Patient safety requires doctors report incompetent physicians

Recently, JAMA published a study concluding that doctors are hesitant to report incompetent physicians or those who were impaired.

According to the article,

more than a third of docs don’t think they’re responsible for reporting those who aren’t fit to practice, according to the results just published in JAMA. And only 69 percent of the docs who knew about an impaired or incompetent colleague reported them.

To those who advocate that the medical profession self-police, the numbers aren’t encouraging.

Who’s the blame? Here are some reasons:

The most common reason — given 19 percent of the time by doctors who said they were aware of a problem doctor — is that they thought someone else was on top of it. After that 15 percent of the respondents figured nothing would happen anyway. Fear of retribution was also a factor, cited by 12 percent of these doctors.

According to the study’s lead author, smaller specialty practices are dependent on referrals, so angering colleagues can jeopardize that. I’d imagine this is less of a problem in larger, integrative practices where doctors are paid on salary.

Having a formalized system of reporting, along with ensuring the anonymity of whisteblowers can help.

I recently wrote that medical residents aren’t formally taught something as simple as filling out an incident report. A culture of patient safety requires teaching doctors — especially those early in training — to know when and how to report their impaired or incompetent colleagues. Only then can we improve the integrity of how the medical profession polices itself.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

Comments

http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
Kevin, I blogged on this last week:
http://drjshousecalls.blogspot.com/2010/07/sayeth-ap-many-docs-dont-blow-whistle.html
I BLEW THE *&^%$#@! WHISTLE TWELVE YEARS AGO (while in public service no less) and have done nothing but suffer every manner of sling and arrow for it.
EVERYTHING that I had worked for and held dear was turned to ashes – my career is now a shadow of what it might have been. It galls me to no end that the AMA and all of the rest of my so-called “advocacy” agencies – most notably the high & mighty NC Medical Board – have all recently lectured the troops that it is our duty to report medical badness.
Yet somehow, even as they lecture, they do not admit that they’ve done NOTHING – ZERO, ZIP, NADDA – to protect or defend those of us who became entangled in medicolegal quagmires because we did.
It certainly was not an integral part of healthcare reform. Do you have ANY idea of how many politicians I’ve written to and pleaded with over the years – including three White Houses?
The MSM had determinedly, methodically IGNORED these stories.
And/so here, now, FIVE YEARS after entering the blogosphere to tell my story and BEG for help, I still stand in the muck and mire as a living example of why no doctor (particularly no SANE) doctor should (1) blow the whistle or (2) blog.
http://drjshousecalls.blogspot.com/2010/07/hello-roch-hello-ed-cone-hello-john.html
Christina
I’m quite frankly surprised at those figures. My experience has been that most doctors(I’d say 90%) refuse to report an incompetent doctor. It’s an atmosphere of “I don’t want to work with him/her but because they are a fellow physician I won’t report their incompetency”. In the high profile case I recently saw it was the nurse who reported the doctor. Not long after she reported it, she was fired by the doctor who owned the practice. It took outside agencies and the local newspaper getting involved before the doctor finally lost his job. He still has his license though. It makes us patients questions all doctors and the length they will go to hide incompetency in a fellow physician.
Vox Rusticus
Small, specialized practices are not complicit in ignoring incompetent practice from referring sources. That suggestion is speculative and untrue. Receiving patients that have been harmed by incompetence or negligence is not a desirable way to grow or sustain a practice, nor does tolerating or ignoring poor practices from referring doctors result in sustained referrals. All it does is invite the receiving practice to be tarred by litigation, even if one is not the direct target of that litigation, and it puts the specialist in the unenviable position of both explainer to the patient and clean-up man, neither of which are positions doctors want to find themselves in.
http://www.edhayes.com Edmund Hayes
An incompetent and impaired physician killed my sister. After the fact I learned that this mans impairment was a well known fact in the professional community where he practiced. No one said anything and the hospital where he practiced never suspended his privileges even after many battles with the Office of Professions. He had his license suspended a handful of times for things such as “moral unfitness during the practice of medicine” and “practicing while impaired and being a habitual user or having a psychiatric condition which impairs the physician’s ability to practice.”
The kick in the pants is that durning his last license suspension (yes not termination) he went to law school where he is now practicing as an ambulance chasing sleazy malpractice attorney.
Should we turn these people in and maybe even get them help before they hurt someone? – YES.
Because of this man and what happened to my sister I am now a member of the Professional Assistance Program in my state and while it is to late to fix what he did to my family maybe it’s not to late to help other patients that fall prey to impaired health care professionals.
A physician
The issue is more complicated than this discussion suggests.
As a physician I have taken care of several physicians who were incompetent. If I had reported them, I would have been violating patient confidentiality and could have been sued. These doctors were clearly at the end of a long career and were going to have to retire soon in any event.
I would no more have reported them than I would have reported an incompetent structural engineer who could have threatened far more lives.

http://www.edhayes.com Edmund Hayes
In my sisters case the man was in the middle of his career and had no plans to retire.
Not reporting the “incompetent” (and I know that word has to be used carefully) or the impaired is morally wrong.
And this goes for any professional whether we are talking about a physician, engineer or a cop.
Hey, even a lawn care professional gets reported to people like the Better Business Bureau.
I will stress again that sometimes reporting the person is what they need. It might actually save THEIR live.
twicker
So, let me just get this straight:
You would neither report an incompetent doctor (who can still, through incompetence, cause morbidity and/or mortality), nor would you report an incompetent engineer (who can cause the same) — because you want them to retire in peace?
Far be it from me to think that this is an easy issue; it’s one of those where we all want to do the right thing. But the “right thing” for saving the health and lives of patients may not be the happy thing for the incompetents — and the incompetents/incapacitated doctors/engineers/whatever may have to suffer the consequences.
With incompetence, someone is likely to suffer (that’s what incompetence is all about). Why is it better for multiple patients to suffer instead of one doctor?

http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
“If I had reported them I would have violated patient confidentiality”.
THAT is a cop-out.
A medical license is a privilege granted by the state – not a right. I you are a Psychiatrist and the doctors were you patients, and you knew they were incompetent/dangerous, you still had an obligation to notify their (and your) licensing board – just as I, as a Pediatrician, have an obligation to report a parent who abuses a child.
And if you talking about patients caught in the crossfire, there are ANY number of ways to report bad/impaired doctors that do not violate confidentiality – or at least that’s the theory that did not work in my case (you’re right things are much more complicated than this post suggests).
I wonder how the patients/families harmed by the doctors you did not report might feel about your dedication to the doctor’s confidentiality?
A physician
No Mary. It was not a cop out. I put pressure on the physicians and their families to retire. Both quit practice within a year. They were both disabled due to disease and early dementia. That course was far better than the hassle and legal risk of reporting them to a state agency which would probably have taken longer in any event. As your case demonstrates, physicians are not protected from liability and reprisals if they lodge a formal complaint. You as a pediatrician are protected in most states if you report a parent for abuse. That immunity doesn’t apply when you report incompetence as you have sadly found out.
http://www.meyersmedmal.com Jivanmeyers
The article referred to as nothing to do with physician’s who are treating impaired physicians reporting on their physician patients.
The study demonstrated that one third of physicians who were aware of incompetent practices kept it to themselves. I think the study grossly underestimates the number of physicians who remained silent.
Is physicians will not police themselves, then who should accept this undertaking? One comment includes a reference to malpractice attorneys in a very unsavory light. And yet the same commenter recognizes this the complete failure of self regulation at a hospital level.
I am a malpractice lawyer and have been for 34 years. I am not ashamed of having helped many victims of careless or in competent practice. To whom shall lame and innocent raise their voices?

http://www.edhayes.com Edmund Hayes
Jivanmeyers
There are good and bad in every profession. You might be extremely good. The physician turned attorney that my sister used is on the other side of the coin. The only reason he went into law was because he had his license to practice medicine suspended. My sisters family did use a wonderful malpractice attorney and they did receive some compensation.
My point was that the he should have gone to jail not to law school. He practice under the influence and killed at least one person I know of.
Someone needs to police this type of individual.

jsmith
How about states passing laws protecting docs from lawsuits if they report an incompetent colleague in good faith, analogous to the child abuse reporting laws?
http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
On three occasions in my career as a locums (since 1998), I’ve covered for sick/impaired doctors with (1) dementia secondary to recurrent/lingering malignancy/chemotherapy, (2) alcoholism, depression & dementia and (3) lung cancer. In only the third case, was the situation handled quickly and appropriately, with compassion for the doctor and the highest priority placed on patients. In the other two cases I had to tap-dance around egos and office politics and cover minor disasters & lapses – until, in case #1, I quit (making the reason why clear as I left), and in case #2, the doctor (whose license had been suspended by the Medical Board) died.
And as the doctor-in-the-middle, cleaning up the messes and answering to the angry patients, I can tell you that there has GOT to be a better way.
Despite everything I’ve been through, I would submit that (1) it is still our duty to report, and (2) since it is our duty to report, it is far past the time for the AMA and JCAHO and the Medical Boards and Attorneys General to get off their tuckuses and start doing something to protect and physicians who report badness.
Medical peer review as it is currently done (with BLANKET immunities for HOSPITALS/their committess) does not work.
The Happy Hospitalist
But I thought paying $1000s of dollars to our medical specialty boards guaranteed competency. If not, why am I paying to get certified?

http://www.edhayes.com Edmund Hayes
Not every physician is board certified, so who certifies they remain competent?

http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
Oh, Happy, the subject of board-certification is another subject that the AMA doesn’t really want the grunts to talk up.
http://www.epmonthly.com/whitecoat WhiteCoat
So who exactly makes the determination of when a physician is “incompetent”?
Is a physician who repeatedly prescribes antibiotics for bronchitis “incompetent”?
Is a physician who has a lapse in judgment and injures a patient on one occasion “incompetent”?
What about a doc who refuses to take call for the emergency department? Incompetent?
What about a doc that goes into a patient’s room and “says hello” without examining a patient and calls that his “rounds”?
Yes, there are the outliers that need to be reported, but the closer you get to the mean, the more difficult it is to separate those who are competent from those who are not.
http://www.abimfoundation.org Daniel Wolfson
I am sure there are many reasons why physicians are not reporting impaired and incompetent colleagues. But the focus needs to be on the lack of a standard that requires physicians to report impaired and incompetent colleagues 100% of the time. It’s not only because of the need for self-regulation — which is of paramount importance to the profession — but because the public needs to be protected from harm. We need to be outraged by the results of this study and not have a discourse on reasons physicians don’t “completely agree” with this reporting of impaired and incompetent physicians.

http://www.epmonthly.com/whitecoat WhiteCoat
So Daniel, why don’t you come up with exactly what behaviors need to be reported. Define “incompetence” for me and tell me how to protect the public from harm.
I think you’ll quickly find that defining physician “competence” is similar to trying to define the concept of “pornography” or “justice” — not very easy until its your rights that are being affected by the definition.
We can’t have meaningful discourse about doublespeak.

http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
At no point here have I said that I disagreed with reporting bad medicine.
But (big but) I do stand as a poster child for a good portion of the reasons given by others on this thread for not reporting.
So you will forgive me if I chose to remain outraged at what I’ve been through because once-upon-a-time I met that “standard” . . .
. . . a standard that does, in fact, already exist in North Carolina in the form of a position statement for physicians to follow (lest they be disciplined for not). . . but that the AMA/JCAHO and my Medical Board have done NOTHING to protect or defend (that wasn’t reported in the report).
I believe it’s called a “Catch-22″.

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