Independent Medical Reviews

Peer Review: Benefiting Patients and Physicians

December 09, 2016

Physician on the phone with a pen in hand working on a patient's chart at his desk as part of an insurance medical peer review.

Many physicians are experts in their areas of practice, but the medical field is vast, and there’s no way for one doctor to be an expert in everything. It is impossible to keep up with each advancement for every condition or treatment option. That is why physicians and health care facilities use the peer review process: To rely on one another to determine individual areas for improvement and maintain an overall high quality of care. Peer review enables physicians to learn and be confident in their observations and decisions. From a patient’s point of view, peer review ensures everyone receives the best medical care possible.

Utilizing Peer Review

Peer review is used by hospitals and other health care facilities in a variety of ways. Hospitals are required to use peer reviews for existing doctors to maintain their privileges, and for new physicians seeking privileges at the facility, according to an article by Dinesh Vyas and Ahmed Hozain from Michigan State University and published in the World Journal of Gastroenterology. Hospitals, doctors and administrators can request peer reviews of their colleagues if they are concerned about the quality of patient care. Additionally, facilities use peer review of random or selected patient’s charts to identify problem areas and improve quality of care. While this last reason appears most directly related to patient care, all peer review benefits patients by ensuring physicians are highly qualified in their areas of practice and treat all of their patients within the standard of care.

An Exchange of Ideas

Peer review often occurs through internal or external peer review committees. These committees include physicians with varying backgrounds and disciplines, bringing a variety of knowledge to the table. They generally review other physician’s charts to determine if patient care met the relevant standard of care. The physicians use discussion and an open exchange of ideas to evaluate the other doctors’ work, enabling everyone involved to better understand the various options and roads they can take with patients while maintaining the standard of care and providing the best medical care possible.

Identifies Strengths and Weaknesses

Peer review enables doctors to learn where they lack knowledge, how they need to improve and where they excel. Internal or external peer review of a physician’s performance offers constructive feedback intended to make him or her a better doctor.

This knowledge can also help facilities shift where patients are assigned for certain types of care. By identifying physicians’ strengths and weaknesses, facilities can send patients to the most knowledgeable doctor or transfer a patient to a new doctor when more is known about the patient’s condition.

Promotes Collaboration

When doctors understand their own lack of knowledge regarding the evaluation and management of certain conditions, they can identify when it’s time to seek advice from another physician for the benefit of their patients. When a doctor encounters an area of practice with a patient where they lack expertise, they help the patient most by introducing them to an expert in that area of medicine.

Directly Related to Quality of Patient Care

Hospitals and other facilities have many tools to measure patient care and promote the highest standard of care possible. Peer review is one of these tools. At Advanced Medical Reviews (AMR), an independent review organization that offers Peer Reviews, customization is key. As Dr. James A. “Jaime” Phalen observes, “Strong group accountability elevates the quality of care being delivered by every team member at a hospital. AMR prides itself on offering peer reviews that can be customized by facility type and region to ensure a fair assessment.”

Quality care for patients relies on knowledgeable doctors who care for patients to the best of their abilities and purposefully maintain the relevant standard of care; the peer review process identifies those physicians who do not. This process can lead to the dismissal of poorly performing or unethical physicians who don’t improve their work. It can also lead to additional training for less experienced doctors who want to improve. Whether physicians are removed from treating patients or improve their performance, peer review protects patients and promotes providing the highest quality of care possible.


Peer Review: Benefiting Patients and Physicians