By Raja Mishra, Globe Staff, 1/26/2003

n a groundbreaking attempt to police doctors' behavior, state lawmakers will soon consider a measure allowing government officials to punish physicians who repeatedly offend or intimidate patients and colleagues. The bill opens a new front in the national movement to hold doctors accountable for second-rate care.

The proposal, written by a Harvard medical-error specialist, is believed by its supporters to be the first bill of its kind in the nation.

It comes at a time of increasingly vehement public demands that doctors be held accountable not only for medical mistakes but for poor bedside manner and workplace demeanor, which studies have shown can erode the quality of care they provide.

Responding, in part, to recent horror stories of physican mistakes and crimes, the new measure delves beyond clinical errors into the more ambiguous terrain of attitude in a high-pressure, hard-charging profession.

''Do their attitude and comments engender trust among patients? Respect? Do they treat nurses with appropriate respect? It's basic stuff but it makes a big difference,'' said state Senator Richard T. Moore, an Uxbridge Democrat and a key health care lawmaker who is sponsoring the bill. ''A lot of patient recovery depends on mental attitude.''

Though few local doctors and hospitals have seen the proposal, many oppose such a state-run grading sytem, calling it an intrusive measure that would further burden swamped state health agencies while duplicating procedures in place at most hospitals.

Statistics on ''soft'' measures of doctor care like bedside manner are difficult to come by. At Physician Health Service, the nonprofit firm that counsels many of the state's troubled doctors, behavioral problems accounted for 30 percent of the cases handled this year - double the percentage a decade ago, suggesting the problem may be growing, specialists said.

Local hospital officals, however, insisted they already monitor doctor behavior with comprehensive patient satisfaction and doctor evaluation systems, which sometimes result in doctor discipline, including firings.

''We are doing a lot internally. We act on it. It's not data for the sake of data,'' said Dr. Robert Goldszer, associate chief medical officer at Brigham and Women's Hospital.

The architect of the new measure, Harvard's Dr. Lucian Leape, also authored a 1998 government-commissioned report that estimated that up to 98,000 people die annually because of medical errors in the United States. His study helped galvanize the movement to demand more accountability from doctors.

The new bill directs the state medical board to craft a list of behavioral criteria on which doctors would be judged every two years, such as rudeness, demeanor with nurses, punctuality, behavior with patients, and vulgar remarks.

Exactly how state regulators would assess individual physicians was not specified in the bill, though Moore said interviews with physician colleagues and nurses would play a central role. Those flunking could have their hospital credentials revoked. Repeated failures could lead to a suspended medical license, though all discipline would be open to appeal.

Moore expects Beacon Hill debate on the measure to begin in March. When told that many doctors oppose the proposal, he replied, ''The ones who have that reaction probably need it.''

Physician Health Service counseled 163 physicians last year, almost half of them medical residents and internal medicine doctors. That number represents a small minority of the more than 15,000 doctors practicing in the state.

Hospitals themselves catch the vast majority of cases quickly, said Brigham's Goldszer, who oversees a system that quizzes every patient, through mail-in surveys, on their satisfaction with doctors, as well as more mundane aspects of their stay, such as food and hospital cleanliness.

''It's important that each doctor is held to high standards,'' he said.

Beth Israel Deaconess Medical Center conducts phone surveys of all patients. Both hospitals have extensive in-house procedures for dealing with serious complaints raised by patients and staff. Problematic doctors must follow staff behavioral recommendations or face discipline, including job termination, though hospital officials said such drastic action is extremely rare.

The state Board of Registration in Medicine, charged with actually running the proposed doctor evaluations, views the idea warily.

''That would be a tremendous drain on resources, and would require extra funding,'' said Nancy Achin Sullivan, the board's executive director.

''We've taken tough action when we've needed to take it,'' she said, citing recent disciplinary actions against a doctor who started mid-surgery fisticuffs with a colleague and another who angrily threw bloody sponges at a nurse.

But the measure's supporters seek to catch the less dramatic cases they say eat at health care quality.

''It would be a pretty significant cultural shift for doctors,'' said Moore.

Raja Mishra can be reached at rmishra@globe.com.

This story ran on page B1 of the Boston Globe on 1/26/2003.
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