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US doctors reluctant to rat on each other--study

The prime reason for not reporting a colleague to relevant authorities was the belief that someone else was already handling the issue. Also, most of the physicians felt that it was a futile exercise and nothing would happen anyway.

A new study evaluating doctors' attitudes towards alerting higher authorities about impaired or incompetent colleagues, found that more than one third were reluctant to do so.

According to researchers, these findings are "troubling" because doctors checking up on each other is vital for patient safety.

Lead author of the study, Dr Catherine M. DesRoches, of the Mongan Institute for Health Policy at Massachusetts General Hospital, stated, "Self-regulation is the primary mechanism that patients have as protection against physicians who should not be practicing because their judgment is somewhat impaired.”

Doctors with medical experience of 10 years or less were most willing to report unfit colleagues. However, those with greater experience, 20 years or more were less inclined to do so.

Some specific findings of the report
Researchers from Massachusetts General Hospital in Boston used data from a 2009 national survey of nearly 3,500 physicians practicing in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics and psychiatry.

All the participants were questioned in three key areas. They were asked about their responsibility to report colleagues who were incompetent to safely fulfill their duties, whether because of mental health issues, alcohol or drug abuse or a lack of necessary technical skills.

They were also questioned about their readiness and comfort level in doing so, and about their experiences with such issues.

In all, a total of 1,891 doctors responded. Among them only 64 percent physicians fully believed they had an ethical obligation to tell those in charge if a colleague was unable to do his or her job.

On the other hand, more than 36 percent felt that there was no such need to inform the hospital, clinic or other organization about them.

Around 17 percent had been aware of an incompetent or impaired colleague over the last 3 years, but one-third of them chose not to report them.

Doctors with medical experience of 10 years or less were most willing to report unfit colleagues. However, those with greater experience, 20 years or more were less inclined to do so.

Doctors from US medical schools, whites, Asians and those working at universities, medical schools, hospitals and clinics were in favor of alerting higher authorities.

The least likely to report unfit peers were physicians working in small practices. Only 44 percent of those in solo or two-person practices were likely to report about a fellow physician.

Pediatricians and family doctors were not prepared to deal with impaired or incompetent colleagues, but anesthesiologist and psychologists were most prepared.

Some plausible explanations
The prime reason for not reporting a colleague to relevant authorities was the belief that someone else was already handling the issue. Also, most of the physicians felt that it was a futile exercise and nothing would happen anyway.

Some felt it was not their responsibility, while others were afraid the doctor would be punished excessively.

Feelings of empathy or the fear of retribution may be stopping them. Physicians in small practices depend on referrals and might not want to risk their reputations.

Dr Matthew Wynia, of AMA's Institute for Ethics in Chicago, commented, "Despite any minor flaws, this research is proof that individual physicians cannot always be relied on to report colleagues who threaten quality of care.

"Calls for more education, improved socialization into the norms and obligations of professionalism, and better protections for whistle-blowers should be heeded.

"Yet the study ... is also a reminder that physicians are always seeking to perfect the complex web of interactive processes used for quality assurance in medicine. That, too, is in the nature of medical professionalism.”

The study has been published in the weekly 'Journal of the American Medical Association' (JAMA).