| One-Minute Clinician

The 4D Model: Why Doctors Get Into Trouble

Why do doctors get into legal trouble? The 4D model: dated, duped, dishonest, disabled (from decision making). You see this happen in the courtroom. Experts will point that out that a doctor

  • Didn’t stay current on licensing board guidelines
  • Was fooled and didn’t have the appropriate measures or reasonable steps to prevent abuse and diversion

Identifying a fifth, most malignant, D: the defiant doctor, the one who thinks s/he is smarter than everybody else. From a clinician’s perspective as an auditor and peer assessor, when we do chart audits:

  • We look for patterns of knowledge deficit, of ineffective boundary limit setting
  • Many doctors come from the “ballistic trajectory of medical education” school of thought: we’re going to fire you out of a cannon with the most energy packed knowledge you’ll ever have and we hope that by the time you retire you’ll still be competent
  • The problem is medical knowledge changes at a ferocious rate
  • We find significant amounts of new knowledge; we small amounts of what we thought we knew just wasn’t so
  • The real model of continuing medical education now is what’s called maintenance of competency
  • In courts and tribunals we’re looking at how people have tried to stay current
  • Family practice is required to do a certain number of maintenance of competency credit hours per year

Sometimes it’s as simple as a doctor who can’t say no; you take away their prescribing privileges and they become effective medical practitioners who are no longer burdened with this challenge of feeling like they’re not meeting their patient’s needs or demands, because they simply can’t. They’re not licensed anymore to write that prescription. The 4D model is one of interdiction, but it’s also a model of rehabilitation.

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