Monday January 28, 2008
Incompetent Doctors: who knew?
What do you call the person who graduates last in med school? It's a set-up to a joke that is anything but. Of course, you call that person 'doctor.' There are incompetent people in every job, and doctors are no exception. We don't have any good statistics on how many incompetent doctors are currently in practice. A few years ago, a report in the US estimated that up to 5 percent of doctors aren't up to snuff for reasons that include substance abuse, cognitive impairment, and just not keeping up with developments in medicine.
Dr. Charles Smith, former chief forensic pathologist for the Province of Ontario, may be the most egregious example of incompetence that's been made public. His error-filled autopsy conclusions and expert witness reports resulted in wrongful convictions and lives ruined. The week of January 28, he gives testimony before a provincial inquiry set up to look into problems in pediatric forensic pathology in the province.
This week and next week on White Coat, Black Art, we take a close look at how doctors are supposed to maintain their competence and the system that's supposed to protect the public. As you'll see, the news is not very reassuring. Provincial regulators are just beginning to realize they can't simply trust doctors to maintain competence. Only two provinces -- Nova Scotia and Alberta -- have mandatory checks on doctors. Ontario will soon follow, once the province passes enabling regulations.
In the meantime, the only comfort the public should take from all this is that the majority of doctors care about their competence and take pride in maintaining it.
Previous Comments (11)
Marvellous show; the Sam Harris of
the Medical Profession!
The opinion of the patient must be considered in assessing the competency of their physicians. The complaints process at the College of Physicians and Surgeons of Ontario is self-serving and offers little protection to the public. Self-regulation does not work.Ann, February 1, 2008 11:26 PM
Glad to see Ontario taking steps to check on competence of doctors - most of whom do a fine & honest job. Time to weed out the incompetents and dollars-for-doses doctors. A good place to start is for the CMA to check this website & see what REAL patients say about their doctors:
www.ratemds.ca and any other website devoted to patients rating treatment by their doctors.
Some ASTOUNDING comments there, good and bad. GO FORWARD with nurse practitioners, Ontario, & get the 'dont care doctors' out of business.A. Forsberg, February 4, 2008 4:29 PM
Today on your show, you had a nurse talking about how we are regulated. I am currently a third year nursing student. Every year, every nurse in Canada picks areas of their practice which could use improvement, plans on ways to improve and carries through with the plan. We don't know when we could be selected to see if we are creating and following through with our learning plans. But doctors don't have to evaluate their practice until they are already evaluated as being less than competent?? That needs to change, and I am glad it is changing.
However, I was unhappy with how the nurse on today's show seemed to portray her fellow nurses, especially new grads. She seemed to think new grads were lazy and incompetent, not willing to stay at one job for a long time. New grads come out of school with a lot of new responsibility - it takes awhile to adjust. And also, with the thousands of nursing opportunities, why would you choose to stay at your first job for the rest of your life? Nurses can travel and work worldwide, see different things, gain new perspectives. This is a new generation of nurses - literally and figuratively. We want to see more, do more, learn more, be more. We need and want to travel, and take advantage of the world that is our oyster. The more we see and the more often we give ourselves a new environment, the more I feel we will stay fresh, and not be the cranky old nurse so many people complain about.
I'm listening to anecdotes on your program dealing with exhausted interns and doctors. This drives me crazy. Why is this somehow acceptable?? As an airline pilot, I see the negative effects of fatigue. We are responsible and empowered to manage the effect of fatigue. I swear, should I unhappily find myself in hospital, I am going to ask the doctor, in his dirty tie and steth. "If I had been awake as long as you, would you want your family flying in my airplane?" I'd be interested in the answer.
Fatigue makes you incompetent. Just because "that's the way it's always been done" is no longer a tolerable practice.
The negativity of the ER nurses in this segment reminded me of the old mantra I was warned of when I decided to become an RN "warning...nurse eat their young".
In the stressful acute care environment, no nurse or other health care provider should tolerate abuse from burnt out, cranky and unsupportive colleagues. These are the unfortunate symptoms of horizantal violence that ultimately impedes on the team work required to ensure the safety of patients (and a major factor that turn off talented graduates from the units that needs them the most. The criticisms of new graduates were flawed and limited as it did not factor in systemic factors that set-up all nurses in acute settings(especially our newer colleagues) for failure. Unlike our autonomous physician colleagues who bill OHIP for services they rendered, nurses are considered employees of the given health system they work in. In the increasingly competitive business environment of hospitals, adminstrative cutbacks of nursing staff in the effort to save money coupled to the lack of guaranteeing full time employment to nurse are major factors in the nursing shortages so many hospitals are facing. It would have been nice if the segment explored some of these factors.
I have given up on doctors all together to assist me with health issues. Any meaningful or lasting cures I've come upon I devised for myself. I see doctors now as gatekeepers for needed items such as prescriptions or blood tests. Firstly, I think there is too much reliance on x-rays; secondly the training methods for doctors now I have heard are "learn how to analyze" instead of "learn about conditions". The only worthwhile docs i've encountered are either elderly or trained in another country. Med schools need a major shake-up, and to bring back house calls. I really like the idea of internet medicine - I think it makes alot of sense, especially for contagious diseases and with the increased costs of transportation. Why drag a bunch of sick people out of their homes to go share their germs? Sure, internet can't do everything, but it could be a start.vt, February 11, 2008 7:16 AM
Yes, I agree with you that all doctors are not equal. Some doctors do keep up on the new medicine others are still back in the era when they were med students i.e. their information is decades old. In this climate I think it is up to the patient to learn everythink he or she can about the condition or disease that presents itself to him or her. As well we need to be wary of the medication that we are given and again google them as you say in your intro.
I had a situation after Christmas I had a sore throat that led to a bronchitis. I did not bother to go visit the doctor for a sore throat because my doctor does not give antibiotics for hardly anything. So when the bronchitis developed I went to a walk in clinic. I was given a prescription for an antibiotic for five days. In five days I still had all of the symptoms as before. I then went to another doctor who said yes I did still have the bronchitis and he never uses the antibiotic that I had been prescribed for bronchitis. He then gave me a prescription for an antibiotic which was a second generation antibiotic and yes it did work and thankfully I went back to work.
So we wonder why people are not getting the results from antibiotics that they think they should? Could it because physicians are not matching the correct antibiotics to the right disease. And furthermore, if I had been given the correct antibiotic I would have been able to go back to work sooner and indeed there would have been less suffering on my part.
I think that science should prescribe protocols of antibiotic use for common infections. I think that all too often the manufacturers of medicines are the ones who give doctors the information that this antibiotic is supposed to be best for such and such an ailment. The reality is that patients would be better served if there was some kind of published standard of antibiotic use available to doctors that does not come from the drug companies so that we don't get the antibiotic that the drug company wants to push but the right antibiotic for the right infections.
Also, I do not use or abuse antibiotics I rarely use them for anything but if I have a sore throat and go to the doctor he acts like I am asking for a gold mine instead a treatment.
I personally do not trust doctors and I try to handle most little issues on my own with home remedies and otc solutions. I know I use those at my own risk but I don't know who is influencing my doctor. Between the drug companies and their freebies and the lack or re education on the doctors part I feel patients are swimming against the tide.
Please do not use my name on the broadcast. But feel free to read my e-mail.Withheld, February 15, 2008 8:45 PM
The job of nurses is to serve doctors, and, when necessary, to sacrifice themselves to cover up physician incompetence.Jane, February 29, 2008 5:25 PM
The College of Physicians and Surgeons said that a retinal surgeon met the standard of care in my case. They merely gave him a caution on communication and record keeping. I went to him with vision of 20/200 in one eye (legally blind); he charted that my vision was 20/25; I didn't read any eye chart that day. The optometrist was concerned about a epiretinal membrane (a central vision problem) - the retinal surgeon made no metion of my central vision problem. (I just assumed that was what he was attending to because that is what my chief concern was, and had been for years) The optometrist had told me that I problem that might be able to be fixed; he charted that I had a retinal hole on the fundus. The retinal surgeon gave me a "simple procedure", told me that I "made too big of a deal out of things", didn't get consent, and lasered a retinal tear, 5 o'clock. I couldn't see the Big E properly; the simple procedure couldn't fix that - so what was the optometrist talking about? Probably he thought that I needed a vitrectomy, which was the surgery I finally got by another retinal surgeon over a year later. (My prognosis was not as good by then) So - how did the College respond? The investigator told me, almost right from the start - "He's not going to lose his licence". She blamed me for not having a signed consent on the chart. (I am a nurse, but that day I was one very scared patient, and I didn't think of it) She thanked the referring optometrist when he didn't remember me, and didn't investigate further. She made a point of highlighting the fact that I didn't get to my appointments in 2000 and 2002 with this retinal surgeon, but didn't consider the fact that I wasn't ever given the appointments. I feel that I was neglected, battered and verbally abused, and re-victimized by the investigator for the College, who at one point, even told me that I could be charged for slander when talking to her. It's not slander or libel if it's the truth - my story is the truth, and it needs to be heard. The care that I received cannot be considered "the standard". If I lose my appeal with HPARB, the doctor will continue on, his reputation intact, meanwhile, the vision in my eye is now at "Count fingers" level. Saving reputations can not come before saving patients' vision. What is the College's mandate? They are supposed to protect the public, not protect the doctor at the expense of the health and safety of the patients.
The CPSO is not doing it's job; it's time for change.
I brought complaints against 9 doctors.The issue was very serious.The College failed to protect me from fraud and abuse and the public from what I had(infectious).I am sure they investigated behind closed doors..People probably don't know they do that..Its part of keeping the public from finding about what is going on.We need a fair system where the judicial system is involved.Heda, November 26, 2009 7:25 PM