I write further to the contributions by Eike-Henner W. Kluge1 and C. David Naylor2 on whether physicians' practice profiles should be made available to the public.
Kluge's proposal is much like Swiss cheese - tantalizing but full of holes. Even if we accept Kluge's expansion of the concept of informed consent - and some recent lower court decisions suggest he is on the right track - there is no evidence in his article that the information he proposes to provide to patients and (or) health care consumers is relevant or helpful in selecting a competent physician. Naylor does a good job of pointing out the practical problems associated with Kluge's suggestion and of proposing how we might find solutions.
The question that needs to be answered is whether there is any connection between a physician's involvement in a legal action or a disciplinary proceeding and the competence of that physician (not to mention the ability to provide quality care in a compassionate manner acceptable to patients). Although licensing bodies can begin to look at this question, there is only one source that provides the link with legal actions - the Canadian Medical Protective Association (CMPA).
The CMPA's annual reports indicate that it has a database of almost 20 000 legal actions involving Canadian physicians. Several hundred disciplinary matters and several thousand matters regarding licensing body complaints are also available for analysis. We must begin to learn from this gold mine of bad outcomes. To date, the efforts of the CMPA's own Education and Research Department, although interesting, have not begun to address even remotely the questions raised by Kluge and Naylor.
Any such analysis must be done in a fashion that meticulously respects confidentiality. It is hard to imagine that conditions could not be put in place that would overcome the CMPA's reticence about allowing outside physicians access to data. Indeed, it is very hard to imagine that a research scientist of Naylor's reputation should not be allowed to examine the potential relationship between a physician's involvement in a legal action or disciplinary matter or both, and the competence of that physician through analysis of the CMPA database.
For the CMPA to allow such a scientific and confidential examination of the database would be to provide some of the basic building blocks that will ensure the provision of quality care to patients in Canada. Even as it continues to provide physicians with legal defence assistance, the CMPA can also play an important role in helping to develop a better understanding of the issues raised by Kluge and Naylor.
Where is evidence-based medicolegal investigation when we really need it?
References
- 1.
- 2.