A Tale of Two Professions

Here's one to ponder: Would patients be better off if doctors had the same ethical standards as journalists?

Those thoughts came to mind this morning in reading about the mea culpas issued by the editors of the liberal (mildly) New Republic and the hard-right conservative National Review. Both publications had come under withering criticism for running hard-to-believe articles by soldier-journalists in Iraq.

Stories that make readers sit up and say, "holy shit," are the holy grail for editors. But they are supposed to learn in editing school (oh, would that there were such a place since the editor ranks are filled with great former reporters living out their days proving the Peter principle) that if a story is too good to be true, it probably is. They are also supposed to learn that if your mother says she loves you, check it out. According to this morning's column by Howard Kurtz of the Washington Post, editors at both magazines have retracted stories. After finally checking them out, they discovered the stories were too good to be true.

But at least they corrected the errors. How about your doctors? According to a survey released yesterday by Harvard researchers, there is a huge gap between the professional ethics of physicians and how they behave in practice. Nearly half of physicians who knew about serious medical errors by themselves or colleagues failed to report them, even though well over 90 percent knew they ought to.

At a press briefing held yesterday at the National Press Club, officials from the Federation of State Medical Boards, the American College of Cardiology, and the American Board of Internal Medicine (the folks who regulate physician licensing and two of the nation's largest physician guilds) repeatedly cited fear of malpractice suits as a primary reason for failures to report errors. "We need to reward doctors who report errors and change, not penalize them," said James Thompson, chief executive officer of the Federation of State Medical Boards.

But when asked if stricter regulation and penalties (like temporary suspension of licenses for physicians who repeatedly make medical errors) ought to be part of the solution, most of the panelists shied away from taking on the powerful guilds that control the practice of medicine. "If the medical board and regulatory apparatus were monstrous, it wouldn't solve our problems," said David Blumenthal, the Harvard researcher who was part of the survey team.

It seems to me that is trying to have it both ways. Bad journalism only harms reputations. Bad medicine harms, and sometimes destroys, lives. The tort system serves as the backstop for a failed regulatory system. If you want to reduce role of malpractice suits in the medical system, you must increase the regulatory penalties for failing to adhere to professional standards.

Prudent regulation needn't involve the heavy hand of the state. Self regulation is possible. Editors get it. What news outlet is Janet Cooke working for today? Or Jason Blair? Or the Baghdad diarist? Yet how many doctors have been barred from practicing medicine after being successfully sued for malpractice?

Unfortunately, medicine's professional societies are having a difficult time moving beyond their role as guilds designed to protect the economic interests of their members. When they try to advance practice in their fields, "we get pushback from that proportion of the profession that remains in the guild mentality," said Jack Lewin, CEO of the American College of Cardiology.

Posted by gooznews at December 4, 2007 08:59 AM