Better Physician Credentialing Needed.

New ORLEANS -- Recent cases in which physicians intentionally killed their patients without detection have resulted in the need for a more strict, thorough process of credentialing and privileging, said Dr. John W. Thompson Jr. of Tulane University.

Referring to the cases of Dr. Harold F. Shipman in the United Kingdom and Dr. Michael Swango in the United States, both of whom were convicted of poisoning several of their patients, Dr. Thompson said the physician community needs to take steps to prevent future occurrences and to restore patient confidence. "We have to assure the public that we're doing something ...that we're at least picking up on the most [critical] cases," he commented at a forensic psychiatry meeting sponsored by the university.

Credentialing and privileging is of concern to many physicians across medicine, who are eager to see improvement in these processes, Dr. Thompson said in an interview with this newspaper.

Credentialing--or documenting an applicant's career--is important because it may reveal past patterns of inappropriate behavior. In several cases of physicians turning bad, there were frequent examples of inappropriate behavior that had either been ignored or dismissed but that should have been more easily recognized by the physicians' colleagues, he said.

Credentialing should include a lifetime licensure history, lifetime medical education and training history, 10-year malpractice history specialty board status--including failure, sanctions, and signed professional references, Dr. Thompson suggested. Hospitals should consider each applicant's past 12 months of clinical activity including the number of patients, type of patients, and types of procedures performed.

Screening also should include verifying unusual letters of recommendation, talking to coworkers and supervisors, looking for frequent moves or gaps in employment, and paying more attention to risk factors for violence, he said.

Dr. Swango, who was convicted in the deaths of four patients but is suspected of killing as many as 60, escaped detection by moving from job to job. He was often hired by facilities that failed to do a thorough background check and ...