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Physician, Reveal Thyself

Consumers increasingly want to check out their doctors' backgrounds, but organized medicine and consumer advocates don't always agree on what information should be public.


Let the buyer beware, goes the old saw. But consumers have an easier time tracking down safety information about sport-utility vehicles than about the doctors they entrust with their lives.

To help patients in managed care plans who increasingly must choose from among unfamiliar names in a physician directory, more than 20 states, led by Massachusetts, are providing physician profiles to consumers.

But the profiles can be sketchy. Only a few states augment records of a doctor's education and credentials with a list of disciplinary actions, medical malpractice and criminal convictions.

"I am the consumer. I should have the ability to learn all the facts to make a decision by myself," said Julianne D'Angelo Fellmeth, a San Diego lawyer and consumer activist who favors broader public access to physician records. When medical boards, which are responsible for disciplining doctors, leave out information, "they look like they're trying to cover up for a bad doctor."

More frustrating to those who favor fuller disclosure of doctor records is the fact that the single national repository for such information is off-limits to the public. Housed in a commercial office building outside Washington, D.C., the National Practitioner Data Bank holds more than 229,000 electronic files on discipline and malpractice of doctors, dentists and other health professionals. The data, compiled over 10 years, is provided by state medical boards, hospitals, professional societies and malpractice insurers.

Only physicians, hospital administrators, medical boards, professional societies and plaintiffs' attorneys are given access to the data. Your local hospital routinely checks it when, for example, a new anesthesiologist applies for hospital privileges--and is required every two years to check on staff doctors or others who admit patients.

When Congress created the data bank in 1986, it acceded to the demands of organized medicine and agreed to keep the contents confidential. The American Medical Assn., for example, argued that doctors would be harmed if the public could access data on malpractice awards and disciplinary actions that lacked sufficient context to be meaningful. They pointed out that some physician specialists, such as those who treat lots of very high-risk cases, are more likely to be sued for malpractice. But the data bank was not set up to provide comparisons of the malpractice history of, say, an obstetrician-gynecologist to others in that specialty.

Consumer advocates counter that the public's right to know the history of their doctors outweighs the concerns that a doctor may be judged unfairly.

They also argue that the data bank is only a partial compilation of physician problems, because it does not include criminal convictions, and because disciplinary actions from hospitals and medical boards are sometimes not reported promptly or at all. For that reason, activists say, some bad doctors could escape detection.

Congressman Wants Data Open to Public

Some consumer activists and legislators say it's now time to unlock the data bank, originally designed to make it more difficult for doctors with problem histories to move their practices to another state, hoping that their records wouldn't follow them. Rep. Thomas J. Bliley Jr. (R-Va.), chairman of the House Commerce Committee, has been an outspoken proponent of opening the data bank and is drafting legislation that would give the public access to the data bank. Such a move, he has said, "may be one of the best and quickest ways to improve patient safety."

In a recent letter to Bliley, Health and Human Services Secretary Donna Shalala wrote that she agreed consumers need more information to help them choose medical professionals, but she said Congress voted to keep the databank confidential because of "potentially incomplete negative information."

The AMA, in the meantime, continues to oppose opening the data bank to the public.

"We do not feel this malpractice information has anything to do with competency or quality of care," said AMA President Dr. Thomas Reardon, a general practitioner in Portland, Ore.

The AMA, however, is supporting adoption by other states of a physician profiling system similar to the one Massachusetts started in 1996. The system, backed by the influential Massachusetts Medical Society, lists information on education, malpractice, criminal convictions and sanctions by hospitals or the medical board. The malpractice information allows consumers to compare a doctor's history against those in the same specialty. Instead of listing the dollar amounts of malpractice awards, the profile tells consumers whether the amount was average or not for doctors in that specialty.

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