"When Good Things Happen To Bad People"

We are all patients, yet politics and money corrupt medical peer review. They thwart the interests of the public and the profession. There are too many middlemen between doctor and patient.

This situation will cost us all time, trust, and treasure as long as "mere administrative" proceedings protect libel on the peer review committee. Laws requiring Due Process in Peer Review would save patients' lives and money. 

It is a jungle out there. The saying in business is that "Bad Money Drives Out Good." You complete 25 years of education,  enter practice, and find that hard work is not always compensated. Someone else is telling you that arbitrary rules apply, threatening through an undemocratic committee to control your income and job security.  This is slavery--corporate, competitive, or both.  

Even if the laws never change, doctors entering practice or re-locating--even medical students considering various scholarships--can make informed choices with knowledge of the terrain ahead. They can avoid "buying a first-class ticket on a wonderful train tour to the EAST on the finest rolling stock available" (as advertised in BERLIN during WWII: The trains entered the camps.). 

First, peer review committee members must be PEERS--doctors practicing in the same specialty who therefore understand what is being said. 

Second, the doctors must be INDEPENDENT, biased neither for nor against the doctor under discussion. As Dr. Edwin Day stated eloquently on his superb web page that was formerly (~2001) at SemmelweisSociety.org (in contrast to the present site there), anything else is a sham. Established physicians on the committees effectively grant themselves and their friends immunity from prosecution for libel: This conduct is racketeering. Could it be stopped by a Medical RICO Act requiring due process in medical peer review as a condition for Medicare payment to doctors? 

Is there a less-cumbersome approach? (Remember, every medical dollar spent on a non-medical salary detracts from the care you receive--how many "K-Mart greeters" and "health-education promoters and coordinators" do you want to support before you finally get to the doctor?) 

Would a law abrogating the right to sue for libel in exchange for impartial peer review be acceptable, or would it be suicidal, a unilateral disarmament? Do we really need the equivalent of a "civilian review board" to take on the corruption of the present peer review boards, or can we institute impartial peer review quickly, quietly, responsibly? 

Third, there is every reason to regard the Credentials Committee as de facto peer review, even though its claim to fairness is flawed by the presence of non-physicians who promote themselves with a personal, a monetary, or a private psychological purpose--self-promotion: The Credentials Committee should not be accepted as the peer review committee because an independent committee is needed, as judged by all concerned.  De facto, peer-review is a trial; the jurors must be acceptable to the doctor under discussion. 

H.E. Butler III M.D., FACS