Dealing with incompetence
=========================

* Jan O. Sundin

*   © 2004 Canadian Medical Association or its licensors

The description in a recent “Query” of the longest-serving physician in Dr. Ursus's hospital1 raises numerous questions. In particular, where were Dr. C's departmental head, the chief of staff, the hospital's quality assurance committee and its credentials committee, the senior administrator, the CEO? All of these parties have a duty to deal with incompetent health care professionals. That Dr. C did not attend morbidity and mortality rounds would in itself be a reason to revoke his privileges. 

Other questions come to mind: Why do we call a physician with high ethical standards, like the one who “has been waging a battle with Dr. C for years,” a “troublemaker”? Why don't we call him or her “Dr. Integrity”? 

I have witnessed an almost identical situation, in which all of the players mentioned above were involved and did nothing. In that case, Dr. Integrity was a member of the hospital's board of directors, but when the problem reached that level, the other board members wrote to the minister of health requesting that Dr. Integrity be removed from his board position. The board's inaction in the face of knowledge of the problem rendered their liability insurance null and void, and each board member could have been found personally liable if a legal suit had been started. 

Even the provincial college of physicians and surgeons was uncertain about how to deal with a complaint by Dr. Integrity concerning another physician's competence. In contrast, if the case had involved sexual misconduct, the college would have immediately started an investigation.

When we see medical incompetence today, we can no longer stick our heads in the sand, regardless of the status and reputation of the incompetent member of the health care team. Perhaps it is time to introduce the Swedish “lex Maria” to Canada. This law dictates that when a patient has been injured or has become sick while receiving medical care, or there is a risk that injury or illness could happen, even because of such things as insufficient competence, staffing, equipment or facilities, the department of health should be notified.2 Such a process might decrease the medical errors and patient deaths that we now hear so much about,3 at least the ones that are due to professional incompetence. 

**Jan O. Sundin** General Surgeon South Shore Regional Hospital Bridgewater, NS

## References

1.  1. CMAJ 2004;170(8):1360.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTcwLzgvMTM2MCI7czo0OiJhdG9tIjtzOjIyOiIvY21hai8xNzEvNi81NDkuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Ödegård S. From punishment to prevention? Medical errors reported in Sweden in 1989 and 1993. *Saf Sci Monitor* [serial online] 1999;3(article 1):1-10. Available: [www.general.monash.edu.au/muarc/IPSO/vol3/te1.pdf](http://www.general.monash.edu.au/muarc/IPSO/vol3/te1.pdf) (accessed 2004 Aug 3).
    
    

3.  3. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004; 170 (11):1678-86.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTcwLzExLzE2NzgiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTcxLzYvNTQ5LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)