By Bryan D. Bohman
Q: Do You Have a File on Me?
A: This is a pretty common question. And the short answer, dear colleague, is yes. We, the Medical Staff office, not me personally, do have a file on you. We have one on me too. Everybody has a “file”. Some are a bit girthier than others, let’s be honest, but everybody has a file. Each of our files contains basic information on credentials and clinical experience to document why we have the privileges that we do. It also increasingly contains performance data relating to our practices — complication rates, mortality data, length of stay, etc. All of this information is routinely used for re-credentialing every two years, but it’s actually monitored continually so that significant concerns can be promptly addressed.
But what many people are really wondering when they ask this question is whether there is a file with complaints about their behavior. It’s currently quite possible that there are such complaints in our records, even if you don’t know about it. Don’t panic — if these complaints were thought to be important, you definitely would have heard about them by now.
Still, I’ve found that most of our physicians don’t like the fact that there may be negative information in their records of which they are unaware. We’re currently working through the Care Improvement Committee and the Committee on Professionalism to establish a protocol so that Medical Staff members will be notified promptly when there is any complaint about their behavior. This is important for at least two reasons: first, it gives the physician an opportunity to modify behavior that others may find questionable; and second, it gives the physician an opportunity to provide his or her own perspective by providing a response to be kept in the file along with the complaint.
Q: How Do I Get Involved in Medical Staff Committees?
A: OK, I’ll admit that this question comes up less frequently than the first, but I still hear it more than I had expected when I took this job. The truth is that we haven’t really had a good system for surveying interest and getting people involved until now. And we’ve also had less turnover on our committees than is probably desirable. But we’ve instituted three-year terms (renewable) for Medical Staff committees, which should provide more opportunities to serve. We will be soliciting interest from Medical Staff members within a couple of months, so you’ll definitely have a chance to show your interest —and we’ll do our best to match you to a committee that suits your preferences and strengths.
Q: Why Doesn’t the Medical Staff Organization Do More for the Medical Staff?
A: Usually, this question isn’t meant to inquire as to how well the Medical Staff organization is accomplishing peer review, credentialing and promoting quality of care in the Medical Center — which of course is its primary purpose. In fact, it comes up most frequently while discussing the quality and quantity of food and drink in the Medical Staff lounge.
The lounge itself, however modest, has been very popular since it opened (largely through the efforts of past Medical Staff presidents Bruce Adornato and Kent Garman). But it’s true that the food is not exactly gourmet fare. We did improve the quantity considerably several months ago by switching vendors, but even though we spend a lot of our very limited Medical Staff budget on the food, it’s impossible to keep everyone’s favorites in stock at all times. If you have any specific suggestions, please let me know.
But another context for this question revolves around other quality of life concerns, such as a sense of community, camaraderie, and other wellness issues. My own opinion is that this is a critical function of our Medical Staff organization, but it’s one that has never really been adequately nurtured. We are all acutely aware of the increasing pressures on physicians, from many directions, and our Medical Staff organization is quite rightly working to create a structure that ensures accountability for disruptive behavior and other failings that might in turn disrupt the quality of care.
But along with increasing accountability, I think it’s incumbent on us to provide increased support for our Medical Staff members. We have the Well Being Committee for folks who are having serious difficulties, and that’s extremely valuable, but we don’t really have many resources available to help our members as we all struggle to balance our professional and family responsibilities in a profession which is notoriously difficult in that regard. And this of course is important for not only our own wellbeing but also that of our patients – there’s no doubt that optimal patient care and patient satisfaction is impossible without well and professionally satisfied physicians.
Based on that, we’ve recently formed a small task force to examine opportunities to improve physician wellness and professional satisfaction. If you have any suggestions, I’d be most grateful if you would contact me.
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Well, we’ve run out of room for questions this month, but if you have another question about the Medical Center — especially about the Medical Staff organization – I’d be happy to answer as best I can. Be assured that you will get a response whether your question appears in this column or not. Please send any inquiries, suggestions or complaints to bbohman@stanfordmed.org. And until next time, we hope your holiday season is going well.
