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The Doctor You Never See Is the One Who Can Kill You

This story from Arkansas is disturbing, very disturbing. In healthcare, there are doctors the patient typically never sees – and, in fact, may have no idea who they are. There are other examples, but mostly what we are talking about are pathologists, the doctors who examine microscopically tissue taken from the body, and radiologists, the doctors who examine images from x-rays, CT’s, MRI’s and other devices. Indeed, these unseen physicians are often the most important players. The information they provide to the hands-on doctors, the clinicians, usually drives the treatment decisions.



In some ways, pathologists and radiologists have the toughest jobs in medicine. One pathology expert once told me that pathology was all “form and color” and the closest study to it was serious art history. Radiologists have a job that can best be likened to “finding Waldo” dozens of times every day. An impaired pathologist is a dangerous character indeed. That seems to be what was going on at the Fayetteville, Arkansas VA. This pathologist was terminated due to impairment. He has already been linked to over 1100 errors and three deaths. My guess is that that number grossly understates the problem. Over 20,000 of his reports may be at issue.


Impaired doctors can be found in any institution. One cannot necessarily fault the VA for one of its doctors being an alcoholic or drug addict. However, this VA hospital likely can be faulted – and probably should be faulted – for not figuring out sooner that they had a doctor who had a big problem. A problem that put veterans at risk. The VA frequently has a problem fixing its problems in a timely and effective way. This sad case is just another example.