The crucial elements in managing such problems involve their early identification and reporting, as well as the development of a patently fair process which recognizes the interests of all concerned. In the case of the incompetent physician, complaints or concerns may arise from staff physicians, residents, other healthcare staff, patients or their families. No matter what channel these complaints follow, they should, in the case of staff physicians, be directed to the chair of the relevant departments or, in the case of residents, to the director responsible for medical education. These complaints should be handled differently from complaints of incompetence, as will be discussed shortly. Before complaints of incompetence can be addressed in a meaningful manner, three steps must be implemented.
General guidelines are insufficient.
Indicators might include resource utilization, length of stay, complication rate or rate of unscheduled readmissions to hospital. Second, the system of physician performance evaluation must derive specifically from these standards and expedite the ready identification of outliers. Finally, the hospital administration must establish a process that facilitates communication of complaints or concerns about physician performance, and revise hospital bylaws and policy as necessary. Complaints of impairment need to be handled with the utmost discretion. To achieve this balance, complaints or concerns about physician impairment should be directed simultaneously to the relevant department head, the Vice-President of Medicine, and a permanent designate of the MAC, presumably a physician with expertise in this area.