Doctors Behaving Badly: Medical boards should drop the stone tools, join the digital age

CHJ Fellow

August 11, 2010

Antidote has been on an alphabetical tour of state medical boards this year. As summer fades, I thought it would be a good time to pull over. To show where we've been, I created this Google map, and I will update it weekly.

View Doctors Behaving Badly in a larger map

First, why this road trip?

When Michelle Levander, the editor-in-chief of ReportingOnHealth and one of the smartest journalists you will ever meet, first talked to me in 2008 about my joining the site, I suggested a weekly item about doctors straying outside the lines of accepted medical behavior.

Bad doctor stories have always been a reader favorite, and I wanted to remind reporters and the public to constantly be vigilant about doctors' credentials and claims. Initially Antidote called the feature "Contraindications" to show that I took the subject seriously.

Too seriously.Nobody seemed to understand what "Contraindications" meant, and some of my (few) devoted readers asked me, "Why don't you write about bad doctors anymore?"

So I changed the title to "Doctors Behaving Badly," an homage to the British sitcom "Men Behaving Badly." A doctor friend of mine suggested I call it "Doctors Gone Wild."

By the end of 2009, I thought it would be good to stop picking random, oddball doctors for a while and turn my focus more onto the agencies ostensibly monitoring them.

Here's what I have found so far.

In most states, detailed information about a doctor's disciplinary, criminal or malpractice histories is either nonexistent or heavily redacted. The worst states, in alphabetical order, are: Alaska, Arkansas, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois and Kansas.

Even in the best case scenarios, despite massive advances in transparency, accessibility and accountability among government agencies, medical boards use antiquated and obtuse technology that confuses, frustrates and deceives consumers.

A cynic might think that their websites have been designed to shield doctors from public scrutiny. The boards, after all, are made up mostly of doctors, and the doctor's lobbies nationwide are among the best funded and most effective voices in state legislatures.

I think the problem lies in poor website design. A board starts with a simple site that allows people to see if a doctor has a valid license. Then that same board adds scanned documents from its disciplinary files, but instead of linking these two things together, it puts them in completely different parts of its site. When the board gets around to adding malpractice information or criminal histories, it layers those on top, too, instead of fully integrating them.

The effect is a stratified system of information that lets patients think their physicians have a clean history when, in fact, their records are simply too hard to find. States such as Alabama, Georgia and Indiana provide a lot of information but make it unnecessarily difficult to locate.

I am nearly half way through the country at this point. Right now, the Medical Board of California leads all other agencies in the way it provides information to the public in one easy-to-use and largely complete database. Like all medical boards, the board should provide consumers with longer histories, but the information that is provided is detailed and dummy-proof.

My reporting at The Orange County Register and the reporting of my fine colleagues there played a role in driving the state to improve its site, but the agency itself has made advances through the work of some great executives over the years, some visionary board members and one constant: Candis Cohen, the best agency PIO you will ever meet. Cohen can be tough on reporters and has called this reporter "shrill" more than once, but she is an honest broker. I have asked her to send me enough paper and electronic documents to fill a community college library, and she has never balked. This cannot be said for most other medical boards, state agencies, federal agencies or universities.

California's success is not attributable to size alone. Small states actually do a much better job than many larger ones. Idaho and Iowa make information relatively easy to find while Illinois, one of the country's most populous states provides next to nothing online.

As far as discipline goes, that requires a more detailed analysis, and perhaps I will put that together before year's end. For now, thanks for coming along for the ride with Antidote. I hope you enjoy our trips through Kentucky, Louisiana, Maine and beyond in the weeks to come.

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