Disclosing doctors' errors

From Dr. Hadley Callaway, president of the North Carolina Medical Society and a practicing orthopedic surgeon in Raleigh:

The N.C. Medical Board is asking for public comment on its proposed rule to post all medical malpractice judgments and settlements on its web site. The N.C. Medical Society supports consumers having access to information about physicians, but we recommend it be done in a more meaningful way.

The Society is a voluntary membership organization for physicians that does educational programs and represents physicians in the state legislature. The Board is a government entity that licenses and disciplines physicians. Both seek to improve healthcare for N.C. citizens, but occasionally they disagree about the best way to do so.

The Board protects the public from substandard medical care by reviewing public reports, patient complaints, judgments and settlements. It gathers medical records, takes testimony and determines whether the care or conduct was substandard. Physicians found to have provided substandard care may be disciplined in a variety of ways, including loss of license to practice.

At present, physicians disciplined by the Board are listed on its website in an effort to inform the public and shame the physicians into better behavior. This is reasonable and the Society supports it.

The Board's new idea is to post all judgments and settlements, regardless of whether substandard care was involved. The Society does not support this. A review of the Board's statistics shows that most of its investigations do not find substandard health care. By posting all the judgments and settlements, the Board would seem to be telling us it is unable to do its job and asking the public to comb through the records themselves.

Posting all the judgments and settlements is unhelpful to the public and unnecessarily smears the reputations of physicians who – by the Board's own reckoning – provided good care. The Medical Society believes this is a bad idea and should be abandoned. The immediate past-president of the Medical Board seems to agree. He wrote in a 2007 article that web “profiling is the display of practice-relevant information …[W]e must insist that the information is accurate and relevant.”

A patient reviewing a doctor's online record may think that judgments and settlements indicate a problem. In many cases this is not true. Some of the very best doctors in critical specialties who see more high-risk patients may have more judgments and settlements on the Board website. If these are posted despite the Board's determination that there was no substandard care, doctors will be strongly discouraged from taking on these high-risk patients. Every judgment and settlement for which substandard care is demonstrated should be posted – but not those cases where the physician met standard of care….