presentation to the Alaska Association Medical Staff Services next week.  My topic is “Red Flags”.  As I was looking at the examples I’m going to use it occurred to me what a unique role we have in this “investigation” process.  I know we use the term “credentialing” but aren’t we really doing investigations?

Taking that into consideration, how would that impact our current job titles?  Director, Practitioner Investigation and Privileging Department
Manager, Quality Investigation Service
Medical Staff Investigator
Health Plan Practitioner Investigator

Oh the possibilities!  Think the patients would have a better understanding of our responsibilities?

Carole  La Pine, MSA, CPMSM, CPCS