I have always been passionate about quality in medical practice, trying to understand what it means, how to measure it, and how to enhance it. Having now hung up my scopes (stetho- and endo-) the issue has become more personal in recent years.
Who can I trust to look after me as I traverse my final years in which serious illness becomes inevitable, if not overdue?
Choosing providers and facilities
I now think more like a patient than a physician. Of course, my training and contacts make it easier for me to make choices about care than for most people who are not in the medical world, at least when I am at home. But, I will be concerned and challenged if I am dragged off a distant golf course with GI bleeding or acute cholangitis.
Who is on call at the local hospital? How can I tell if they have the necessary skills (and indeed the facilities and equipment)?
All hospitals have credentialing committees charged with making sure that they give privileges to practice only to those with proven competence. My experience as an expert witness in lawsuits indicates that credentialing is lax in many hospitals.
My experience as an expert witness in lawsuits indicates that credentialing is lax in many hospitals.
A recent survey showed that 21% of hospitals had no written guidelines for credentialing a risky technique – ERCP (Endoscopic Retrograde Cholangio Pancreatography) – and 51% had none for renewal of privileges. This puts patients at risk, and indeed lays hospitals open to legal redress.
What to do?
Obviously, hospital credentialing committees need to do a better job, but they need the tools. Often, decisions are made simply on numbers. The decision makers assume that when folks do things often it means they must be doing them well.
That doesn’t apply to my golf. My golf skills are judged by my scores, which I am obliged to report at my club. Credentialing committees need similar outcome data.
Benefit of report cards
I have recommended for years that endoscopists keep “report cards” of their performance, and have them available when requested by patients, privileging bodies, payers (and even plaintiff lawyers). Few do, because there is currently no motivation. Hospitals should insist on them, and I recently suggested some templates for ERCP.
Gastroenterology focuses on much more than procedures, and there are quality issues in many aspects of the patient experience. I am proud to be part of the SE Healthcare team, which has produced several tools designed specifically to measure and improve the quality of GI practice.