International Practitioner Data Bank: false premise, false promise.

In 1984, the US General Accounting Office issued a report pointing out that physicians who lost their licence to practice in one state were continuing to practice in another [1]. In 1986, a federal court issued a ruling that physicians carrying out peer review activities in an Oregon medical clinic violated antitrust laws [2]. Both actions triggered calls for congressional action. Consumer advocates urged that patients be better protected from incompetent or unscrupulous doctors. Medical professionals urged that physicians conducing peer review be granted greater legal protection: The National Practitioner Data Bank (NPDB) emerged from these developments. In 1986, the US Congress gave physicians the peer review liability protections they sought, but as a quid pro quo called for the establishment of the NPDB. The data bank began operation in September 1990. After some early implementation problems, it has functioned in an efficient manner and proven to be useful. Hospitals, which are required by Federal law to query the NPDB as part of their credentials verification process, seldom obtain information of which they were unaware. Yet, they tend to find it useful: as a means of confirming information, as a way of encouraging applicants for staff positions to be honest and complete in reporting any prior adverse or malpractice actions involving them, and, occasionally, as a source of new information [3,4]. As the quantity of information in the NPDB has increased over the years, it has become an increasingly valuable central source of information for organizations employing health care professionals. Managed care organizations, even though they are not required to query the Data Bank, now account for the majority of enquiries being made to it. Consumer advocates argue that consumers should also have access to the NPDB to help them make more informed choices about the physicians they choose in the turbulent health care marketplace of the late 1990s. But among physicians, the very notion of this central clearinghouse of information has continued as a major irritant. A past president of a state medical association certainly echoed the views of many of his colleagues when he said about the NPDB: "I'd like it to just disappear. Let's put it somewhere beyond the reach of fiber optics" [5]. The American Medical Association could not agree more, as it continues to call for its dissolution [6]. Enter Drs Israeli and Altholz with their call for an international data bank modelled on the American one. As a rationale, they present the same basic concern that gave rise to the NPDB. They do not dwell on the phenomenon of bad doctors banished in one jurisdiction and continuing to practice in another, but they do stress the need, in an increasingly global economy, to protect patients and organizations "from the increasing risks in today's medical environment." Their concern and their search for a way to address it are certainly important and timely. But I submit that the vehicle they propose is flawed in both its premise — that the NPDB serves as a relevant reference point for the kind of international data bank they outline — and in its promise — that such an entity could be effective in addressing their concern. First, the premise. In a number of significant respects, the international data bank they propose bears little resemblance to the NPDB. The following are of particular note: