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Wednesday, 14 July 2010 23:32

1 of 3 incompetent doctors not reported to authorities


A U.S. study finds that impaired or incompetent physicians are not identified by their peers and colleagues about 33% of the time. How do we get rid of the 'bad apples' when the 'good apples' don't report the problems 100% of the time?


The paper written in the Journal of the American Medical Association (JAMA) is entitled 'Physicians' Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues' (JAMA. 2010;304(2):187-193. doi:10.1001/jama.2010.921).

Written by Catherine M. DesRoches, Sowmya R. Rao, John A. Fromson, Robert J. Birnbaum, Lisa Iezzoni, Christine Vogeli, and Eric G. Campbell, the paper states, 'Seventeen percent (n = 309) of physicians had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice. Of those with this knowledge, 67% (n = 204) reported this colleague to the relevant authority.'

Yes, 67% of medical colleagues are reporting incompetent behaviors of other doctors to authorities (which is good), but that means 33% are NOT reporting such incompetent behaviors to authorities (which is bad).

The goal should be to get 100% of doctors to report incompetent behaviors, which is part of the professional commitment of physicians. This action, reporting of incompetence and impairment 100% of the time, should also be the goal in all professions, not just in the medical community. What happens if colleagues don't report impaired pilots and engineers, and incompetent nuclear power plant technicians and soldiers and politicians? Get the picture!

The U.S. researchers state in their paper that the two main ways to identify 'impaired or otherwise incompetent' physicians are (1) peer monitoring and (2) reporting.

They add, ''¦ but data suggest that the rate of such reporting is lower than it should be.'

Page two continues with details of the study, and the results they found.



To verify the percentage of doctors reporting impaired or incompetent behaviors of their peers, the researchers took a representative survey of 2,938 'eligible physicians' practicing in the United States in 2009.

The various specialties included ''¦ anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry.'

Of this number, 64.4% of the physicians responded to the survey'”or 1,891.

The researchers found that:

'¢    64%, or 1,120 participants, 'agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice."

'¢    69%, or 1,208 participants, were 'prepared to effectively deal with impaired colleagues in their medical practice.'

'¢    64%, or 1,126 participants, reported ''¦ being so prepared to deal with incompetent colleagues.'

'¢    17%, or 309 participants, had "direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice."

'¢    And of those 17%, 67%, or 204 participants, 'reported this colleague to the relevant authority.'

Page three continues with the type of doctors that report the least and the type that report the most impaired and incompetent colleagues.



The researchers found that (1) minority doctors and (2) graduates of non-U.S. medical schools were less likely to report such behaviors than other such doctors.

They also learned that (1) doctors working in hospitals and (2) doctors working medical schools were most likely to report such behaviors to the proper authorities.

The paper states the following reasons (and the percentages and number of doctors reporting such reasons) for not reporting impaired or incompetent doctors:

'¢    19% (58) : ''¦ someone else was taking care of the problem.'

'¢    15% (46): ''¦ nothing would happen as a result of the report."

'¢    12% (36): ''¦ fear of retribution."

The conclusion of the researchers was: '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.'

The authors were affiliated with the following medical organizations: Mongan Institute for Health Policy (DesRoches, Rao, Iezzoni, Vogeli, and Campbell); Biostatistics Center (Rao); and Department of Psychiatry (Fromson and Birnbaum), Massachusetts General Hospital, Boston.

Page four concludes with comments from Dr. DesRoches, one of the authors of the study.


Learn more about this study in the July 13, 2010 WebMD article "Many Doctors Don't Report Incompetent Colleagues.'

Dr. Catherine M. DesRoches, one of the authors of the study, stated within the WebMD article, ''I was expecting the number who said they reported to be higher.'

DesRoches, who is an assistant professor of medicine at the Mongan Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School, Boston, added, "If you are the patient, you would want all the impaired or incompetent physicians to be reported."




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