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Survey Shows One-Third Don't Blow Whistle on Peers Who Are Impaired or Incompetent
By Kathleen Doheny
WebMD Health News
Reviewed By Laura J. Martin, MD
"I was expecting the number who said they reported to be higher," says 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.
She and her colleagues evaluated responses from 1,891 doctors in a variety of specialties. "We had 17% of physicians who had direct knowledge of a colleague in their practice or hospital whom they believed was impaired or incompetent. About two-thirds of those did report that physician, but we still had about a third that did not report."
More than one-third did not completely agree that doctors should report all instances of impaired or incompetent physicians, they also found.
While some may argue that the majority do turn in incompetent or impaired doctors, DesRoches says the percent must be higher. "If you are the patient, you would want all the impaired or incompetent physicians to be reported."
The study results are in The Journal of the American Medical Association.
Impaired Physicians Survey: A Closer Look
DesRoches and her colleagues sent surveys to 2,938 doctors practicing in the U.S. in 2009 in a variety of areas: anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry.
In all, nearly 65%, or 1,891 doctors, responded.
Updating a 2004 questionnaire on the same topic, DesRoches' team asked respondents to the new survey to rate the extent to which they agreed with statements such as "Physicians should report all instances of significantly impaired or incompetent colleagues to their professional society, hospital, clinic, and/or other relevant authorities."
Among the results:
- 64% agreed with the professional commitment to report doctors who are significantly impaired or otherwise incompetent to practice medicine.
- 69% reported being prepared to deal effectively with impaired colleagues in their practice.
- 64% reported being prepared to deal with incompetent colleagues.
- 17% said they had direct knowledge of a peer incompetent to practice in their hospital, group, or practice.
- 67% of this 17% reported the colleague to relevant authorities.
Why Not Report?
When the doctors who didn't report impaired or incompetent colleagues were asked why, they gave a variety of responses:
- 19% said they thought someone else was taking care of the problem.
- 15% said they thought nothing would happen even if they did report the problem.
- 12% said they feared retribution.
Organizational Experts Weigh In
The study results don't surprise Arthur Brief, PhD, the George S. Eccles Chair in Business Ethics and Presidential Professor at the University of Utah in Salt Lake City.
In general, he says, "people don't speak out in the workplace. Fear of reprisal is a principal cause. In the case of physicians, that could be ostracization or reduced referrals."
With the troubled economy, the fear of repercussions is probably greater, he says.
The new results mirror those seen in whistle-blowing studies of federal workers, military employees, corporate employees, and internal auditors, says Janet Near, PhD, chairwoman of management and entrepreneurship of the Kelley School of Business at Indiana University in Bloomington.
In her research, she has found the more egregious the wrongdoing, the higher the chance a worker would blow the whistle. "In the JAMA [Journal of the American Medical Association] study, a strong majority of physicians did blow the whistle when they observed wrongdoing, similar to the internal auditors whom we studied several years ago," says Near, who co-authored the book Whistle-blowing in Organizations.
Putting It in Perspective
The take-home for patients? "Don't freak out about this," says Matthew Wynia, MD, MPH, director of the Institute for Ethics at the American Medical Association, who wrote an editorial accompanying the study.
The study finding "does not mean that bad doctors are rampant," he tells WebMD.
"I am the last to say we have a perfectly safe health care system," he says. But reporting of colleagues is only one check on the health care system, he says.
These days, he says, doctors are required to pass certification tests and get relicensed regularly in their practice area, providing more assurance of competency.
Patients can take action, too, he says, if they suspect a doctor is impaired or incompetent. "Many hospitals and larger clinics will have a patient advocate or an ombudsperson, and that person might be a very good place to start if a patient thinks they might be dealing with an impaired or incompetent doctor."
Another option, he says, is to contact the state medical board.
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Matthew Wynia, MD, MPH, director, Institute for Ethics, American Medical Association, Chicago.
Arthur Brief, PhD, George S. Eccles Chair in Business Ethics and Presidential Professor, University of Utah, Salt Lake City.
Janet Near, PhD, chair of management and entrepreneurship, Kelley School of Business, Indiana University, Bloomington.
DesRoches, C. Journal of the American Medical Association, July 14, 2010; vol 301: pp 187-193.
Wynia, M. Journal of the American Medical Association, July 14, 2010; vol 304: pp 210-212.
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