We applaud Medscape for broaching the tough subject of sham peer reviews and the legal analysis of their effects.

The issue needs more attention, as the peer review process sets the tone, determines behavior and ultimately reflects on quality of care in our medical institutions. As the article puts it, financial competitors and administration can "act as judge, jury, and executioner" and can in a stroke of a pen ruin practitioners' reputations.

The most troubling fact is that the process lacks transparency, happens outside the public scrutiny and results in black-or-white determination, that stays on a record forever. You are either a criminal or everything is perfect. A few well-connected individuals can easily manipulate the outcome that is next-to-impossible to appeal.

What is the root cause problem and what process is needed to fairly serve both the public and the doctors?

Without going too far to knock the current system, we would like to repeat that the current process, much like the peer review of publications, traces its roots to 19th century. Perhaps it was good enough back then, but as Medscape article describes it is being overtaken with corruption, while the latest technology can offer better alternatives, as we discussed before.

The stated beneficiary of the professional evaluations is the consumer, who needs to know which professionals can be trusted. A black-or-white grading system is woefully inadequate and unhelpful. Failing grade often is given for the wrong reasons. Passing is not a useful measure of quality by any means. Above all, only a "chosen few" can get their judgement count. What about asking the patients of what they think?

We need a genuine reform, which must be more than just relaxing liability safe harbors, as Medscape article suggests. Pass/fail reviews rendered in fear of litigation will be no more helpful to the ultimate cause. What needs to happen is a continuous 360-degree feedback system that accrues over professional's career, is a matter of public record and includes reviews by both peers and patients. Greater number of reviewers, providing more details, will decrease both the impact and legal liability of every particular reviewer. Continous record will give providers real-time feedback to improve and will direct patients to their real champions.

Our doctors deserve better than to be painted in black and white and risk destruction by accident. The public deserves to know more about their providers to make informed choices. The technology can make the change happen.