Study says 36% of physicians say they wouldn't report other doctors who are impaired by mental illness or substance abuse

From the Wall Street Journal:

Would you want the colleagues of a doctor whose medical decisions were affected by mental illness, substance abuse or just plain old incompetence to report him (or her)?
Physicians have an ethical obligation to notify authorities in those cases, but 36% of respondents in a newly published study said they didn’t agree they should always do so.

The study, by researchers from the Mongan Institute for Health Policy at Massachusetts General Hospital, reflects the responses of 1,891 doctors in various specialties. It appears in JAMA.

Most of the respondents — 69% — said they felt prepared to deal with colleagues who were significantly impaired, and 64% said the same about incompetent colleagues. Of the 17% of physicians who said they had direct personal knowledge of an incompetent physician co-worker, 67% said they reported the colleague.

There are a few different options for how a doc would go about reporting a colleague, including licensing boards, medical societies, clinical supervisors and hospital peer-review groups, according to the AMA, whose code of ethics requires reporting impaired, unethical or incompetent physicians.

Why wouldn’t a doctor report someone? According to the survey, due to the beliefs that someone else would do it and that reporting incompetence wouldn’t actually make any difference, in addition to the fear of retribution. The authors also noted that physicians who belonged to one- or two-person practices, are a racial or ethnic minority or who graduated from non-U.S. med schools were less likely to report a physician colleague. Those at hospitals or med schools were most likely to do so.

Self-regulation can be improved, says Catherine DesRoches, lead author of the study. “There’s a large group of physicians who don’t feel prepared to deal with the situation,” she tells the Health Blog. Efforts to educate doctors about why and how to report impaired colleagues could help, she says. And external regulation from professional societies, licensing groups and hospitals could come to play a bigger role, she says.

William Norcross, who started the Physician Assessment and Clinical Education program at the University of California, San Diego to evaluate the competence of troubled doctors, tells the Health Blog he’s not surprised by the findings. “We don’t know why doctors tend to ignore doctors who are impaired or incompetent,” he says. “There’s probably some feelings of empathy — there but for the grace of God go I — and probably a fear of being sued.”

But, Norcross says, “Most ethical questions in medicine that seem murky seem much more clear when you ask what’s best for the patients.” And that requires impaired physicians be identified, assessed and, if possible, treated, whether they have outdated skills, are practicing outside their specialty, or have medical problems like sleep apnea or dementia. (Norcross estimates some 8,000 practicing physicians suffer from some form of dementia.)

“Doctors need to know that whomever they’re reporting this to will have a compassionate and conscientious approach to the problem,” he says.