An 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.

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