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Templates for detailed peer review documentation

In the November issue of Medical Staff Briefing, we discuss peer review documentation and the importance of creating comprehensive records for peer review files. This includes documenting informal or collegial meetings with physicians, according to Joanne P. Hopkins, JD, a health law attorney based in Austin, Texas. Records of these interactions serve the purpose of establishing trends in physician performance and behavior, and may also be required as evidence in the event of a peer review hearing.

Hopkins, who presented on the importance of documentation in peer review and hearing preparation at the 2012 NAMSS conference in San Francisco last month, provided several examples of correspondence between the practitioner and the peer review committee following a meeting. These letters should include specific details about the meeting and any follow-up actions. See the attached document for Hopkins’ examples.

Peer Review Documentation Examples

Keys to improving physician competency and professional development

These days, everyone is talking about how helpful reducing stress, having a positive mental attitude, and being mindful can be for people with health challenges. But when was the last time you heard anyone say that reducing stress, having a positive mental attitude, and being mindful of personal actions can actually increase a physician’s effectiveness while promoting health, healing and well being? It can and it does.

I don’t have to tell you that physicians and all medical professionals working in hospitals or other medical settings are under a great deal of job-related stress. What you might not be aware of is that left unchecked, negative stress is a workplace contaminant that can have a deleterious effect on your health, well-being and effectiveness. Imagine that you are being assisted by a person who is agitated, stressed out, preoccupied or in a bad mood. Now imagine that that person is you. How do you think your attitude and mood will impede your effectiveness and work experience as well as all you are in contact with? Remember that when physicians are stressed out, their patients and colleagues are more likely to be stressed out too.

A positive attitude and focused attention set the tone for how you work (and also how you play, which is important for a good work-life balance). This can be accomplished through simple mental exercises. Briefly, the key to transforming negative stress into positive stress is found within one’s “internal connections;” the way one perceives, experiences, and relates to the internal and external stressors of daily life. Instead of unrelenting pressure, you can sense productive excitement. Instead of helplessness and hopelessness, you and your patients can sense practical action and confidence.  Instead of fatigue, you, your staff/employees can find mutual satisfaction. Once these mental re-connections are in place and operating automatically, you can feel robustly challenged by stressful situations rather than incapacitated, drained or debilitated by them.

Learning how to de-stress and focus your attention can help you put the zest back into your life and your practice and diminish the destructive impact of negative stress. It is enlightening to realize that reducing stress, having a positive mental attitude and being mindful will improve patient care along with your competency and professional development. And keep in mind, that these same techniques can help your patients take the suffering out of pain.

Michael Ellner, CHT, is a certified medical hypnotist in private practice in New York City. He teaches advanced courses in medical hypnosis at schools throughout North America and South Africa and is a featured instructor of Hypnotic Pain Relief, Effective Medical Communication and Stress Management at the annual PAINWeek conference. Ellner is the lead author of a peer-reviewed paper “Hypnosis in Disability Settings,” IAIABC Journal, Vol. 46 No. 2; the co-author of “HOPE is Realistic – A Guide to Helping Patients Take Suffering Out of Pain,” co-written with Kelley T. Woods; and he is the author of “BEDSIDE MANNERS – The Pain Clinicians’ Guide to Effective Medical Communication” To contact Ellner, visit his website: www.nycanxietyhypnosis.com or email michaelellner@verizon.net.

Cognitive decline associated with aging: What medical staffs need to know

Most of us may not consider aging to be an impairment, but it can greatly affect a physician’s ability to practice safely. Currently, the aging baby boomer generation of physicians is treating other aging baby boomers who require three to five times the amount of healthcare as younger patients. When you couple this with the fact that more physicians are electing to practice later in life for financial or personal reasons, medical staffs must implement safeguards that ensure aging physicians maintain the competence to practice safely.

Medical staffs cannot refer a physician for evaluation for suspected cognitive decline arbitrarily. A referral is warranted if there are clinical or behavioral aberrations that are difficult to explain, a history of head injury, a history of substance or alcohol abuse, or a known neurologic disease. But before we delve into referrals, a brief explanation of neuropsychological testing is in order.

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Poll: Managing good clinicians with behavioral problems

It can be challenging for medical staffs to address issues that don’t have clear, black and white answers. For example, how would your medical staff respond to a practitioner who has excellent clinical skills but exhibits disruptive behavior? What if your medical staff had worked hard to recruit a practitioner, only to find out shortly thereafter that he had relapsed into chemical dependency? Obviously there are some clear regulatory standards that must be followed in these instances, but there are also ethical issues and concerns that each medical staff must address individually.

Take our poll below and find out how your organization compares with your peers’ organizations.

Audio clip: Update on nurses who face charges for reporting to Texas Medical Board

We first told you about the case of two nurses from West Texas who faced felony charges for reporting a physician to the state medical board last summer. The case has been working its way through the court system ever since then. Prosecutors dismissed the charges against Vicki Galle, RN (the felony indictment on her record will remain), but the trial against Anne Mitchell, RN, began on Monday, February 8.

Click here to listen to an audio news report from NPR that sheds more light on the case.

Some of the complaints against the physician include evidence that he performed procedures without the necessary privileges and that he has a side business selling herbal medicines to patients, according to the news report.

How would your organization handle a practitioner who faced similar charges? What penalties does your medical staff impose on practitioners who practice outside the scope of their privileges?

Physicians lose privileges for refusal to participate in violence-prevention workshop

After a nurse was killed on the job in 2005 by her former boyfriend and physician colleague, Hotel-Dieu Grace Hospital in Windsor, ON instituted a violence prevention workshop. The workshop is mandatory for all employees and physicians seeking privileges at the hospital, according to a January 7 article in The Windsor Star.

Met with initial skepticism, the workshop has gained traction over the past year. Many staff are embracing the idea and suggesting improvements to the hospital’s safe-workplace advocate. There are, of course, a few stragglers who don’t embrace it. In fact, they feel insulted by it and refuse to participate. So, Hotel-Dieu Grace Hospital has revoked their privileges. According to the article, two physicians in the courtesy staff lost their privileges, but the hospital has lost no specialists.

I’d love to hear your opinion on the issue of revoking a physician’s privileges based on his or her unwillingness to participate in a workshop. Is it overzealous, or do you think the hospital is simply reinforcing the definition of “mandatory?” Share your thoughts in the comment box below.

Nurses face felony charges after reporting doctor to the Texas Medical Board

texasAnne Mitchell, RN and Vicki Galle, RN, two nurses from West Texas, tried reporting a physician’s problem behavior through designated hospital channels. When their complaints fell on deaf ears, they took the next step and anonymously reported the physician to the Texas Medical Board.

If you’re a follower of Rita Schwab’s Supporting Safer Healthcare blog you already know what happened next – the medical board notified the physician of its investigation. In turn, the physician contacted the local sheriff to file a harassment report. The sheriff’s investigation led to third degree felony charges for the nurses.

The Texas Medical Board and the Texas Nurses Association both support the nurses’ actions, but that hasn’t stopped the sheriff’s office’s investigation.

Newspaper columnists have also come out in support of the nurses, saying the state’s whistleblower laws should offer more protection.

What do you think of the case? Do you think a similar situation could occur within your medical staff?

Just when you thought you’ve seen everything: Physician extends the definition of ‘privilege’

The Medical Board of California revoked Dr. Roy Chi Wing Lung’s medical license after he was found to have repeatedly stolen medical supplies from hospitals  to sell on eBay, according to an Orange County Register article.

In 2004, the physician allegedly stole two computers from Long Beach Memorial Medical Center after showing up at the hospital in scrubs in an attempt to blend in.

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AMA unveils model code of conduct

The American Medical Association (AMA) has unveiled a new model code of conduct in response to The Joint Commission’s new Leadership Standard (LD.03.01.01), Elements of Performance 4 and 5, effective January 1, which state that hospitals must have a code of conduct that addresses acceptable and unacceptable behavior, and how they handle the latter. 

A sample code developed by the AMA can be accessed here. The AMA also suggests codes of conduct be incorporated into facility bylaws, and cover members of the board, management, and all employees.

Todd Morrison
Managing Editor

$1.6 million victory for female doctor claiming harassment and mistreatment

If you missed the memo, disruptive, discriminatory behavior will no longer be tolerated in the workplace—especially hospitals.

A U.S. District Court jury awarded $1.6 million to Dr. Sagun Tuli, a neurosurgeon at Brigham and Women’s Hospital in Boston, MA and a native of India. The jury found that Tuli was subject to harassment, ridicule, intimidation, or other abusive conduct with regard to her sex and her nationality of origin—much of it instigated by her boss, Dr. Arthur Day, the chair of the neurosurgery department at Brigham and Women’s.

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