Studies

1 in 3 U.S. Docs Wouldn't Report Impaired, Incompetent Colleague

TUESDAY, July 13 (HealthDay News) -- A large survey of American doctors has found that more than one-third would hesitate to turn in a colleague they thought was incompetent or compromised by substance abuse or mental health problems.

However, most physicians agreed in principle that those in charge should be told about "bad" physicians.

As it stands, said Catherine M. DesRoches, assistant professor at the Mongan Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School in Boston, "self-regulation is our best alternative, but these findings suggest that we really need to strengthen that. We don't have a good alternative system."

DesRoches is lead author of the study, which appears in the July 14 issue of the Journal of the American Medical Association.

The American Medical Association (AMA) and other professional medical organizations hold that "physicians have an ethical obligation to report" impaired colleagues. Several states also have mandatory reporting laws, according to background information in the article.

To assess how the current system of self-regulation is doing, these researchers surveyed almost 1,900 anesthesiologists, cardiologists, pediatricians, psychiatrists and family medicine, general surgery and internal medicine doctors.

Physicians were asked if, within the past three years, they had had "direct, personal knowledge of a physician who was impaired or incompetent to practice medicine" and if they had reported that colleague.

Of 17 percent of doctors who had direct knowledge of an incompetent colleague, only two-thirds actually reported the problem, the survey found.

This despite the fact that 64 percent of all respondents agreed that physicians should report impaired colleagues.

Almost 70 percent of physicians felt they were "prepared" to report such a problem, the study authors noted.

Minorities and physicians who had graduated from medical schools abroad were even less likely to comply with this professional/ethical commitment. Doctors working in hospitals and universities were the most likely to comply, compared to those at smaller centers.

"The most common reason [for not reporting] was that they thought someone else was taking care of the problem," DesRoches said.

Other reasons included believing that no action would result from the report, as well as fear of retribution, especially among small-town doctors and those in smaller practices.

The authors suggested bolstering confidentiality protections as well as introducing feedback mechanisms so physicians who reported on another doctor would know the outcome.

Although the study authors stated that "peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills, or attitudes are compromised," the author of an accompanying editorial pointed out that there are other checks in place and that the situation may not be so dire.

"The hope that doctors will turn each other in for poor quality care is just one of the ways that we track quality," said Dr. Matthew K. Wynia, director of the AMA's Institute for Ethics, who stressed that he wasn't defending the doctors who haven't reported impaired colleagues. "Professionalism doesn't work perfectly but this isn't the only way in which we track poor quality. We've got a lot of other things we're doing these days."

For instance, doctors have to take tests to demonstrate competency every 10 years and maintain their certification process, Wynia noted.

Decades ago, before such checks were in place, "this [study] would have been a lot more concerning," he said.

Nor should "we turn our backs on professionalism," Wynia said, given that there are other means of keeping track of how colleagues are performing, such as relying on patient reports.

"Medical care is very complicated and this shows there are weaknesses which in one respect are startling and disturbing, but in other respects show that doctors are human beings," Wynia said. "We should know that and we should build in redundancies to our systems for quality monitoring and that's what we're doing."

Wynia stated that he was not speaking on behalf of the AMA.

More information

For more on physicians' ethics, visit the American Medical Association.

SOURCES: Catherine M. DesRoches, Dr.P.H., assistant professor, Mongan Institute for Health Policy, Massachusetts General Hospital and Harvard Medical School, Boston; Matthew K. Wynia, M.D., director, Institute for Ethics, American Medical Association, Chicago; July 14, 2010, Journal of the American Medical Association