Many doctors don’t feel obliged to report incompetence

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© Dennis Degnan/Corbis

More than one in three American physicians say that they do not always feel a responsibility to report colleagues who are impaired or incompetent, according to a new report from researchers at the Mongan Institute for Health Policy at Massachusetts General Hospital. The findings, published in the July 14 issue of the Journal of the American Medical Association, are based on the survey responses of 1,900 physicians throughout the U.S. specializing in internal medicine, pediatrics, cardiology, general surgery, family medicine, psychiatry and anesthesia. Of those who responded, only 64% said that it was their professional obligation to report any colleagues who were significantly impaired — due to substance abuse or mental illness — or incompetent.

The findings suggest that self-regulation in the medical profession may not be enough to ensure that ill-equipped physicians aren’t potentially harming patients, the researchers say. For example, of the doctors who responded to the poll, 17% said they knew of physicians who were practicing despite impairment or incompetence in the previous three years, yet of those who witnessed sub-par performance, only two thirds said they had taken steps to report it.

The reasons that doctors gave for staying quiet included the belief that someone else would report on failing physicians, lack of confidence that anything would result of a report, and fear that they would suffer some form of retribution once the offending doctor found out. Those fears, the authors say, undermine efforts to provide the best possible care for patients. As they conclude in the report:

“These findings further suggest that a large number of practicing physicians do not support the current process of self-regulation: it is underused and appears to have several major shortcomings, including a perceived lack of anonymity and efficacy. All health care professionals, from administrative leaders to those providing clinical care, must understand the urgency of preventing impaired or incompetent colleagues from injuring patients and the need to help these physicians confront and resolve their problems. The system of reporting must facilitate, rather than impede, this process.”