Drs won't Snitch Allowing Incompetent Care

In a recent episode of Grey’s Anatomy, McDreamy ‘spills the beans’ to the hospital board regarding the hospital Chief’s alcohol abuse and subsequent irresponsible decisions which have put patients at risk.  In TV land, McDreamy is appointed as the new hospital Chief with all the glitz and glamour of the title.

Fiction doesn’t seem to be truth however in real life however, as a recent study published today in the Journal of the American Medical Association (JAMA) reveals.

Researcher Catherine M. DesRoches, DrPH, Assistant Professor of Medicine at the Mongan Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School, Boston, said she “expected the number of doctors who said they reported incidence of impaired or incompetent physicians to be higher.”
 Overall, physicians support the idea of a professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority, however when faced with these situations, many do not report.

Due to the daily proximity and first-hand knowledge of physicians working in the same office, clinics and/or hospitals, peer monitoring and reporting are the primary mechanisms for identifying physicians who are impaired or otherwise incompetent to practice.  The data reveals that the rate of such reporting is lower than it should be.

In an effort to understand physicians' beliefs, preparedness, and actual experiences related to colleagues who are impaired or incompetent to practice medicine, a nationally representative survey was sent to 2938 eligible physicians practicing in the United States in 2009. Physicians were contacted in the areas of anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry.  A cross-section of 1891 physicians responded to the survey.

Results of the study reveal that 64% of the physicians agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice, but only 69% reported prepared to deal with incompetent colleagues.  While 309 physicians had direct personal knowledge of a physician colleague who was incompetent to practice hospital in their group or practice, only 204 reported them to the relevant authority.

The most frequently cited reason for taking no action was:

1.    The belief that someone else was taking care of the problem, commonly known as ‘passing the buck’.
2.    Belief that nothing would happen to the accused physician, begging the question ‘what about their patients?’
3.    Fear of retribution.

Physicians working in hospitals or medical schools were the most likely to report, while underrepresented minorities and graduates of non-US medical schools were less likely to report.

While many states have mandatory reporting statutes requiring physicians and other health care professionals to report impaired and/or incompetent practicing physicians to appropriate authorities, it doesn’t seem to make a big difference. 

Demanding better protections for whistleblowers and more education for doctors on how to report a colleague, Dr. Matthew Wynia, director of the AMA Institute for Ethics said, "I don't think there's any excuse for less than 100 percent of physicians holding true to these ideals."

 The Federation of State Physician Health Programs, Inc. (FSPHP), “is a nonprofit corporation whose purpose is to provide a forum for education and exchange of information among state programs, to develop common objectives and goals, to develop standards, to enhance awareness of issues related to physician health and impairment, to provide advocacy for physicians and their health issues at local, state, and national levels, and to assist state programs in their quest to protect the public.”

Among the goals of FSPHP are *promoting the best medical care possible for all patients; *national recognition as a supporter of state physician health programs; and *early identification, treatment, documentation and monitoring of ongoing recovery of physicians prior to impairment/incompetence.

Before entrusting your care, or the care of a loved one to a doctor who is responsible for making decisions relevant to life and death, check them out.  Ask co-workers, friends, teachers; sometimes they offer the most trusted information.    Background information is abundant on the internet regarding education, hospital affiliation, and sanctions for physicians. 

If you have any suspicions that your doctor could be under the influence of drugs or alcohol or is incompetent in any way, don’t hesitate to “take your chart and walk!”

Laura Lamp King