July 13, 2010
Some MDs Shirk From Reporting Incompetents

This news is not good for your health.

More than one-third of U.S. physicians responding to a survey did not agree that physicians should always report colleagues who are incompetent or impaired by conditions such as substance abuse or mental health disorders. The report from the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH), published in the July 14 Journal of the American Medical Association, also finds that substantial numbers of physicians feel unprepared to report or otherwise deal with impaired or incompetent colleagues.

"Our findings cast serious doubt on the ability of medicine to self-regulate with regard to impaired or incompetent physicians," says Catherine DesRoches, DrPh, of the Mongan Institute, who led the study. "Since 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."

The medical profession would prefer less outside judgment (e.g. fewer malpractice suits, less second-guessing by insurance companies) on the basis that only professionals are competent to judge other professionals. That sounds great if the professionals really step up to the plate to do that judging and do so objectively.

Pediatricians are least up to their responsibility. Which leads me to wonder: what's the split on male versus female reporting of incompetence?

Almost 1,900 surveys were returned, and only 64 percent of the respondents agreed that physicians should always report impaired or incompetent colleagues. About 70 percent of respondents indicated feeling prepared to deal with an impaired colleague, and 64 percent felt prepared to deal with an incompetent colleague in their practice. Pediatricians were the least likely to report feeling prepared to deal with impaired or incompetent colleagues, while psychiatrists and anesthesiologists felt most prepared.

In a given year about 6% of American physicians fail to report an impaired or incompetent physician.

Direct, personal knowledge of an impaired or incompetent physician during the past three years was indicated by 17 percent of respondents, but only 67 percent of those with such knowledge actually had reported the colleague.

One wonders how many people suffer or die as a result. One also wonders how much money is wasted as a result.

People who favor immigration restriction and an end to racial preferences will find support for their positions in this report.

The most frequently cited reason for not reporting was the expectation that someone else would report, indicated by 19 percent, followed by the belief that nothing would happen because of the report, cited by 15 percent, and a fear of retribution, 12 percent. Among factors associated with not reporting were belonging to one- or two-person practices and being a member of an underrepresented minority or a graduate of a foreign medical school. Whether respondents came from a state with high, medium or low rate of malpractice claims was not associated with failure to report.

Leave it to someone else, nothing would happen because the rest of the medical profession will ignore the report, and, hey, don't want doctors ganging up on you. This reminds me of the police with their thin blue line. As a practical matter I think police have such dangerous jobs dealing with such dangerous people that they need a considerable amount of solidarity against the world. Doctors have much higher status and cushier working conditions. They should step it up on enforcing performance standards on each other.

Share |      Randall Parker, 2010 July 13 11:09 PM  Policy Medical

grumbles said at July 14, 2010 9:45 AM:

I disagree with you regarding the thin blue line; if nothing else, you have to approach doctors for them to be able to kill you, and even without cohort reporting, word of incompetence gets around, if imperfectly. But we'll probably disagree there.

I wonder if bounties could work in this situation? Higher income may well make it more difficult than it would be with cops to cross the 'stop snitchin' line, but depending on how much damage a drunk doctor does, it might work.

Engineer-Poet said at July 14, 2010 6:19 PM:

If you pay bounties for things like that, you will get two phenomena:  doctors who refuse to report because they can be accused of doing it for the money, and the likes of Andrew Wakefield.

Nick G said at July 17, 2010 7:04 PM:

This study doesn't tell us that 1/3 of physicians are unwilling to report - it tell us that 2/3 oh physicians are willing to lie to interviewers.

There's an enormous amount of reportable behavior by physicians: malpractice, fraud, substance abuse of various kinds, incompetence, etc, etc. Virtually none of it is reported.

If you want to know what really goes on, talk to nurses, not doctors.

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