Volume 1

Medical malpractice : report of the Secretary's Commission on Medical Malpractice.

  • United States. Department of Health, Education, and Welfare. Secretary's Commission on Medical Malpractice.
Date:
1973
Catalogue details

Licence: Public Domain Mark

Credit: Medical malpractice : report of the Secretary's Commission on Medical Malpractice. Source: Wellcome Collection.

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    determine education objectives, institute ap- propriate changes in treatment, and _ then re-audit the results. More than 60 other hospitals are now employing this ‘“Bi-cycle Concept,” which was developed by Dr. Clement R. Brown, Jr. @ The so-called West Virginia Plan, developed by Dr. Daniel Hamraty, is also oriented toward better patient care, but in the setting of the physician’s office. Physicians set their own criteria for patient care and have their actual medical records audited by a peer physician against the selected criteria. @ Under the University of Sourthern California Plan, developed by Dr. Phil R. Manning, physicians at St. Joseph Hospital in Burbank, California, participate in study groups using individually packaged home study materials prepared by the University of Southern Cali- fornia. Group interaction is the principal teaching method, which is not _patient- oriented at this level. At least one hundred specialty societies and medical associations offer courses, lectures, semi- nars and conferences dealing with specific areas of interest, and since 1970 the Joint Commission on Accreditation of Hospitals has made it obligatory for accredited hospitals to provide continuing education for medical staffs. As a Commission, we are in no position to recommend one educational approach over an- other. We do see, however, a positive need for focusing all such efforts on elevating standards of treatment in areas of perceived deficits in profes- sional training. For example, we urge increased attention to the proper prescribing of drugs, an area in which medical leaders have long noted wide discrepancies between practitioners. The need for increased emphasis on medical-legal education has been brought to our attention on a number of occasions, and we find it desirable to develop more effective ways to eliminate common misunder- standings about the interactive roles of medicine and law. We reiterate that, to the greatest extent possible, the continuing education process should be pragmatic, giving the individual practitioner an opportunity to identify his own learning deficits and build thereon. The Commission RECOMMENDS that con- tinuing education be directed toward known needs and that it be designed around perform- ance criteria. Imposing Control We now turn to a more controversial issue: should continuing medical education be voluntary or mandatory? If the stated objective is improving and maintaining the level of competence of all providers, by what means can they be influenced to engage in continuing medical education pro- grams? The difficulty with a purely voluntary program is the old one of human nature: those who need it most are the least apt to use it. The problem is more acute with respect to solo fee-for-service providers than for those who are more active in an institutional milieu. In his own one-man office, responsibility for maintenance of quality control rests essentially with the conscience of each individual physician. The institutional structure is better suited to the exercise of quality controls through peer review and control over the doctor’s use of its facilities. We see a need for a more concrete mechanism to influence solo as well as institution-based and proficiency. Whether the appropriate influencing mechanism should be the Federal government acting under its power of the purse, or State governments acting under their authority to regu- late the health professions, or peer review groups influencing hospital privileges, we choose not to decide. It is our considered judgment, however, that self-regulation must give way to more positive means for assuring the updating of qualifications of all health-care providers. The Commission RECOMMENDS that there be imposed upon the existing system of self- regulated continuing education control mechan- isms which will require continuing medical education and evidence of provider proficiency. The Commission’s interest in seeking improve- ments in continuing education was paralleled by its interest in modifying selected parts of the core curriculum for health care professionals. There is