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Many physicians fail to report incompetent or incapacitated colleagues

The views expressed are those of the author and are not necessarily those of Scientific American.


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doctors not reporting a colleague who is impaired or incompetentAn intoxicated co-worker in many workplaces might be more of a nuisance than a threat. But an impaired or incompetent physician can present a real risk to patients. The American Medical Association (AMA) asserts that all doctors have an "ethical obligation to report" colleagues who are suspected of being unable to safely fulfill their duties, whether because of mental health issues, alcohol or drug abuse or a lack of necessary technical skills.

More than a third of U.S. doctors surveyed last year, however, did not agree that it was their duty to report a "significantly impaired or otherwise incompetent" physician, according to a new report, published online July 13 in JAMA, the Journal of the American Medical Association.

Sixty-nine percent of the 1,891 physicians who responded to the survey reported that they felt at least somewhat prepared to do the right thing when faced with an impaired or incompetent colleague.

Of the responding docs, 309 reported having known about an incompetent or impaired colleague, but about a full third of those did not inform the hospital, clinic or other organization about them.

Matthew Wynia, of the Institute for Ethics at the AMA, calls these statistics "jarring" in an editorial published in the same issue of JAMA. "This research is proof that individual physicians cannot always be relied on to report colleagues who threaten quality of care," he wrote.

He noted 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.

"Our findings cast serious doubt on the ability of medicine to self-regulate with regard to impaired or incompetent physicians," study leader Catherine DesRoches, of the Mongan Institute for Health Policy at Massachusetts General Hospital, said in a prepared statement.

The least likely to report a colleague who was incompetent or impaired were doctors working in small practices, with just 44 percent of those in single-person or two-person practices reporting a fellow physician.

"Our results imply that the current system of reporting is functionally inadequate," Eric Campbell, an associate professor of medicine and research director for the Mongan Institute, said in a prepared statement. The most frequent reason doctors gave for not reporting a colleague was that they thought someone else was already addressing the situation. But, noted Campbell, many doctors think that their reports will not make a difference or are afraid of retribution.

John Fromson, a co-author of the paper and associate director of postgraduate medical education at Massachusetts General Hospital Psychiatry, said in a prepared statement that the issue ultimately comes down to patient safety. "This study underscores the need for the medical profession to educate its members on their reporting obligations to ensure safe and competent care to patients," he said.

Image courtesy of iStockphoto/diego_cervo





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  1. 1. gcaputy 5:11 pm 07/13/2010

    I am a physician and one of the main reasons for not reporting a colleague is the fear of a lawsuit. When physicians have their livelihood taken away, they tend to get very aggressive in the pursuit of legal retribution against those who reported them. We had an inept resident in a training program who was reinstated 3 times due to legal pursuits by the individual and fear of wrongful termination suits by the training program and the hospital. Not only do wrongful termination suits but, also, restraint of trade suits make getting rid of an impaired or inept physician very difficult.

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  2. 2. bloomingdedalus 5:42 pm 07/13/2010

    Sigh… I would’ve made a great physician.

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  3. 3. billmd 6:25 pm 07/13/2010

    Unfortunately, even when you do report a gross medical error, nothing happens except, if you happen to be the whistleblower and work in the VA. Unfortunately, incompetence and coverups are highly valued skills there and forget it if you are ethical and moral- you will lose your job.

    Recently, an investigation by the VA Inspector General regarding the delay of cancer treatment and death for a patient at Zablocki VAMC in Milwuakee

    SEE : http://www4.va.gov/oig/54/reports/VAOIG-09-01348-49.pdf

    It appears that gross medical malpractice was performed by 2 radiologists, a radiation oncologist, a surgeon , and an internal medicine doctor, all of whom are faculty at Medical College of Wisconsin. You might say a comedy of medical errors,unfortunately, the patient died.

    It is likely that coverup was attempted and that is why theIG has to be called in to investigate this gross medical errors, Veterans sacrifice their lives at the war front and to get this type of care at home is immoral. Ethical docs are losing the war in the VA.

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  4. 4. albertsonrich 7:24 pm 07/13/2010

    Back in the ’60s, my torts professor in law school got one of the earliest malpractice judgments against a hospital. At that time he said the principal difficulty had been the code of silence amongst doctors. He said that the legal profession had begged the medical establishment to create a discinplinary system similar to the one lawyers use – it’s pretty effective and universally feared amongst lawyers.

    Well they refused and what we have today is the product of that bad judgment. Now we have to listen to the whining about malpractice judgments many of which would never have happened in an atmosphere of strict enforcement of the rules. Today, the informal method of coping with the possibility of malpractice suits for doctors is to overtest adding piles of unnecessary cost.

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  5. 5. goodmagx 8:01 pm 07/13/2010

    Apparently these findings are not "jarring" enough for the physician community to fulfill a larger view of "first, do no harm." Education is an inadequate response to changing the non-reporting behavior. Implementing significant consequences or changing the system of being the only self-regulating profession are more aligned with the seriousness of these findings.

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  6. 6. pspmd 8:38 pm 07/13/2010

    Precisely

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  7. 7. Jacoba 11:41 am 07/14/2010

    South Africa is as bad! Mine is a long story but in the end, I couldn’t sue him because not one single South African doctor would stand up in court and admit that he had made a mistake. Because of that, the insurance company wouldn’t pay out anything and I couldn’t afford the medical fees. In the end I lost my business, my husband and can’t afford an operation I desperately need that will, hopefully, allow me to walk.
    Ironically, I only wanted my medical bills paid …..

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  8. 8. ssm1959 12:29 pm 07/14/2010

    You had better do your home work!!! I can not tell you of the number of complaints that are filed by health practitioners that are simply ignored by the state boards. If complaints are not brought up for consideration they are not recorded as having been filed. So it might look on paper as if nothing is happening but that is far from a true representation. In fact in my state the board has a stated policy that it will not consider complaints from other physicians. While this may limit the use of the complaint system as a tool against colleagues it forces patients to be the only ones who can bring complaints. Lets face it folks, except in the most egregious cases, you as the patient, are very poor at determining whether you were treated correctly or to a standard of care. The professional organizations and boards are no better. All the regulatory bodies are so scared of being sued, a tactic which the bastard practitioners use to great effect, the disciplinary system is paralyzed. Often those bringing the complaints end up vilified and suffer for their actions. Under such conditions who will make the mistake of filing complaints a second time?

    To fix this, you the public, have to demand the system be revised. Nobody has A RIGHT to practice in the health care field; it is a privilege. One that should be able to be quickly suspended or revoked if needed.

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  9. 9. jbairddo 1:37 pm 07/14/2010

    Ahh, medical boards, worthless as the day is hot in Arizona in July. I reviewed a case where the doctor killed a teenager due to incompetence and he was instructed to take more education. I’d bet that up to a third of physicians are addicted to alcohol or drugs, not all of them though may be impaired at work, so the third that wouldn’t report them may be in the same boat. Reporting is usually anonymous but the investigators aren’t, so unless they have the balls to go forward. There is an immense investment of time and money going to medical school so from the board’s standpoint often it a case of "by the grace of god go I". It does take one strong board member to move the rest to do the right thing. Boards for year have never really policed their own and every year or two your local paper will do an article to that affect. On the other hand, it is easier to find doc’s who still have integrity and will testify against others (not the whores who do malpractice), but then they suffer from other doc’s who see them as traitors. Before the lawyers get too indignant about crappy docs, ask them why it so hard to find a lawyer to sue another one for incompetence. There was a severely impaired lawyer who was so bad he used to fall asleep during consults, yet he is still in practice, lose your license in one state, pass the bar in another, you are still good to go. Given that over 200,000 people die each year from medical related issues(that comes from JAMA), it would be interesting to see how many of those deaths could actually be attributed to impaired docs. I am not sure though as SSM1959 said it is the job of the public to demand that we docs clean up our house, we need to demand accountability. How many docs actually stand up and ask to serve on medical boards? Easy say whatever you want, harder to actually gather the stones and throw them yourselves.

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  10. 10. jimhenson 6:54 pm 07/14/2010

    The immorally impaired doctors are the ones who want to tell someone who was injured by a third party that they are fine not impaired but are healthy or got hurt in another way etc 90 percent of workman comp doctors do evil and violate the vows of first doing no harm. Many have contracts and are called contract killer physicians who the employer will send their workers to. owcp insurance will pay a contract to get their opinions for doctors to lie about medical evidence, trying to prevent disabled people under retirement age from getting their social security. The fact is without a workman comp system, the medical society including physicians hospitals would be entirely corrupt! Workman comp existed to pay medical bills long before the public even had health care or insurance. We need more doctors willing to file claims and help the poor worker who was not at fault for injury on job, to keep their job and still do the same work for the same pay without discrimination and not to burden society with bills or social security.

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  11. 11. jgrosay 6:46 am 07/15/2010

    In one of the big Madrid Social Security hospitals (La Paz), 50 MDs are blamed of schizophrenia, and the management doesn’t know how to handle the issue. However this incidence doubles the one found in common population (3%). So an schizophrenogenic environmental or a selection bias can be suspected

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  12. 12. yaoforever 9:18 am 07/15/2010

    I agree with you

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  13. 13. Unksoldr 2:24 pm 07/15/2010

    Someone knows of a competent doctor???? I’ve been looking for one all my life. Most I see are worried about my wallet and not my health. Then, you have the ones are who are just to busy to keep up with the latest developments or the ones that will lie to you if they think they can get away with it. If society/civilization breaks down to the point of anarchy. I’ll be sure to catch one and chain him to a tree, the rest I’ll shoot in head.

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  14. 14. Steve Skeete 1:58 pm 07/18/2010

    Why am I not surprised to hear this. Most of the "professions" have some kind of immunity from either detection or punishment. If this article had been about lawyers, bankers, contractors etc. it would probably have read the same. It is sad but a fact of life that some groups of individuals are "more equal" than others.

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  15. 15. sparcboy 1:49 pm 08/3/2010

    One of my rules of life: Never trust anyone who doesn’t have as much to lose as you do.

    This article adds significance to that rule.

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