How hospitals can place a check on physician self-certainty


I recently watched a movie that begins with an elderly man admitted to a hospital. He's diagnosed with angina pectoris, but it's forgotten he has emphysema, which leads to a misdiagnosis of pulmonary edema. He's dead by morning.

It's one of many medical errors that occur in this facility, which is populated by doctors who take pains to incorporate but wash their hands of the rap for mixing up patients.

I've regularly heard of such mishaps throughout the years I've spent reporting on the healthcare industry--along with all the vows to correct them.

That film? It was "The Hospital." It was released 40 years ago this December.

Then just last weekend, I read an eyebrow-raising article by Ron Lieber, who pens the "Your Money" column for the New York Times. He's premiered a series of pieces about the particular frailties of professionals in terms of how they invest their money. His first one focused on physicians.

"If (doctors) can save lives, many believe, managing money ought to be easy. But self-certainty like that can lead to all sorts of horrible mistakes," Lieber wrote. Despite the fact that conservative investments would work fine for virtually all doctors, he recounted schemes they've fallen for, such as marijuana farms and rubber horse shoes. He interviewed three clinicians--two physicians and a dentist--who have turned to financial planning full-time.

I can't help but think of the fictional Dr. Welbeck, a surgeon in "The Hospital" who's killed two patients and has put another within a hair's-width of death due to incompetence. He's so focused on his mini-empire--a Medicaid billing practice, a credit firm, a couple of hospitals, and nursing homes--that he's puzzled as to why his privileges are being yanked.

"Good heavens, you shouldn't be brought up before a committee of mere doctors," he's told by Dr. Bock, the film's moral center, who laments about the advances in medical technology but indifference to individual patients. "You should be investigated by the Securities and Exchange Commission."

In the four-plus decades since "The Hospital," physician entrepreneurs have mushroomed. And whipsawing back to Lieber: I wasn't sure whether to laugh or cringe when he reported that the American Medical Association (AMA) published a physician's guide to investing in 2008 authored by one-time fund manager Paul H. Sutherland. He advised against investing in relatively safe vehicles such as index funds, and proclaimed that "ideally, you should own 70 to 150 investments, each of which is so compelling that you cannot stand not to own it."

I referred to Sutherland as a one-time manager because he was recently forced to close his Utopia funds due to torrential losses.
Given the number of physicians likely still smarting from the investment advice approved by the self-certain leaders of their trade association, I wonder if they'd be a little more skeptical whenever the AMA loudly proclaims new Medicare cuts would plunge them into poverty. But that debate's for another time.

Ideally, physicians are the pinnacle of professionalism. They are not supposed to let the judgments they make in their personal lives interfere with those they make in their office or surgical suites. And of course, there are movie stars, politicians, and many other people from all walks of life who are extraordinarily successful in their work but return home every night to personal lives strewn with wreckage. However, none of them are charged with slicing into your viscera.

That is not to say most physicians aren't perfectly competent. But the fact that nearly 100,000 of their patients die every year due to medical errors is an ever-troubling statistic. And if someone is self-certain enough to think an advancement in equine technology is a good investment in an era when tickets can be purchased to voyage into space, it makes me uneasy. So does the need for many hospitals to shield nurses from physician retaliation if they call them on not following protocols designed to spare their patients from devastating infections. A modicum of doubt about one's abilities tends to ensure better quality control.

Meanwhile, an opportunity has been presented to hospital financial executives to put their imprimatur on a new era of medicine. With the formation of accountable care organizations and more physicians becoming employees rather than contractors, some due diligence is in order by those doing the hiring. Credit checks are not only in order--virtually every other large employer now undertakes them--but examining the financial portfolios and bank statements of every physician job candidate makes sense. If that is considered to be a barometer of one's judgment in every other field, it should work well here.

Speaking of financial portfolios, I was staggered by the sums physicians are receiving from the pharmaceutical industry, thanks to a new database created by ProPublica, the not-for-profit investigative organization. I'd say more, but there's an embargo on that data until early next month. Stay attuned. - Ron

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