More than one third of US doctors who responded to a survey did not agree it was their responsibility to report colleagues who were incompetent or impaired, for instance due to substance abuse or a mental health disorder.

You can read about the research behind these findings online: they were published on 14 July in JAMA, Journal of the American Medical Association.

Lead study investigator, Dr Catherine DesRoches, of the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH) in Boston, told the press that their findings question the ability of medical profession to regulate itself when it comes to dealing with incompetent or impaired doctors:

"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," she urged.

The survey also revealed that many doctors felt unprepared to deal with or report impaired or incompetent colleagues.

Studies show that compared to the number expected, far fewer reports of incompetence among doctors actually occur, in spite of increasing attention in the media and professional circles, and the fact many states and professional bodies like the American Medical Association require that health professionals report colleagues whose ability to practise is impaired.

DesRoches, who is also an associate professor of Medicine at Harvard Medical School, and colleagues designed a new study to investigate doctors' experiences, views and beliefs about colleagues who are impaired or incompetent to practise medicine, including the extent to which they felt obliged to report, their preparedness to do so, and actions they took.

They used data from a 2009 nationally representative survey that included a section on beliefs and behaviors regarding impaired or incompetent colleagues.

The survey covered doctors in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry. From 2,938 eligible US doctors invited to complete the survey, 1,891 responded (64.4 per cent).

The survey asked respondents to rate the extent to which they agreed or disagreed with the statement:

"Physicians should report all instances of significantly impaired or incompetent colleagues."

It also asked them to say how prepared they felt to deal with such a situation, and whether they had had direct knowledge of an impaired or incompetent colleague in the past three years.

If they answered yes to having direct knowledge of such a case or cases, the survey then asked them to say whether they had reported the most recent case, and if they had failed to report any cases within the last three years, what reasons did they have.

The results showed that: 64 per cent (1,120 respondents) agreed that doctors should always report impaired or incompetent colleagues.
69 per cent (1,208) said they felt prepared to deal effectively with impaired colleagues in their medical practice.
17 per cent (309) had direct personal knowledge of a colleague who was incompetent to practise medicine in their hospital, group, or practice.
Of these, 67 per cent (204) reported the colleague.
Psychiatrists and anesthesiologists were the most likely to say they felt prepared to deal with impaired or incompetent colleagues, while pediatricians were the least likely.
Underrepresented minorities and graduates of non-US medical schools were less likely than their counterparts to say they would report impaired or incompetent colleagues, while doctors working in hospitals or medical schools were the most likely.
The most frequently stated reason for taking no action was the belief that someone else was alreading dealing with it (19 per cent of respondents, 58), followed by the belief that nothing would happen (15 per cent, 46) and fear of retribution (12 per cent, 36). The researchers concluded that:

"Overall, physicians support the 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."

Co-author Dr John A. Fromson, associate director of Postgraduate Medical Education in the Psychiatry department at MGH, and assistant clinical professor at Harvard Medical School, said:

"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."

"Those obligations include referring colleagues to physician health programs that can guide and monitor their recovery from substance use and mental disorders," he added.

Senior author Dr Eric G. Campbell, research director for the Mongan Institute, said these results imply the current system is failing: many doctors are either afraid to use it or don't believe it will work.

"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," said Campbell, who is also an associate professor of Medicine at Harvard Medical School.

In an accompanying editorial, Dr Matthew Wynia, director of the Institute for Ethics at the American Medical Association, called for better protection for doctors who report colleagues, and more education on how to do so.

One successful story of a doctor who was reported was that of Dr. A. Clark Gaither. 21 years ago, while on a training residency, he found himself reported by a colleague, he does not know who, who said he had smelled alcohol on his breath. Gaither told the Associated Press he wished he knew who had reported him, because:

"I'd like to give them a big ol' hug and thank them for saving my life."

Altogether in Gaither's case, it took that report, three confrontations with supervisors and temporary loss of his tranining licence, to get him into residential rehab with the help of the North Carolina Physicians Health Program. He eventually finished his residency and became a family doctor.

Now 55 he has not touched a drop in 20 years, and runs a free mobile clinic for the uninsured in North Carolina.

Gaither, who speaks freely about his experience, said doctors worry that their colleagues will lose their licenses and livelihoods if they are reported, but he urges them to do it, because reporting is a first step in getting them the help they need, which is preferable to them losing everything, as he was in danger of.

"Physicians' Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues."
Catherine M. DesRoches, Sowmya R. Rao, John A. Fromson, Robert J. Birnbaum, Lisa Iezzoni, Christine Vogeli, and Eric G. Campbell.
JAMA, 304 (2):187-193, published online 14 July 2010.
DOI:10.1001/jama.2010.921

Additional sources: Massachusetts General Hospital, Associated Press.

: Catharine Paddock, PhD