Study: Doctors don’t always report colleagues, errors
Tuesday, December 04, 2007
Although virtually all doctors think they should report impaired or incompetent colleagues or serious medical errors to the relevant authorities, nearly half don't, a study suggests Monday.The authors say they are the first to try to broadly assess doctors' support for and adherence to professional standards. The researchers, whose findings appear in the Annals of Internal Medicine, surveyed a national random sample of 3,504 practicing doctors between November 2003 and June 2004. They received responses from 1,662.
While 96% of respondents said doctors should always report impaired or incompetent colleagues, only 55% of those with direct personal knowledge of such doctors in the past three years said they always did so.
And while 93% of respondents said doctors should always alert authorities when they observe serious medical errors, only 54% of those who had such information in the past three years said they always did so.
"I think human beings always fall short of their aspirations," senior author David Blumenthal says. "The intent of the paper was not to criticize but to … highlight the areas for improvement."
Blumenthal, a Harvard internist who directs Massachusetts General Hospital's health policy institute, said he was encouraged that virtually all respondents supported professional standards. "You don't have to convince them about what they ought to be doing," he says.
Of the specialties surveyed, cardiologists were the least likely to say they always reported direct knowledge of a serious medical error. And, by just 0.8%, cardiologists were second only to family practitioners in being least likely to report an impaired or incompetent doctor. Anesthesiologists, surgeons, internists and pediatricians were also surveyed.
Jack Lewin, CEO of the American College of Cardiology, says most cardiologists, unlike most doctors, practice in groups. Instead of reporting impaired colleagues or serious mistakes to outside authorities, cardiologists are more likely to deal with such problems inside their practices, Lewin says. In addition, he says, many doctors fear being sued if they report incompetent colleagues. "We probably need some kind of whistle-blower protection for doctors."
However, Blumenthal's study found that doctors who practiced in groups of at least three were more likely than other doctors to say that they always reported an impaired or incompetent colleague or a serious medical error.
The other main discrepancy between what doctors said they believe and what they said they practice related to distribution of health care resources.
Nearly all said doctors should minimize disparities due to race or gender. But a third said they would give in to a patient who demanded an MRI because of back pain that was likely to go away on its own.
"There's a lot of pressure on physicians to keep their patients happy," Blumenthal says. "Part of the problem with the American health care system has been that there is no throttle on test-ordering."
Posted in Medical Malpractice