"Our findings cast serious doubt on the ability of medicine to self regulate with regard to impaired or incompetent physicians," said study co-author Catherine DesRoches, DrPh, of the Mongan Institute at the Massachusetts General Hospital, Boston. "Since physicians themselves are the primary mechanism for detecting such colleagues, understanding their beliefs and experiences surrounding this issue is essential. This is clearly an area where the profession of medicine needs to be concerned."
The 1999 Institute of Medicine report, To Err Is Human, and various media accounts have heightened public awareness of egregious physician behaviors, such as surgeons leaving midway through an operation or performing wrong-site surgery. But the rate of reporting by physicians appeared to be far lower than it should be—given the estimated numbers of physicians who become impaired or who are otherwise incompetent to practice at some point in their careers.
For the survey, a sample of nearly 3,500 eligible physicians practicing in the United States in 2009 in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry were contacted. Overall, nearly 1,900 responded. Only 64% of the respondents agreed that physicians should always report impaired or incompetent colleagues. About 70% of respondents indicated feeling prepared to deal with an impaired colleague, and 64% felt prepared to deal with an incompetent colleague in their practice.
Pediatricians appeared to be the least likely to report feeling prepared to deal with impaired or incompetent colleagues, while psychiatrists and anesthesiologists said they felt most prepared. Direct, personal knowledge of an impaired or incompetent physician during the past three years was indicated by 17% of respondents, but only 67% of those with such knowledge actually had gone ahead to report those colleagues.