Medical Licensing in Missouri
The Post-Dispatch is currently publishing a thorough series about how the Missouri state medical board disciplines doctors for medical errors or other crimes in Missouri. I commend the Post for the detail that the series includes. I, like a lot of people, think that long-form investigative journalism is the type of content that will keep newspapers a part of our lives going forward. You can’t just replace a series like this with bloggers.
There is a lot of good information in the series, and there are some solid recommendations for improvement in medical care. There are also some suggestions that make no sense at all, and the articles take some harsh and inaccurate shots on people I have known for a long time. For example, I don’t think there is anything wrong with a lawyer who represents doctors in civil cases serving on the medical licensing board. However, should the board itself have more than one public member? That is another question, but a good one raised by this series. I think the answer is that it should, which is similar to what I recommended a while back for judicial appointment boards.
This is the first time that I have blogged about a story in which my own dad is quoted, although the quote itself is not germane to this post.
The heart of the story is that Missouri’s medical licensing system is not strict enough. There are some frightening stories here about how doctors who have harmed people can continue to practice, leading to greater harms. Closely related are stories about doctors who have committed crimes unrelated to practicing medicine, who also continue to practice.
Not surprisingly, the series has led to calls for the licensing board to toughen up the penalties for doctors. That is different and more defensible than calls to toughen up the licensing of doctors in the first place. However, I think that the best improvements are the ones that involve making more information about doctors available to the public so that patients — and hospitals who hire doctors — have better data available all along. As Sen. Bill Stouffer said, in a quote with which I entirely agree:
State Sen. Bill Stouffer, R-Napton, said changes to the state laws should start with making the letters of concern a public record and allowing patients to compare doctors’ performance.
“I think transparency would cure a lot of our problems in health care,” Stouffer said. “It’s amazing what the light of day cleans up.”
We do have a system in which doctors who harm patients can be held accountable. It is our very robust civil court system. I supported tort reform back in 2005, but even with those needed changes, doctors that irresponsibly treat patients can still be readily held accountable. Is that enough, though? Do we need tighter changes to state criminal penalties and licensing restrictions in order to monitor medical care?
If those changes involve improving the information available to everyone, then I support them, although I understand that concerns of doctors who would fear that some members of the public would not be able to tell the difference between a bogus malpractice suit and a legitimate claim.
If the changes involve restricting the license to practice medicine for those convicted of a crime related to medical care (i.e., sexual abuse of patients, or Medicare fraud), then I can also support that. If the changes involve restricting the license to practice for those convicted of a crime unrelated to medical care, then I have to question the benefit of stripping their license. If they commit a crime, they should receive the proper punishment for that crime. I fail to see why, after they have served the punishment for that crime, they should not be allowed to earn a living in their profession. A person who does not pay taxes on their rental property at the Lake of the Ozarks should be properly punished for that, but not prevented from filling my cavities or diagnosing the debilitating case of globophobia I currently suffer from.
So, don’t come after me and ask whether I think a child rapist should be allowed to practice medicine, because child rapists should receive prison terms long enough to make the practice of medicine moot.
Bravo!
Comment by Eapen Thampy — December 21, 2010 @ 11:58 a.m.
We put a lot of trust in our doctors because the objects they are treating, our bodies, are so far beyond our expertise. Oftentimes, we don’t know what makes a good doctor from a bad doctor. All we expect is to let the doctor work his magic and to feel (and be) better.
For this reason–this blissful ignorance of medicine we like to have–the increased availability and accessibility of information will likely not be enough to keep bad doctors out of practice; even bad doctors can do their jobs right most of the time.
Not only that, but the information itself, as you point out, is not always consistent with the quality of the doctor. “Bogus” malpractice claims have the ability to defame otherwise perfectly accomplished and capable doctors. Such inconsistencies, between the information and reality, will likely render these efforts futile.
Not surprisingly, the goal here should be to open up the healthcare market and allow consumers to choose the doctors they wish. The barriers to this goal, such as the inability to purchase a health plan as an individual apart from one’s employer, must be overcome.
Comment by D. Amiri — December 21, 2010 @ 10:24 p.m.
The article and your post are thought provoking–
For me, the greatest weakness in the system was judgment by your peers. I can’t think of a system where that works. People are human. They want to be liked. It is hard to be tough on your friends.
Imperfect analogy alert–I think of drunk driving and how juries used to let the drunk drivers off pretty easy. Some would say still do. However, the penalties have gotten tougher. The ‘ease’ was due, in part, that the jury may have driven drunk once or twice and they were unwilling to punish people for something that just as easily could have happened to them. I see the same mechanism at work for state doctor boards. Not accusing anyone of practicing medicine while drunk, just using poor judgment, and not meeting the proper consequences.
Comment by Papillon — December 22, 2010 @ 9:13 a.m.
You do not have globophobia, and trivializing it is unfair to those who are justifialbly terrified of balloons. You do, however, clearly suffer from Selachophobia.
Comment by Don — December 23, 2010 @ 1:18 p.m.
Guilty as charged. Also, you are well aware that I suffer from Maimouphobia, although I am much better now than I used to be.
The funny thing is that I am not the only staffer at SMI who has Selachophobia. I think the other person has it even worse than I do, but I’ll leave it up to them to comment.
Comment by David — January 2, 2011 @ 11:56 p.m.
Selachophobia is certainly endemic at the Show Me Institute!
Comment by Christine Harbin — January 4, 2011 @ 10:02 a.m.