You know an issue is important when a variety of people have something to say about it.

It seems that our hospital report from late May has had this sort of effect. The report outlines our findings: Since 1990, when the National Practitioner Data Bank went online, hospitals have reported, on average, just 650 doctors a year that have been disciplined for unprofessional behavior or incompetence. That falls well short of the 5,000 annual reports anticipated when the database was created. Nearly 50 percent of all hospitals did not submit a single name to the database in its first 17 years.

Appalled at this apparent dismissal of the databank by hospitals around the country, we offered some powerful recommendations to fix the system, including more vigorous legislative oversight, substantial fines for hospitals that fail to report doctors and making compliance with the database requirements part of the Medicare certification process.

In July, William Heisel , a longtime health care reporter who is now a communications officer at the Institute for Health Metrics and Evalution in Seattle, offered his own solutions to prevent this sort of problem from repeatedly occurring: Have journalists follow up on recommendations and legislation years later to evaluate their implementation and/or success. By doing so, reporters could perform the essential function of holding government accountable. Had anyone checked to see whether hospitals were indeed reporting dangerous docs to the NPDB, they would have learned that hospitals were failing miserably. (Heisel kindly praises our report, saying that we performed “an invaluable service.”  Thanks!)

In addition,  Robert M. Wachter, M.D., read our report and offered his own ideas about how the doctor reporting system could be fixed. Peer review, he argues, is not working. Not only do doctors have a sort of “fraternity of medicine” whereby they loathe ratting one another out, they also are painfully aware of how much time and effort it takes to be a doctor, which makes them reluctant to take away one’s livelihood.

Dr. Wachter concludes:

A profession is [a] group of individuals with special knowledge, who are granted privileges by society in deference to their expertise and in exchange for self-regulation. When thousands of hospitals can go 20 years without disciplining a single physician on their medical staff, our status as a profession is called into question.

In the end, peer review is about answering one deceptively simple question: Is it more important to protect problem physicians or vulnerable patients? If we can’t answer that question correctly, we should not be surprised when the Sid Wolfes [director of Public Citizen's Health Research Group] of the world call us to task, nor when we find ourselves under an unpleasant media, legislative, and regulatory microscope. Professions don’t need that kind of outside scrutiny to do the right thing, but we just might.

Thank you, Dr. Wachter, for shedding some light on how doctors view the system and revealing one more way in which improvements must be made to ensure the safety of our medical system.