Doctors must step up and better police their own ranks, taking a helpful warning from medical malpractice lawsuits in dealing with problem practitioners or systemic wrongs.
That’s the wise view of Dr. Shah-Naz H. Khan, a neurosurgeon and a clinical assistant Professor of Surgery at Michigan State University (shown, right).
Her trenchant commentary — published on KevinMD, which describes itself as “the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories” — is salient as medicine confronts a startling number of doctors, who, frankly, have run amok in putting forth health falsehoods in the midst of the deadliest public health emergency in more than a century.
The coronavirus pandemic, which has killed almost 690,000 and infected almost 43 million Americans, has spawned what one public interest group has dubbed the “Disinformation Dozen,” a group of top medical super spreaders of covid vaccine misinformation on social media.
Just how will their peers deal with this egregious behavior, which surely does not look like so much an exercise of free speech but the dissemination of dangerous (but profitable) hokum?
Dr. Khan cautions her colleagues that they cannot turn a blind eye to the practice of bad medicine, writing:
“When we shake our heads at the snake oil salesmen of yesteryears and wonder how the people then could have been so naïve as to fall for the crude shenanigans, we are wearing blinders with our eyes wide open. Malpractice remains alive and well. Those who care can cite many causes for this blight in our profession. The frequent targets of a doctor’s pointing accusatory finger are the greedy insurance companies and the churlish hospital administration that reduces humans to a dollar amount. In that accusatory stance, three fingers point at ourselves. So, why not first examine our own contribution to vice?”
She says that poor performing doctors harm patients and undercut their good, dedicated colleagues who keep high standards:
“Malpractice is unacceptable, whether it is done by a friendly colleague, an ambitious newbie, or, that well-entrenched senior physician who gladhands most every physician in the hospital and is on backslapping terms with the administration. Indifference, silence, or lack of meaningful action is permission.”
Doctors know best from their own experiences where lines get crossed and ways exist already for them — including through licensing authorities, hospital internal reviews, and, yes, testifying in legal actions against miscreants — to deal with error, unacceptable performance, and systemic issues that must be corrected, she says:
“To prevent malpractice, raising concerns must be encouraged and not frowned upon for rocking the boat. Within the hospital, the doctors are the members of peer review or quality control committees and participants of morbidity and mortality conferences. We succumb to using these positions for settling scores, practicing petty politics for personal gain, putting inconvenient practitioners in their place, and sweeping complications under the rug. It goes without saying that when used correctly, these bodies do improve the quality of care. They cannot be misused without the acquiescence of a physician. Peer pressure may make it difficult for a wavering physician to become a rubber stamp for the unsavory elements in health care.”
Disciplining doctors who spew coronavirus falsehoods
Physicians are feeling the rising heat to stamp out the tide of bunk that some of their peers are spewing, the Kaiser Health News service reported:
“In July, the Federation of State Medical Boards, the national umbrella organization for the state-based [licensing] boards, issued a statement making clear that doctors who generate and spread covid misinformation could be subject to disciplinary action, including the suspension or revocation of their licenses. The American Board of Family Medicine, American Board of Internal Medicine and American Board of Pediatrics issued a joint statement Sept. 9 in support of the state boards’ position, warning that ‘unethical or unprofessional conduct [in doctors spreading health falsehoods during the pandemic] may prompt their respective Board to take action that could put their certification at risk.’”
As KHN reported, the disinformation docs have made themselves well known and easy for professional peers to act on:
“[A] 2021 report by the nonprofit Center for Countering Digital Hate … based on an analysis of anti-vaccine content on social media platforms, found that 12 people were responsible for 65% of it. The group is composed of physicians, anti-vaccine activists, and people known for promoting alternative medicine. The physician voices are of particular concern because their medical credentials lend credence to their unproven, often dangerous pronouncements. All three continue to hold medical licenses and have not faced consequences for their covid-related statements.”
The nonprofit identified the doctors of concern as: Rashid Butta, Sherri Jane Tenpenny, and Joseph Mercola. (The hyperlinks will take the curious to see some of the MDs’ problematic posts — the material is too outlandish to make respectable by repeating it.)
KHN also reported that it has “identified 20 other doctors who have made false or misleading claims about covid by combing through published fact checks and other news coverage.”
The news service, correctly, points out that medical licensing boards too often have proven to be paper tigers, slow to act, and more likely to mew at offenders than to take needed remedies. Arthur Caplan, founding head of the Department of Medical Ethics at New York University, told KHN:
“The boards are relatively slow and weak and it’s a long, slow process to pull somebody’s license. In many states, they have their hands full with doctors who have committed felonies, doctors who are molesting their patients. Keeping an eye on misinformation is somewhat down on the priority list.”
What has occurred, thus far, is not encouraging, KHN reported:
“To date, only two doctors have reportedly faced such sanctions. In Oregon, Dr. Steven LaTulippe had his license suspended in December 2020 for refusing to wear a face mask at his clinic and telling patients that masks were ineffective in curbing the spread of covid, and even dangerous. Dr. Thomas Cowan, a San Francisco physician who posted a YouTube video that went viral in March 2020 stating that 5G networks cause covid, voluntarily surrendered his medical license to California’s medical board in February 2021. Dr. Humayun Chaudhry, president of the Federation of State Medical Boards, however, said it’s possible some doctors could already be the subject of inquiries and investigations since these actions are not made public until sanctions are handed down. KHN reached out to the medical and osteopathic boards of all 50 states and the District of Columbia to see if they had received covid misinformation complaints. Of the 43 that responded, only a handful shared specifics.”
In my practice, I see not only the harm that patients suffer while seeking medical services, but also the fortitude they must muster if they seek justice by filing malpractice claims in the formidable and often intimidating civil system. Patients already struggle to access and afford safe, effective, and excellent medical care. They face, frankly, an ordeal in dealing with the U.S. health system due to the soaring complexity, uncertainty, and costs of treatments and prescription medications, too many of which turn out to be dangerous drugs.
When they go to court, patients and their lawyers go up against a well-resourced medical establishment and insurers. Both relish making their counterfactual claims about malpractice. But year after year the evidence refutes their myth making, showing that relatively few of these cases advance in state courts across the country. While judges and juries can require defendants to pay substantial judgments, these are not common, and, contrary to the canards otherwise, good doctors don’t encounter just bad luck and end up in court. Instead, a slice of doctors experience two, three, or more malpractice claims — and lose them. Malpractice actions can help to get bad doctors away from patients and to show and get clinicians and institutions to deal with systemic problems they might want to look past.
We have much work to do to quell the epidemic of false information that zips around the globe at light speed these days and plays a huge part in dividing our country. We need to eliminate what a well-known think tank calls “truth decay.” Facts and evidence matter. They can help us see decisive truths we need to live better, safer, healthier, and happier. This includes in dealing with bad doctors with malpractice actions, about which, Dr. Khan should get a final word. As she wrote:
“Physicians have the right to flourish and deserve to be well compensated for what they do. It is possible without harming our patients. We can use our finite resources and time to do so ethically. Or one may choose to go down the rabbit hole. Ultimately, our choices define us. Accountability does come calling sooner or later. Usually, reputations are not made or tarnished by a single act; rather, they are the summation of behavior or actions of an individual or institution … A saying goes, when you see a wrong, stop it forcefully. If that is not possible, speak up against it. If that is not possible, think it wrong. The last being the weakest form of conviction. Curbing malpractice does not mean holding the sword of Damocles over the head of every physician who provided sound treatment but had an inadvertent complication. We know the difference between malpractice and complications. The majority in our field are upstanding and good. Let not the minority define us. Having put our own house in order, we can then set forth to slay those other dragons that dare tarnish our noble profession. We are the difference, and it is not all that hard.”