Doctors often don't report impaired colleagues

NEW YORK (Reuters Health) - One out of three doctors didn't report colleagues they believed were "impaired or incompetent" to authorities, a survey released today found. Slightly more -- 36 percent -- didn't completely agree that it was their responsibility to report these colleagues in every case.

The definition of impaired or incompetent can range from doctors with drug addictions to those that aren't up-to-date on the best way of treating some conditions.

The American Medical Association (AMA) has a policy stating that doctors are ethically bound to report colleagues they believe are unfit to practice.

"I think there's no excuse for less than 100 percent of physicians holding true to our professional ideals," Dr. Matthew Wynia, director of the AMA's Institute for Ethics, told Reuters Health. "Reporting an impaired or incompetent colleague is very clear cut. It's a professional obligation."

But, he said, "The reality is that we know doctors are human beings, and some number of us won't live up to our ethical ideals," Wynia wrote an editorial accompanying the study published in JAMA -- Journal of the American Medical Association.

Doctors from Massachusetts General Hospital in Boston, led by Dr. Catherine DesRoches, a scientist at the hospital's Morgan Institute for Health Policy, mailed out nearly 3,000 surveys that asked doctors about their responsibility in cases when a colleague was impaired or incompetent at work. Nearly 2,000 were returned and analyzed.

Seventeen percent of doctors said they had known of a colleague who was impaired or incompetent in the last three years, but one-third of those did nothing about it.

The most common reason for not reporting a colleague was that the doctor thought someone else was addressing the problem, but doctors also worried that either nothing would happen or the colleague would be punished too strictly if they reported their concerns.

Doctors in solo and two-person practices were the least likely to have reported a colleague - only 44 percent of those who knew a colleague was impaired or incompetent told authorities.

"Papers like this are very important," Dr. Virginia Hood, the president-elect of the American College of Physicians and the former chair of the ACP Ethics, Professionalism, and Human Rights Committee told Reuters Health. "They remind us that we're not doing as well as we should."

The process required for doctors to report a colleague varies based on where they work. While many hospitals and large clinics have systems in place for doctors to raise concerns, in smaller practices doctors might have to go to outside authorities.

DesRoches said that many doctors, especially those in smaller practices, might not know how the reporting process works. "One of the first things that could be done is just greater education ... about where to go and who to call," she told Reuters Health. Doctors always have the option to go to their state medical board, she said.

But, "If you feel like the only thing you can do is turn someone in to the state board, that's pretty extreme," Wynia said.

Hood, who was not involved with the current survey, said that there may be a lot of gray area -- situations when doctors sense that something might be wrong, but aren't sure enough to report a colleague. She wants doctors in this position to be encouraged to voice their concerns.

Hospitals, professional groups and outside regulators should "make it possible for (doctors) to say, 'Look, I'm not actually sure, but I'm concerned,'" she said. And the focus shouldn't be on punishing doctors who are the subject of concern, but on getting them the help they need to do their job better, she said.

But what is most important, Wynia and Hood agreed, is making sure that patients aren't put in danger by impaired or incompetent doctors - and ethics codes make this every doctor's responsibility.

"We want to do the right thing by patients and if a physician may not be able to do that ... we don't want patients put at risk," Hood said.

SOURCE: link.reuters.com/wux37m Journal of the American Medical Association, July 14, 2010.