World's worst doctors

A doctor turned off a woman’s life support ventilator in an Australian hospital because the director of surgery, dubbed "Dr. Death," wanted her bed to operate on another patient, an investigation finds.

The surgeon, Jayant "Jay" Patel, 56, is the subject of an official inquiry in the Australian state of Queensland examining why the doctor was permitted to practice medicine in 2003 despite a nearly 20-year history of criticism and sanctions imposed by medical authorities in Oregon and New York as a result of his work practices

Despite that, he got glowing references from a number of colleagues when he applied for credentials in Australia.

To me this case highlights how poorly the medical profession weeds out incompetence. It seems clear this guy was a butcher, but he moved from New York to Oregon to Australia, somehow getting credentialled along the way despite a disciplinary history.

Part of the problem is he is apparently very incompetent, and as a surgeon, could really do a lot of damage. A bad pediatrician or allergist, say, would kill a lot less people. At my intern orientation in my peds residency a distinguished neonatologist got up and told us the following

“The first law of pediatrics is as follows: if you identify a child with something wrong, you must intervene immediately before the child gets better on their own.”

There is a lot of truth in that; most of pediatrics is correcting single problems or keeping kids comfortable while “tincture of time” works its magic. (I don’t mean to diss pediatricians here, just point out you’ll notice an incompetent surgeon a whole lot sooner).

The major problem is just how big a factor being able to practice medicine is in an individual’s life. I’ve seen this in several medical students who probably shouldn’t have been awarded an M.D. or D.O. But the first two years are class work, so if you are smart you can muddle through. Third year, problems become apparent, but the first impulse, appropriately, is to try to work with the student to overcome their difficulties. By then they are 3 years and $140,000 into medical school and it becomes pretty hard to kick them out.

Those who are geniuses with horrible people skills can be guided into research or a specialty with minimal exposure to patients, but for the generally incompetent who somehow made it into medical school, most end up in a primary care residency at a not-so-good program.

It is a similar situation for an incompetent surgeon. This guy is probably a nice person, and he’s put in a lot of time training to be a surgeon. Plus, every surgeon has the occasional bad outcome, so how do you know if someone has bad skills or bad luck? As a licensed surgeon the guy has a guaranteed high-paying job. Take away his license and his life is completely changed for the worse. Perhaps there should be a program to retrain surgeons with poor surgical skills in other specialties, although, in fairness, this guy seemed to have horrible judgment as well.