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