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How to handle a 'slipping' physician

Credentialing Resource Center Connection, April 7, 2003

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Dear Credentialing Colleague:

What courses of action are available to credentialing professionals when faced with the reapplication of a "slipping" physician? I use the term "slipping" to refer to a physician who has been known as an excellent physician for a long time, but now causes worry. Nurses have begun to detect changes in his or her care. He or she is less decisive and occasionally turns to nurses for advice on drug doses, asking, "What are other physicians using?" He or she now requests more consults than in the past, and consultants grumble that they're often called in too late or unnecessarily. His or her lengths of stay have increased a bit, as have his or her short-duration admissions to critical care. But this physician's patients continue to report their satisfaction with his or her work.

The description above truly paints the picture of a physician who is beginning to "slip." But 90 days prior to the end of the year, he or she reapplies to the medical staff--just as he or she has done every two years for the past 25 years. A new, young department chair confides in the medical staff services professional, saying he or she is concerned about this physician based on information he's heard and his personal experience with the physician. The vice president of medical affairs has known this physician for his entire practice career.

How should credentialing professionals handle such a situation? Consider the "do's and don'ts" list below.

- DON'T even think about summary suspension.

- DON'T recommend denial or revocation of privileges.

- DON'T exacerbate the rumors.

- DON'T initiate a formal investigation.

- DO find an opportunity to speak collegially with this physician about your concerns (e.g., "Bill, we're concerned for you. Is there any way we can help?").

- DO recognize that this situation is ideally suited for a short-term (e.g., six-month) reappointment, which should give you more time to assess and assist the physician.

- DO have a conference with the VPMA, department chair, and chief of staff to determine whether the hospital must take any immediate steps to protect patients (e.g., retrospective review, concurrent review, or directed rounds by the department chair).

- DO contact the state medical society and ask for advice about this hypothetical situation.

- DO begin to gather as much objective data as possible concerning this physician's past and present practice pattern.

Above all, don't sit back and hope this situation will resolve itself or magically disappear.

That's all for this week.

All the best,

Hugh Greeley
www.greeley.com/seminars/

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