Blaming the doctor is cheaper than fixing the record system

0:00Hi, it's Kevin. This episode is brought to you by ModMed. Welcome to your AI-powered practice from ModMed. We're transforming specialty care by embedding AI assistants across your entire workflow. Our all-in-one platform of EHR, patient engagement, practice management, and RGM helps reduce repetitive work while keeping you firmly in control. Train on de-identified data from nearly a billion patient encounters. This isn't just smarter software. It's a new way of working for specialty medicine, more efficient, and more connected to the patient experience. Start building your AI-powered practice at modbed.com. That's M-O-D-M-E-D dot com. The link will be in the show notes. And now onto the show. From Kevin MD, I'm Dr. Kevin Poe, and this is The Podcast by Kevin MD.

1:03Welcome to The Podcast by Kevin MD, the only daily medical podcast where we share the stories of the many who intersect with our healthcare system but are rarely heard from. Now, here's your host, Dr. Kevin Poe.

3:13Because, and I quote, she failed to follow the health system's vaccine policy. Now, any new employer looking at that is going to say, she's an anti-vaxxer. She probably brings her patients in and tells them to eat more red meat and drink raw milk, and you don't need these vaccines. It would have been devastating to her career. She felt she had no choice, but she actually resigned so that she wouldn't get that corrective action plan on her record. Of course, there's a covenant not to compete. So the bottom line is that community lost a pediatrician that was very, very popular, been there many, many years, and she's never going to see any of her patients again. And again, it's, if ever there was a system error and not a physician error, this was clearly it. So it just boggled my mind and I just kind of had to vent the, that's where the article came from. So I can see this happening, not just in pediatric wellness checks, but this happens in primary

4:17care all across the country. And I'm sure that this scenario is certainly plausible. You have a new family that comes in and their medical records may not have been on Epic. And in that case, it gets scanned in and it's in all different sections and sometimes it's difficult to find. So from what I'm understanding in the story, this particular physician or this physician's staff wasn't able to locate that this patient had a vaccine previously and then decided, of course, give it anyway. And it turned out to be a duplicate vaccine. Now, how much do you know about the case? Did you do you know that was the family council that there was a potential that it may have been a duplicate? How exhaustive was a search to the physician themselves to the search or was it delegated to a staff member? What kind of details can you say? Staff member did it. But again, you can't, so we could blame the staff member. But again, you know, if the kids coming in for a vaccine, who's going to say and make sure you go through the media portion and it's funny after

5:22this article came out, I had a physician call me and said, my health system is just the same, the EMRs and S and it was the same health system. I didn't identify it, I didn't tell her. But it was the same health system that the story I got from her was a gastroenterologist that if a cardiologist sees your patient sends a letter to the primary care and sees the gastro in July of 24, it may be scanned in in March of 25 and the letter will be dated March of 25 and frequently it's shown as coming from the gastroenterologist. So if you're looking for cardiology on that patient, you better read every single thing. If you know the docs, you would know that that's a gastroenterologist that sent it and you probably wouldn't be looking, you wouldn't check that letter if you were looking for cardiac issues. So I mean, it really is a huge problem and again,

6:24we fixed it by blaming the doc. That's, you know, that's the easy way to do it. It has a lot cheap or certainly then, you know, I can't imagine what it would cost to get that system fixed up and pointed out in the article, imagine if the federal aviation administration did that, we wouldn't need it to be nearly as big, you know, maybe one MBA could run the whole thing and, Boeing 727 start falling out of the sky. The obvious solution is we've got to bring the pilots under time off and train them on how to, you know, handle a plane that's lost all power. It's exactly the same, but you know, the FAA says, oh, let's check all the systems, let's check the gear, let's check everything else. I mean, I said, imagine if they were run like health care, I'd be afraid to get on a plane, honestly, you know, knowing anything that happens is the pilots so whenever we have you on, we talk about of course contracts and we talk about the impact on physician's lives. So in this particular story, you told us that the hospital recommended or force

7:27stuff, physician to undergo corrective action. So from a contract standpoint, once a physician is faced with that demand or choice, what kind of recourse would they have? Do they, can they say no, can they, do they have to do it? Should they obtain counsel? What are their choices at that point? They should, but if it got to that point, I think you got to bat at contract. When I review contracts, I always ask for a provision that says if there's a quality of care issue, we have a set procedure, we follow that if you think the physician had poor quality care, the physician and the health systems agrees on a third party reviewer to come in and look at it, you know, that they both agree to the reviewer, the reviewer decides, is that poor quality care? Yes, no. If the reviewer says it is poor quality care, the physician has 60 days to fix it. If the physician doesn't fix it in 60 days, then, you know, the physician can be terminated. And I think that's important because I can't imagine

8:32an independent reviewer coming in and saying, yeah, this was poor quality care on the part of the physician. But again, you know, the system just says, well, somebody's to blame, you know, you're the captain of the ship. So it's obviously you. So you're saying that this particular scenario could have been mitigated during the contract negotiation process potentially. Yeah. Yeah. And I think it would have fixed it. As I said, I can't imagine an independent reviewer saying, yes, that's poor quality care that you've given. So I think she would have walked. So tell us in general, what the impact of a corrective action like this on a physician's career? Well, whenever, you know, when you do credentialing, that's one of the questions they always ask, have you been in a corrective action plan? Have you been mentored? Have you done that? So that's going to follow you for five years. It's going to really make it more difficult to get a position. And if somebody says, no, I haven't because people tend to feel where there's smoke, there's fire,

9:32and you know, any physician will say, I was blameless. You can't really pick out, you know, this physician from somebody that, you know, really did leave a scalpel in the patient or something. And something like this can't be explained away because let's say this comes up during a credential meeting. And if this pediatrician simply told the story about what happened, is this something that could be understood in future credentialing meetings as a system's oversight? It could, but it's just it's an issue. And again, we're going to hear your side of the story. We see from the health system that we identified an issue and we put this physician in a corrective action plan, physician in any situation, you know, good, bad or ugly is always going to say, well, I wasn't really to blame. Let me tell you what happened and phrase it in such a way that they appear blameless or at least less to blame. So I think, I think there's a good chance that she could have been hired even after this, but it certainly would have made it a lot more difficult. And again, she's going to be explaining that for the next five years.

10:36So you told us that this physician eventually resigned. Now, was that the only choice that she could have made to avoid a corrective action? We could have brought pretty much, I mean, the health system was going to do a correction, corrective action. So we could have tried to negotiate and say, no, we don't want a corrective action where you want to do this. But at this point, I can't say as I blame her, she's been in a community 40 years. She was totally fed up with the health system. And she just said, if that's the way they're going to treat me this time, then I'm out. Because, you know, when something like that happens, you're more under the microscope and any physician. I mean, I know you're a fine physician, but if we went through all your charts very carefully, I'll bet we could find something that maybe wasn't done precisely, you know, the way every other physician would have done it. So once you're under the microscope, you know, things get bad. And if you're terminated for poor quality of care, that's really going to be very difficult to come back from.

11:39And would future employers know that you resigned because of a pending or a potential corrective action? No. Well, one of the things we agreed to was the letter that she would get from the employer. And it was simply she worked here from here, from this time to this time. And she resigned her medical staff privileges voluntarily as a result of termination of her employment. And so we negotiated so that it isn't clear what happened. So as we reflect on the story and as you think about the story, what are some of the lessons physicians should come away with after hearing about this? Well, I think is make sure your contract has due process rights for you if you're accused of poor quality care. And a lot of times physicians poo poo this because they say I'm a great physician. It's not going to happen to me. Well, I think this was a great physician too. And it happened to her. So I think the biggest thing is make sure that there's some kind of due process before you have

12:40put into a corrective action plan or something else that indicates your giving poor quality care. And in most cases, is this due process normally included or in most cases do they have to be negotiated in mostly it has to be negotiated. Most people say we can terminate you for poor quality care or do disciplinary actions based on poor quality care. And physicians look at that and say, Oh, yeah, that's fair. If I'm doing poor quality care, they should fire me, you know, but they don't think in terms of what's the hospital going to call poor quality care. We're talking to Dennis Hirsch. He's a health law attorney. Today's Kevin and the article is my errors get blamed on physicians not systems. As always, Dennis, let's share some take-home messages. They want to leave with the Kevin and the audience. Well, again, I think make sure your contract gives you due process rights if you are in trouble for poor quality care. Again, that blind side's physicians all the time because they say, well, I don't do poor quality care. So it doesn't apply to me. And you know, the fact that you didn't

13:45do poor quality care doesn't mean the health system won't contend that you did. And I'm going to end off with just that observation that this particular physician was in her community for 40 years. And a story like this where there was an EMR oversight. She left under these unceremonious conditions. Says a lot about her current health care system. Oh, yeah, yeah, shocking. Like I said, if the FAA were on the same way, none of us would flaw. Dennis, thanks again for sharing your perspective in insight. Sure, it's my pleasure. Thank you for listening to the podcast by Kevin MD to share your story and appear on the show. Visit KevinMD.com.