Physicians may not report their impaired colleagues

Over half keep concerns to themselves

If a physician at your hospital observed that a colleague's substance abuse was putting patients in danger, would you expect that this information would be reported?

More than half the time, it would not, according to a recent survey of 1,662 physicians conducted by researchers at the Institute for Health Policy at Massachusetts General Hospital and Harvard University. Although 96% of respondents agreed that physicians should report impaired or incompetent colleagues to relevant authorities, 45% of respondents who encountered such colleagues had not reported them.

"Hospitals can't manage what they don't know about," says Eric G. Campbell, PhD, the study's lead author. "If hospitals don't know about half of the cases that are happening, they can't take steps to prevent it from happening again."

Physicians may think a medical error was a one-time incident that won't occur again, when in reality, there are underlying systems problems that need to be fixed. For instance, a doctor may give a medication that causes a patient's severe allergic reaction, because systems aren't effectively flagging allergies.

If a doctor suspects a colleague is incompetent, there should be a way to report this concern without being identified, says Campbell. "If people feel they are putting their careers on the line, that is a significant disincentive," he says. "We've got to make sure that people are not punished for reporting. Mechanisms should be put in place to make sure that this gets done — maybe not universally, but pretty darn close. Certainly more than half of the time."

Problem is 'tip of iceberg'

The study's findings are just "the tip of the iceberg" of a much bigger problem jeopardizing quality — that of conflict of interest, says Skip Freedman, MD, executive medical director of AllMed Healthcare Management in Portland, OR.

Judgment calls about impaired physicians should not be left to their colleagues, argues Freedman. "Why don't physicians report impaired colleagues? Because they are friends with them, they are business partners or in fact because they are competitors, and they would be accused of doing it for their own economic gain," he says.

Whatever the case, there is a conflict of interest, says Freedman. "The doctors' interests are for their own patients, but the hospitals' interest is for all of their patients. If you are a bad heart doctor and I'm a bone doctor, I protect my patients by just sending them to someone else," he says. "The hospital's interests are not parallel with the physician's."

Anonymous reporting systems aren't enough protection if a physician really wants to keep the report confidential, adds Freedman. "If you work in a small community hospital, do you really think I can keep anything secret in there? It's just not realistic," he says.

External peer review is the best solution when there is questionable care due to either impairment or a knowledge deficit, says Freedman. "Specialists who don't suffer from these conflicts of interest can speak to the standard of care, and whether the care is up to snuff," he says.

Physicians are losing their reluctance to report incompetent or impaired physicians — but only slowly and somewhat grudgingly, says Frederick P. Meyerhoefer, MD, a quality consultant based in Canton, OH. "In part, it is because they are also loath to accept that their professional colleagues can be less than adequate clinical physicians."

The reporting track must be clear, such as through a knowledgeable and involved vice president of medical affairs, chief medical officer, or other senior medical staff leader, says Meyerhoefer. "Depersonalize reporting by taking it from the 'ratting out' aspect to putting it in terms of the quality of patient care and patient safety," he says.

Physicians also want assurance that if they do report an incident or an individual physician, it will be taken seriously and followed through on, even if the final resolution may involve no specific findings or corrective action. "There can be no shooting the messenger or any implication that it is a witch hunt," says Meyerhoefer.

[For more information, contact:

Eric G. Campbell, PhD, Associate Professor, Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA 02114. E-mail, ecampbell@partners.org.

Skip Freedman, MD, Executive Medical Director, AllMed Healthcare Management, 621 SW Alder St., Suite 740, Portland, OR 97205. Phone: (503) 274-9916. Fax: (503) 223-6244. E-mail: skipfree@allmedmd.com.

Frederick P. Meyerhoefer, MD, 1261 White Stone Circle NE, Canton, OH 44721. Phone: (330) 966-6717. E-mail: meyerorg@aol.com.]

Reference

  1. Campbell EG, Regan S, Gruen RL, et al. Professionalism in medicine: Results of a national survey of physicians. Ann Ital Med In 2007; 147(11):795-802.