Sham Peer Review or True Concerns? Compare and Contrast

Recently on 10-12-2013 Parliamentary Health Select Committee's member Ms Charlotte Leslie MP (photo above) asked medical regulator, the General Medical Council:

Q10 Charlotte Leslie: To follow the points Sir David was making, do you recognise or acknowledge that sham peer review takes place?
Professor Sir Peter Rubin: What do you mean by “sham peer review”?

Medical regulator, now more than 150 years old,  has persecuted medical whistleblowers and other doctors on demand from some medical directors working in National Health Service (NHS) in the manner of sham peer review. While some doctors can tell the difference between sham peer review and genuine concerns, it would appear the regulator cannot tell the difference. Dr Lawrence Huntoon has described psychology of sham peer review HERE.

So, what is the difference between genuine complaints and those asking for sham peer review (backstabbing)? What are the characteristics of these two very different complaints? Table below attempts to compare and contrast Sham Peer Review with genuine concerns about  a doctor:

Feature	Sham Peer Review request	Genuine concerns about doctor
Investigation of the complaint(s)	Done poorly or not at all	Investigation done more carefully
Time pressure	Putting pressure on doctor to answer the complaint very quickly, without access to records and within a couple of days e.g. on weekend for complaint made on Friday. When this is complied with, refers to regulator anyway. Does not seek clarifications from doctor if not happy with a reply. Poor conflict management skills. Pulls doctor out of the clinic while seeing patients for an urgent meeting to answer a non-urgent complaint because “busy” at other times.	Given reasonable period to respond
Hoarding of minor complaints	Complaints not disclosed to doctor on time but reserved to hit him/her with several complaints at once. Habitual stacking of complaints and issues not dealt with. Pathological avoidance of situations which may give rise to a difference of opinions. Pathological fear of conflict.	Complaint(s) disclosed promptly to doctor to answer
Abuse of poor policy or process	On reading regulator’s faulty policy e.g. policy which has features of indirect discrimination against a group of doctors (like those who are contract workers or in private practise) decides to use this to get rapid access to the regulator	Not used
Language of serious concerns	Complaints written in a way to maximize the interest of the regulator in the absence of harm to patients: “I have serious concerns about Dr……”	Evidence of harm to patient or potential harm to public presented after thorough investigation and when other options are not feasible
Emotional abuse/humiliations	Statements as to the mental health of the doctor in the absence of any medical evidence or reference to the internationally accepted criteria. No referral to Occupational Health or any reference to doctor’s medical practitioner.	Refer doctor if ill to Occupational Health promptly without referral to regulator and ensures right questions are asked and answered. Patients protected by use of locum doctor to cover absence due to illness
Gain	Preservation of own reputation takes precedence over lives of others. Sham peer review serves as a cover up of own wrongdoing	No gain from making a referral to the regulator .
Honesty	Prepared to lie on oath. Tries to cut a deal so to avoid giving evidence on oath if written statement is accepted	No need to make false allegations has evidence to back the complaint
Staff turnover	Higher than average staff turnover and a more frequent user of regulator’s services	Normal staff turnover
Culture of bullying	Over the period of years bullies tend to surround themselves with bullies. Authoritarian approach, dislike of dissent	Complaint politely submitted outside the culture of bullying
Manipulation and status seeking	Infiltrate medical establishment as additional means of self-protection. This may involve the regulators themselves i.e. starts to work for them.	Has no need for self-protection from within the regulator
Outcomes for patients after dismissal of doctor	Deterioration in the outcomes for the patients when excellent doctor is dismissed and not replaced	There can be an improvement in the outcomes for the patients when incompetent doctor is removed even temporarily
Chronology of referral to the regulator	Referral follows after whistleblowing, or threat to the egos, or fear that disclosure may occur more widely outside the organization, or due to business rivalry or dispute, or after a court case taken by the doctor complained about	Referral follows from events related to poor patient care
Concerns about conduct of the doctor	More likely to be concerned about the conduct of the doctor, claims disruption. Provokes disruptive behaviour by doctor in a variety of ways such as frustration caused by passive aggressive behaviour of hospital administrator or others	Concern about patients’ welfare
Allegations	False and numerous, gossip, hearsay. Witness Statements that get withdrawn because witnesses unwilling to give the evidence once the process is in full swing and about to be heard in public	True complaints backed by Witness Statements
Person who makes false allegations	Sham peer review complainer is protected by medical regulator. Determinations by medical regulator do not give the names of, for example, medical directors who made false allegations to regulator and initiated the process of sham peer review. The names of the witnesses who gave evidence for doctor are published.	No backtracking  on Witness Statements or secret allegations or little chats with investigators at the regulator that accused doctor never hears about
Wish to do harm	Despite all the bad intentions that started the complaint process, at the disciplinary hearings before the regulator the accusers feign surprise that things got that far for the accused doctor. “I did not mean it”. Denial in contrast to the actions taken and the knowledge what the outcomes of those actions could be.	Patients are real concern
Protectionism	Protects either himself/herself and/or other colleagues he/she thinks cannot live without-feels compelled to work with them	Protects patients
Medical records	Withholds medical records and even when asked by the regulator sends only bits of the medical records at the time. Disclosure of one single medical file can take years. Regulator despite their powers to order immediate and complete disclosure is complicit with delay.	Sent promptly to regulator and doctor
Fraud	The accusers may be involved in fraud, sometimes widespread. Prepared to send even completely different patient’s records from the case complained about to the regulator.	No evidence of financial or other gain to be made by discrediting the doctor
Mobbing	Engages a crowd of people to act as complainants in order to hide behind them. Creates impression of widespread concerns to engage the regulator.	No need to have numerous witnesses to misconduct
Concealment of evidence	Documents missing, denies existence even when one document states another one is attached to it and staple marks are present.	No need to conceal the evidence
A User of others	Prone to prejudice and could use those considered inferior to write the complaints so as to avoid personal responsibility. Hides behind others. Divide and rule.	Not present
Phoning around to get more troops	Telephones previous employers to get them to complain as well.	Not present
Pseudo consultations	Engages in pseudo consultations to get the “green” light to make the complaint to the regulator. For example, telephones National Clinical Assessment Authority for advice but actually trying to find if there are other complaints there already against the doctor. Calls other employers who also engage in pseudo consultation with Clinical Assessment Authority	No hostile dependency on other public bodies to get the support to report to the regulator.
Personality type	Snakes in suits	Unremarkable, no delight in harming others