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Don't ask, don't tell

A third of physicians in a study don't feel obliged to report impaired docs


By Melanie Evans
Posted: July 19, 2010 - 12:01 am ET
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One out of three doctors do not agree they must report all colleagues who perform poorly or are impaired by alcohol, drugs or mental illness, and nearly as many do not do so, according to a study released last week in the Journal of the American Medical Association.

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The results, from a survey of 1,891 doctors' opinions and experiences with incompetent or impaired physicians, also found many were unprepared to deal with such colleagues. The findings underscore a need for greater physician education and more support from hospitals or medical societies for doctors to step forward, said experts in ethics and addiction.

Of those surveyed, 64% said they completely agree doctors should report all instances of impaired or incompetent doctors, which the AMA's code of ethics includes as an obligation, and almost as many said they were prepared to deal with such situations.

“If you're a patient, you want 100%,” said Catherine DesRoches, one of seven Massachusetts General Hospital researchers who conducted the study and who is an assistant professor at the 907-bed hospital's Mongan Institute for Health Policy. “This is one of the primary ways that patients are protected” she said. It's also one of the chief ways doctors who need help receive it, she added.

Results may also overstate doctors' willingness to report an impaired colleague because of an impulse to give surveyors the most socially acceptable answer, a bias widely acknowledged in polling that skews results, DesRoches said.

The AMA defended the profession's efforts to self-regulate errant doctors in response to the survey. “This study shows that the vast majority of physicians are doing the right thing when it comes to reporting impaired or incompetent colleagues,” Edward Langston, a board member for the Chicago-based professional association, said in a written statement.

The AMA declined an interview request for this story.

Langston said that 5% of all doctors surveyed knew of an impaired or incompetent doctor but failed to alert proper authorities.

But that includes more than 80% of those surveyed who had no encounter with troubled doctors. Of those who did, one in three surveyed did not notify hospital, clinic or medical society officials or other authorities, the JAMA article authors noted.

Langston also said in his statement that those who took no action most often said the reason was they believed others had done so. More could be done to educate doctors and improve reporting, but he added that oversight does not fall entirely to physicians, and pointed to regulators, quality measures, patient-safety organizations, credentialing and doctors' continuing medical education.

Seventeen percent of those surveyed said they had direct knowledge of a troubled colleague within the prior three years. Those who said nothing to authorities about impaired or incompetent colleagues most often did so because they thought someone else had intervened (19%) or that it would make no difference (15%).

Doctors shouldn't assume someone else has intervened, DesRoches said. “It's entirely possible that no one is taking care of the problem,” she said. “It needs to become everyone's responsibility.”

Others feared retribution (12%), said they did not believe it was their responsibility (10%) or said they believed doctors would be excessively punished (9%).

Reasons for not reporting highlight the need for hospitals or clinics to promote cultures that support self-regulation, according to Laurence McCullough, the Baylor College of Medicine Dalton Tomlin chair of medical ethics and health. McCullough said he was encouraged by results that show doctors in practice for fewer than 10 years were more likely to agree doctors have an obligation to report troubled colleagues, which he said only emerged as a standard in recent decades. “Younger doctors get it,” he said.

Robert DuPont, a president of the Institute for Behavioral Health, a Rockville, Md.-based drug prevention not-for-profit, called the percentage of doctors surveyed who balked at reporting colleagues worrisome.

DuPont said doctors need more education on programs that evaluate and manage treatment and monitoring for impaired doctors. To allow those abusing alcohol and drugs to continue puts physicians as well as patients at risk. “It's not like the common cold,” he said. “It doesn't go away. It just gets worse.”

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