Doctors fail to report impaired/incompetent colleagues

From The Boston Globe, December 4, 2007:

Nearly half of doctors surveyed say they have failed to report an impaired or incompetent colleague or a serious medical error, and more than one-third say they would order an unneeded MRI scan for an insistent patient - though these actions conflict with what the physicians consider the heart of their professional obligations. The survey results, to be published in today's Annals of Internal Medicine, are part of the first comprehensive study of whether physicians believe in the values of their profession - and whether they adhere to them in practice...

Physicians' actions were most consistent with the physicians' near unanimous belief that doctors should be honest with patients and inform them about all significant errors: Less than 1 percent surveyed said they had lied to a patient's family and just 3 percent reported withholding important information in the past three years. But researchers and physicians who reviewed the results said they were surprised that in other areas, the behavior did not reflect standards the doctors endorsed.

"Given all of the work that has been put into patient safety, the fact that half of doctors don't report impaired colleagues, I find absolutely astonishing," said Eric Campbell, of the Massachusetts General Hospital Institute for Health Policy and the lead author of the study. "I was struck by the idea that virtually all physicians believe doctors shouldn't waste scarce resources," Campbell added. Yet 36 percent of doctors surveyed said they would order an MRI for a patient with low back pain who demanded the test, even if a doctor believed the test was useless...

Dr. David Blumenthal, director of the health policy institute and an author of the study, said he did not expect doctors to always live up to their beliefs. But he was surprised that 25 percent said they would refer patients to an imaging facility in which the doctor had a financial interest, because doing so is usually illegal...

The survey, conducted November 2003 through June 2004, was intended to measure whether physicians believe and behave in accordance with this new physician charter.

The authors mailed the survey to 3,504 US internists, family practitioners, pediatricians, surgeons, cardiologists and anesthesiologists, and 1,662 responded. The doctors were asked whether they agreed with 12 specific statements about fair distribution of limited resources, improving access to and quality of care, managing conflicts of interest, and self-policing by doctors.

More than 90 percent agreed with eight of the 12 statements, including that physicians should minimize inequalities in care, put the patient's welfare above the doctor's financial interests, and report all instances of significantly impaired or incompetent colleagues to hospital, clinic, or other authorities. Agreement fell below 80 percent for only one statement: "Physicians should undergo recertification examinations periodically throughout their career..."

Dr. David Bates, chief of general internal medicine at Brigham and Women's Hospital, said he was really surprised that 45 percent of doctors said that in the last three years they had direct personal knowledge of impaired or incompetent colleagues but that they did not always report them to a hospital, clinic, professional society, or other relevant authority...

Blumenthal said the Mass. General group is developing follow-up studies to determine the obstacles that keep doctors from consistently following professional tenets. One clue in the current research is that doctors in solo or small practices are less likely to report problems than those at universities or large HMOs.

- Liz Kowalczyk / The Boston Globe / December 4, 2007