Lucian L. Leape, MD; John A. Fromson, MD
Potential Financial Conflicts of Interest: None disclosed.
Leape LL, Fromson JA. Problem Doctors: Is There a System-Level Solution?. Ann Intern Med. 2006;144:863. doi: 10.7326/0003-4819-144-11-200606060-00018
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Published: Ann Intern Med. 2006;144(11):863.
We agree with Dr. Kuhn that much more attention needs to be paid to assessing medical students and residents for their suitability and fitness to practice medicine, and that failure to do so is a breach of the fiduciary responsibility of schools and hospitals. These are issues that the Association of American Medical Colleges and specialty boards should address.
However, Dr. Kuhn's dismissal of the need for additional testing is diametrically opposed to every specialty board's strong (and, we think, laudable) initiative to develop much more rigorous and effective assessment of physician performance. Although we are sensitive to the fact that rural practice clearly has unique accountability issues, the ability of physicians to learn and maintain personal standards is not one of them. There is neither an ethical nor practical justification for accepting lower standards for physicians in rural areas.
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