Credentialing and Privileging of Doctors in an Era of Safe Medicine has become mandatory
Dr Fiaz Fazili
Srinagar | Posted : Apr 12 2017 1:17AM | Updated: Apr 11 2017 11:47PM
I would never take up the regularly advertised offers by any Medical practitioner unless I have a look on his or her credentials. Why? Are there any regulators ,which can be o provide formal accreditation of a doctor's competency in a certain area of practice?
Tips of iceberg; Kulsum, (name changed), aged 28, picked as a frequent visitor of Psychiatrist’s private clinic by Clinical Sociology Intern conducting a research on frequent causes of depression in young women in conflict zone. Social workers are highly trained professionals often possess a high degree of compassion and empathy, a passion for helping others, strong interpersonal and problem-solving skills, and good listening and organizational skills. On probing the Intern discovered that patient had a small swelling in uterus for which a gynaecologist was prescribing her tablets. When her problem became too painful to ignore, she visited a variety of doctors and ultimately landed in private clinic of one Surgeon ( name withheld ), and was told that her condition demands removal of uterus. Tired of multiple visits, and cyclic medicines she underwent this operation. After few months she had to struggle with the heartbreaking reality that she can no longer menstruate or have children. For her, the hysterectomy was an emotionally painful experience, with sad and depressed note the patient asked Intern ,” Can you tell me if this is normal? And is to be expected following her surgery,?” Reassuring the inquisitive patient the intern told the patient , “If your gynaecologist says it's time for a hysterectomy, you'll need to know what it could mean for your sex life, your hormones, and your future before you agree, but what surprised the Intern In her case the Doctor’ name (name withheld) who conducted surgery of removal of uterus on this young female was not a Gynaecologist but a General surgeon.
Case 2: In my inbox of “ask the expert,” I am having a case profile of 60 year old male teacher, (name withheld), who had disc operation eight weeks ago. The surgeon also performed a dynamic stabilization at this level. As I understand it, this involves the insertion of metallic screws, similar to fusion at this level while at the same time preventing the vertebra from slipping. Prior to surgery, patient was able to walk or stand for more than 5 - 10 minutes without becoming uncomfortable because of weakness in his legs and a tight cramping sensation in his buttocks. Surgery should have relieved him of these symptoms, but post-surgery he was having severe pain on other leg when standing or walking for more than 5 - 10 minutes. After trial of different pain killers, when pain was not relieved family sought opinions from other spinal surgeons. Many more radiological tests were ordered at patient’s expenses, and second operation was recommended as during the first operation one of the screws done to stabilize the joint had inadvertently gone near nerve root on other side which was the source of his pain. The dissatisfied family inquired about the previous “Doctors profile “ and were take back as the previous Surgeon had no formal certification (MCI recognized degree) to qualify or practice as a Spinal Surgery but with few years’ residency in neuro surgery after Post General Surgery degree the surgeon was practicing as spinal surgery.MCI rules are loose in this respect. Surely, there are more stories from our land.But,it’s conventional wisdom that there are “good” and “bad” physicians/Surgeons and that selecting a good one can protect patients from the kinds of medical errors that injure or kill hundreds of thousands of patients each year. When you look at medical literature you will find that, when it comes to elective operations, it is much more important to pick the right (competent, qualified) surgeon having privileges to perform such type of intervention granted to him /her by a designated or recognized professional body . Today, I am focusing on a very important and sensitive issue on patient safety, “In a system where accountability and supervisions has always remained under scanners of news watch, why choosing the right surgeon matters even more than you know?
As a promoter of safe surgery practices, I have few questions to our healthcare policy makers.
1. Can any non-gynecologist or Doctor with certification of any Medicine branch practice or do intervention outside his or her own specialty? 2. Is certification in any branch of surgery enough for any Doctor to perform any type of surgery or intervention?, when it is well established fact in surgical practice despite obtaining degree in a specialty all qualified surgeons cannot perform all sorts of procedures. With modern innovations like laparoscopy or Robotic surgery etc for intervention, credentialing, privleges and proctoring has become very important, especially for the last few years many nonresident Medical specialists are visiting valley, with tall claims on competencies, skills, experience all sorts of ads are published in local dailies which at times are confusing for me. To assure the eligible patients that only qualified practitioners who can demonstrate current clinical competence within their specialty domain are granted clinical privileges and permission. Are there any state or medical council guidelines, rules, regulations, or any supervisory bodies which credentials and grants privilege’s to local doctors and visiting Physicians? Even after search on MCI web site I could not get exact answer on this subject.
A of Physicians is a process of establishing the qualifications of licensed professionals, organizational members or organizations, and assessing their competency on skills and knowledge along with legitimacy to perform certain types of interventions/operations. Many health care organizations/hospital conduct their own privileging, generally through a credentialing and privileging committee, which at times are displayed on hospital web sites so that patients can easily check to choose right kind of Doctor for themselves . Credentialing ensures the physician has the requisite training, education and competence to provide appropriate care. The responsible surgeon's eligibility to perform a surgical procedure is based upon his/her “ log book” record about Physician’s interventions/operations as either an independent surgeon, assistant or observer validated and signed by supervising authority, a must requirement for job seekers all over world. A surgeon or resident trainee is supposed to maintain/update record of log book and privileges throughout his or her career. It may include granted and under review specific clinical privileges. The statement of principle called “privileging. “in simple words is, Who can perform which type of intervention(operation), and in which set up following the code of professional conduct.
As Surgeons, we treasure the trust that our patients have placed in us because trust is integral to the practice of Medicine. What doctors won’t do?, Betrayal of that trust, or “Do no harm,” like values in Medicine which hold relevance even todays corporate world.
(Dr Fiaz Fazili- Healthcare Quality and accreditation Consultant, works on Healthcare policy and hospital performance improvement programs.
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