I strongly suspect that most quality problems and most errors are the result of system or structural problems and require system re-configuration and process change to reduce and avoid. And I recognize that sometimes, even when a system is well structured, running smoothly and there are no errors, fate intervenes and the result is unfortunate. That's simply the laws of probability at work.
But sometimes, I'm not so sure that any of the above applies to a particular case or a particular practitioner. Let's face it. Sometimes, people know their stuff, but just can't apply it consistently correctly in the real world, especially under stress. This was the case when I read recently a news account of a physician whose license was suspended for "incompetence and negligence" by New York's Office of Professional Medical Conduct, initially for three years. The suspension was then reduced to three months with the proviso that he complete 125 hours of CME. This particular physician had failed to diagnose an ectopic pregnancy, had wrongly prescribed a drug for a patient "potentially deadly" in combination with another drug another the patient was taking, and had made other errors with other patients.
When I read about this case I thought back to a co-pilot I flew with on just one mission to Europe and the Middle East when I was in the Air Force. This particular co-pilot (we'll call him "Ted") was very experienced. He had lots of flight hours and was technically ready to upgrade to Aircraft Commander. He was quite smart, had graduated from a prestigious technical university, and knew the technical details of the plane we flew. But, sometimes, Ted just didn't seem to be fully present. First, when it was his turn to fly, he seemed sloppy and "disengaged." Then while I was flying into a short field in terrible weather, Ted failed to perform one of the most elemental checks he was responsible for during landing. And when I challenged him on it, he didn't seem to be particularly bothered. I finally lost it when we were just short of departing Turkey for the Middle East, an area politically sensitive even then. Despite the fact that I had reminded the entire crew at least three times, Ted didn't have the proper personal paperwork, and again didn't seem to be particularly concerned about it. Then he told me that he'd known that he didn't have it when we left the US and hadn't bothered to tell me even when I'd raised the issue.
Fortunately, I had a second co-pilot. So I left Ted in Turkey, telling him to find his own way back home and the rest of us continued with our mission. Yes, I threw him off the crew. I later learned that some of the crew celebrated because they already thought Ted was unsafe.
On the way home, I re-read, start-to-finish, Ted's complete flying record. The eight hours over the Atlantic gave me the opportunity to see the patterns that neither I nor anyone else had seen before. Before, it was just isolated incidents. Afterwards, we could see the pattern. Ted was incompetent. He wasn't a bad guy. His book learning was above average. But he just couldn't put it together in the real world in a consistent and safe manner. And no amount of re-training was going to solve the problem. I was greeted by the Squadron Commander and the head of Standarization and Evaluation (quality control) when I returned to the US. Needless to say, they wanted to know why I had tossed a crewmember off my crew. My response was to ask them to read Ted's flying record as I had. The next day, the head of Standardization called to tell me that, having read the record, they didn't need any more information from me. Ted never did become an Aircraft Commander.
This brings me back to where I started. Just as in all fields, some doctors are incompetent. I believe their percentages are much lower than in other fields, but I have no doubt that they're out there. And the solution isn't to suspend their licenses for three months because while they may know more at the end of that time, their ability to apply it will not have improved. A three month suspension strikes me as a political solution, but ultimately inadequate. Ted should never have become responsible for the lives of others. The same is true of some physicians. It's painful; it's unfortunate, even sad. But sometimes, it's just necessary.