Study: Nearly a Third of Doctors Wouldn't Report an Impaired or Inept Colleague

July 16, 2010
Todd Kunkler

One in three physicians who know a colleague is impaired or incompetent would not report that person to the proper authorities, a new survey reports. Doctors, has this ever happened to you?

This article was first published on HCPLive.com.

Results from a study on physicians’ perceptions and behavior regarding their responsibility to report impaired or incompetent colleagues reveal that one in three physicians who know a colleague is impaired or incompetent would not report him or her to the proper authorities.

The authors of the study, “Physicians' Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues,” published in the July 14 issue of The Journal of the American Medical Association, concluded that although “physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority,” when faced with these situations, many do not report the behavior to the proper authorities.

Seventeen percent of the 1,891 physicians surveyed “had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice.” Two-thirds (67%) of these physicians reported this colleague “to the relevant authority,” meaning that nearly a full third of practicing physicians surveyed opted to ignore their colleagues’ dangerous behaviors. For the study, researchers distributed surveys to physicians practicing in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry.

The study also found that “underrepresented minorities and graduates of non-U.S. medical schools were less likely than their counterparts to report” dangerous behaviors, with physicians who work in hospitals or medical schools most likely to report an impaired or incompetent colleague. Reasons given for failure to report included the belief that “someone else was taking care of the problem” (19%), the belief that “nothing would happen as a result of the report” (15%), and “fear of retribution” (12%).

Sixty-four percent of surveyed physicians agreed that physicians always have a “professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice. Nearly 70% of physicians said that they felt “prepared to effectively deal with impaired colleagues in their medical practice;” 64% stated that they were “prepared to deal with incompetent colleagues.”

In a press release from Massachusetts General Hospital (MGH), lead study author Catherine DesRoches, DrPh, Mongan Institute for Health Policy at MGH, said: “Our findings cast serious doubt on the ability of medicine to self-regulate with regard to impaired or incompetent physicians.” DesRoches also said that because physicians themselves “are the primary mechanism for detecting such colleagues, understanding their beliefs and experiences surrounding this issue is essential. This is clearly an area where the profession of medicine needs to be concerned.”

Co-author John A. Fromson, MD, associate director of Postgraduate Medical Education, MGH Psychiatry, said that the study “underscores the need for the medical profession to educate its members on their reporting obligations to ensure safe and competent care to patients.” According to Fromson, those obligations include “referring colleagues to physician health programs that can guide and monitor their recovery from substance use and mental disorders.’

In the same press release, senior author of the study Eric G. Campbell, PhD, research director for the Mongan Institute, said that the study results “imply that the current system of reporting is functionally inadequate.” Campbell stated that “many physicians are afraid to access [the reporting system] or believe that reporting will not be effective.” This clearly outlines the need for improvements to be made to the current system, including “helping physicians understand their professional responsibility to report impaired and incompetent colleagues, enhancing protections for reporting physicians and providing confidential feedback about outcomes,” said Campbell.

Matthew Wynia, of the Institute for Ethics at the AMA, in an editorial that appears in the same issue of JAMA, wrote that “this research is proof that individual physicians cannot always be relied on to report colleagues who threaten quality of care.” A post on the Scientific American blog notes that Wynia’s editorial also points out that “although professional organizations and hospitals have a variety of systems to help detect potentially dangerous doctors -- such as continued certification and performance monitoring programs -- co-workers are generally considered the first line of defense.”

HCPLive wants to know:Have you had direct, personal knowledge of a physician who was impaired or incompetent to practice medicine? If so, did you report him/her to hospital/practice administrators, the state medical board, or another authority?

If you opted to not report your colleague to the authorities, what were your reasons for doing so? Is there an unwritten “code of silence” among physicians?

Should state medical boards, professional medical societies, and other institutions be doing more to educate physicians about their ethical responsibilities in these situations? Should the procedures for reporting colleagues’ dangerous behaviors be changed?