Keeping Us Honest
In the early days of Medicine in the United States, the profession consisted of independent practitioners, accountable to no supervisory bodies whatsoever. During the 20th century, various entities emerged, the activities of which combine to oversee or influence medical practice, including laboratories. I am referring to agencies that in the broad sense either directly regulate and monitor laboratory activity, or indirectly have interests in laboratory performance. For an academic pathologist working in New York State, the bodies to which attention must be paid are, in no particular order: Joint Commission on Accreditation of Healthcare Organizations (JCAHO; The Joint Commission); The College of American Pathologists (CAP); Centers for Medicare and Medicaid Services (CMS); Accreditation Council for Graduate Medical Education (ACGME); Office of Professional Medical Conduct (OPMC; New York State); New York State Department of Health; The United States Department of Health and Human Services (HHS); The National Data Bank; Healthcare Integrity and Protection Data Bank (HIPDB); Occupational Safety and Health Administration (OSHA); New York State Legislature; U.S. Congress. Each of these organizations is complex and it is well beyond my intention or ability to deal with them in depth. I suggest perusal of Appendix 2 (under CONCLUSION), which shows the extent to which they hover over the medical profession. Since the American Medical Association (AMA) generates coding procedures for billing, I include it in this group as well.
It is true that people act differently when they know they are being watched. One would hope that the process whereby carefully selected college students gain admission to medical school would populate the profession with individuals who have internalized strong values and who do not need constant, close surveillance. The hope, regrettably, is unrealized, and pathologists (like all doctors) are scrutinized from many directions. Each of the above-listed bodies aims to improve the delivery of healthcare by coercion, accreditation, regulation and laws. Stringent penalties await institutions and individual doctors who fail to comply with the parameters set by these authorities. This has a beneficent effect, in that society monitors the healthcare system and finds recourse in the event of unacceptable lapses in performance. Considering, however, the combined, cross-linked weight of these powerful structures, it should not be surprising that physicians feel hemmed in from side to side, above and below. Contrast the intensity with which the medical profession is monitored with the level of oversight imposed upon our once vaunted financial institutions prior to their compounded debacle in 2008.
The agencies supervising us are supplemented by (1) Web sites allowing consumers to check our credentials and the disciplinary actions taken against us (www.medicalconsumers.org, www.health.state.ny.us, www.op.nysed.gov); (2) malpractice lawyers on the prowl; (3) internal hospital committees ensuring that we spend a certain number of hours each year rededicating our adherence to corporate compliance and foreswearing all conflicts of interest. It is to be hoped that recent initiatives towards creating a fair and independent approach to doctor evaluation will somehow lead to a rating system that will better serve the people of New York, and perhaps elsewhere (New York Times editorial, 8th December, 2007). The desire for good doctors has spawned businesses that thrive off the public’s need to find physicians who are good, and whom they like and trust. Indeed, a Google search for “best doctors” unearthed 88 pages, plus sponsored links.