Peer review: determining what's best for patients by professional self-assessment

Many influences outside of physician control have begun to undermine traditional physician autonomy. Studies of physician practices reveal differences not based on patient case mix alone, but on variations in decisions and lack of intra-physician accountability. Failure of physicians to be accountable to each other is related to inadequate due process understanding, fear of legal recriminations from peers, and a traditional long-standing history of individuality and accountability. The malpractice crisis and the advent of a National Practitioner Data Bank of physicians whose privileges or licenses have been modified serves as an impetus to rebuild accountability into a new emphasis on peer review based on optimum patient-focused outcome. To get physician buy-in, a five-step process is described which is separate from professional review of privileges and is seen as collegial, educational, and patient focused.