Peer Review


man-yellingI sit on a couple of committees at our hospital. In one committee, we review a random sampling of cases to see whether there was a discrepancy in care.

I happened to receive a few cases where the patients had been diagnosed with heart attacks and I raised a couple of minor questions about the treatment the patients had received.

The surgeon who sits on the committee was in a bad mood. When I raised my issues, he blurted out

“Why is ER doctor reviewing inpatient MI cases? He doesn’t have the experience to do so.”
Then he turns to me and says “You shouldn’t be reviewing any inpatient MI cases. The care is different.”
I asked him “How?”
“You know damn well it is. VERY different.”
“It just is.”
“Tell me how.”
“Don’t you argue with me.”
“Unless you can justify your opinions, it doesn’t seem that we need to change anything.”
“Fine. I’m taking this to the Medical Executive Committee, then.”

“Whatever. We’ll drop it. Let’s move on.”

We looked through the other cases and happened to see one from an admitted patient who had subtle changes suggestive of a small MI that were not diagnosed until later in his hospital stay. The case was previously reviewed by our committee and then referred to the internal medicine committee for comment. The internal medicine committee returned the chart with a notation that “there was no cardiology consult ordered, so no myocardial infarction occurred.”

The surgeon started shaking his head, got this annoyed look on his face and said “What the hell is that supposed to mean?”

I replied “Beats me, we’re not qualified to review inpatient MI cases, remember?”

I don’t know which was more fun – watching everyone in the room try to keep a straight face or watching the surgeon scowl at me, gather up his papers, and walk out of the room in a huff.

And the meeting ran so smoothly afterwards …


  1. “You can leave in a taxi. If you can’t get a taxi, you can leave in a huff. If that’s too soon, you can leave in a minute and a huff.”

    Groucho would have been great at peer review.

    Maybe the surgeon developed some crushing chest pain and went to get some PeptoBismol to treat it. 🙂

    “there was no cardiology consult ordered, so no myocardial infarction occurred.”

    Well, I guess that is one way to avoid peer review.

    What about –

    “The patient was not transported to the morgue, so no death occurred.”

    “The patient received excellent care, so no complaint occurred.”

  2. Hehe, that is too good. Having worked in surgery for a long time, that made me laugh. And everyone wondered, why, after years of moonlighting in ED’s, that many years ago, I made the switch to FT EM work.

    BTW, just posted about my experience with Peer Review not too long ago.

  3. I wish I could be like you and stand up for myself like that sometimes …but i could never think of anything like that to say =(

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