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   Many physicians do not accept responsibility to report incompetent, impaired   
   colleagues   
   Date:   
   July 14, 2010   
   Source:   
   Massachusetts General Hospital   
   Summary:   
   More than one-third of US 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 survey also   
   found that    
   substantial numbers of physicians feel unprepared to report or otherwise deal   
   with impaired or incompetent colleagues.   
      
      
   FULL STORY   
   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."   
      
   Many states and professional organizations -- including the American Medical   
   Association -- require physicians and other health professionals to report   
   colleagues whose ability to practice medicine is impaired. In spite of   
   increased attention to and    
   concern about medical errors in professional circles and in the media, studies   
   have shown that fewer impaired physicians are being reported than would be   
   expected. The current study was designed to examine physicians' beliefs about   
   the obligation to    
   report, their preparedness to report, and their experiences with and actions   
   taken when confronted with impaired or incompetent colleagues.   
      
   A larger survey of medical professionalism taken in 2009 included a group of   
   questions focused on beliefs and behaviors regarding impaired or incompetent   
   colleagues. The survey was sent to 3,500 physicians -- 500 each in internal   
   medicine, family    
   practice, pediatrics, cardiology, general surgery, psychiatry and anesthesia.   
   Participants were asked to rate their agreement that "physicians should report   
   all instances of significantly impaired or incompetent colleagues." They also   
   were asked how    
   prepared they felt to deal with such a colleague and whether they had direct   
   knowledge of an impaired or incompetent colleague in the past three years.   
   Those with such knowledge were asked whether they had reported the most recent   
   incident and also if,    
   within that three-year period, particular reasons were associated with a   
   failure to report.   
      
   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.   
    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.   
      
   "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," says John A. Fromson, MD, associate director of Postgraduate   
   Medical Education, MGH    
   Psychiatry, and a co-author of the report. "Those obligations include   
   referring colleagues to physician health programs that can guide and monitor   
   their recovery from substance use and mental disorders."   
      
   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.   
      
   "Our results imply that the current system of reporting is functionally   
   inadequate; many physicians are afraid to access it or believe that reporting   
   will not be effective," says Eric G. Campbell, PhD, research director for the   
   Mongan Institute and    
   senior author of the JAMA report. "Improvements to the system need to include   
   helping physicians understand their professional responsibility to report   
   impaired and incompetent colleagues, enhancing protections for reporting   
   physicians and providing    
   confidential feedback about outcomes." Campbell is an associate professor of   
   Medicine, DesRoches an assistant professor, and Fromson an assistant clinical   
   professor at Harvard Medical School.   
      
   Additional co-authors of the study -- supported by a grant from the Institute   
   on Medicine as a Profession -- are Sowmya Rao, PhD, Lisa Iezzoni, MD, MSc, and   
   Christine Vogeli, PhD, Mongan Institute for Health Policy at MGH; and Robert   
   J. Birnbaum, MD, PhD,   
    MGH Psychiatry.   
      
      
   Story Source:   
      
   The above post is reprinted from materials provided by Massachusetts General   
   Hospital. Note: Materials may be edited for content and length.   
      
   Journal References:   
      
   Catherine M. DesRoches; Sowmya R. Rao; John A. Fromson; Robert J. Birnbaum;   
   Lisa Iezzoni; Christine Vogeli; Eric G. Campbell. Physicians' Perceptions,   
   Preparedness for Reporting, and Experiences Related to Impaired and   
   Incompetent Colleagues. JAMA, 2010;    
   304 (2): 187-193 [link]   
   Matthew K. Wynia. The Role of Professionalism and Self-regulation in Detecting   
   Impaired or Incompetent Physicians. JAMA, 2010; 304 (2): 210-212 [link]   
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