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Peer Review Requests

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  • Peer Review Requests

    I get a lot of "Peer Review" requests from my Administration to critique other Radiologists' work, usually emailed to me by a Nurse manager whom I've never met, with a deadline to evaluate a case using a database, which I log into and write (and sign) comments with a statement of whether the original interpretation was "correct."  The party line is that these documents are used to "improve patient care" and "quality" but they sure feel like a punitive control measure by the hospital administration.  It seems to be a very secretive process, I don't get to talk to anyone, and I have no idea what is done with what I write.  I am very uncomfortable with this.  I feel like my knowledge is being used to throw a colleague under the bus, help lawyers, create administrative jobs for nurses, etc.  (Let's face it, a lot of people stand to gain from doctors fighting each other.)  Oh and my time spent doing this is not compensated.  I believe in upholding high standards but 1) I seriously doubt this process is actually helping anyone, and 2) it sure seems there are better ways for doctors to collaborate and review errors and learn from them.  Lately I am inclined to refuse to participate in this process due to these concerns.  Am I being unreasonable?

  • #2
    Is this service (and compensation rate   ) included in your contract?
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    • #3

      Is this service (and compensation rate ) included in your contract?
      Click to expand...

      Right...basically the hospital by-laws state clinicians have to "participate" in Peer Review and quality improvement.  But I think this has evolved into something else.  As I said I am more than happy to discuss a case in a consensus meeting or respond to a question and have my name included on the diagnostic report.  I just feel like I am being used in a punitive process which I have no insight into.  On the other hand if there are "bad" doctors then of course the administration has to do something about it.  Maybe I should take a more practical view of this, change my thinking?  Just wondering if anyone else has these concerns.


      • #4
        We've had a similar issue. The nurse in charge of quality has been talked to for similar behavior. If something is egregious enough to go through the formal medical staff peer review process, then let's do it and do it right. But this nickel and diming quality behind the scenes crap needs to be called out and put in its place.

        Take your concerns to your medical staff president. This discussion belongs in the MEC meeting.
        Helping those who wear the white coat get a fair shake on Wall Street since 2011


        • #5
          Do you have an administrative role at the Hospital? When I did act as a radiology department head, I was often called upon to review cases where there was an adverse outcome or dispute, especially a patient complaint, as a second (or third) set of eyes. Occasionally, this was part of a formal sentinel event investigation, and I was told so. There would be meetings, RCAs, and formal recommendations, and I would see the work product along the way.

          Additionally, in order to be compliant with JCAHO, CMS and ACR standards, there must be a formal peer review process in place (but not what you are describing here).

          If it were me, the next time I received such a request I would mention it to the Chairman (unless you are the Chairman) and explain to him/her your concerns. If I were the Chairman (you or your Chairman), I would take this to the MEC, as WCI recommendations, as allowing clipboard nurses to lord over the rads to help with witch hunts is unprofessional, uncollegial, and will result in a demoralized department and flight of talent elsewhere.

          Remember, too, if you are "peer reviewing" your colleagues, they are providing the same, er, service to you. It all sounds pretty ugly. I would not want to work in the environment that you describe.


          • #6
            Thanks for the perspectives--we do have Root-Cause Analysis meetings which are open discussions in a conference room of a case where something went wrong, and these are very productive.  We also have an internal "Difficult Case Conference" where we show each other our own challenging cases and the point is to keep our skills sharp.  But these secretive hospital-directed witch hunts under the guise of "Quality" where nurses tell me to throw a colleague under the bus are just the wrong way to go about things for reasons as well-stated above, and I do plan to bring this up with the medical staff.


            • #7
              My few thoughts. First, I totally agree that you should not do these without more information. And I agree with the general advice of WCI and Vagabond.

              But you also need to take part in this process from a constructive standpoint first. The first time I got this type of request in a prior job, I got up and walked to the office of the person who sent them and talked with them about the process, what was being looked at, etc...

              Sometimes your best tool is the face-to-face (and I am an introverted radiologist who "hates" conflict). I think this both in terms of trying to get on the good side of these folks, who can be useful allies, and also trying to get insight into who/what is really behind the process. I know physicians currently suffer from the perceived lack of respect, but sometimes we exacerbate it by feeling like we are above the process or just rubber stamp stuff. Mid-level admins and staff can be very appreciative of a physician that takes the time to listen. Empathy helps too. Maybe the nurse manager is a really nice person and overworked and just also trying their best. (Although I have certainly met some admins that are the witch hunt type)

              It honestly might feel "secretive", but some of that might be because you have filled out evaluations in the past without asking for for more information and the person sending them is always happy to use the path of least resistance....

              So yes, bring it to your med staff leadership, but you should spend some time on your own to collect information about the process first.

              You mention it feels punitive - but have you ever seen results of that sort - have your colleagues actually been disciplined because of your work? I found in my prior experience I was dealing with a nurse in Patient Satisfaction with had tons of complaints about all sorts of departments - mostly bogus - and they were trying to collect information, but were very protective of our hospital as a whole. You don't want to start a complaint against the process and then find out that somehow they are really on your side (or were anyway).

              But should you find out it is a witch hunt or adversarial, then up to the MEC and Med Staff leadership it should go...