JAMA recently published an article, “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues” 1 and an editorial in the same issue titled “The Role of Professionalism and Self-regulation in Detecting Impaired or Incompetent Physicians”. The study was designed to investigate attitudes and willingness of fellow physicians to report a physician that is impaired or incompetent.
The authors reported that 64% of surveyed physicians agreed with the professional commitment to report physicians who are significantly impaired or incompetent to practice medicine. This premise of medical professionalism asserts that physicians are best able to establish the “standards and values that govern their practice and to monitor each others’ adherence to these standards.” However, only 69% indicated that they were prepared to deal with colleagues that were exhibiting impairment in their own practice, and 64% reported being prepared to deal with incompetency. 17% of those surveyed reported having direct personal knowledge of a colleague that was incompetent to practice medicine in their hospital, group, or practice. Of this group, 67% reported their colleague to the “relevant” authority; the remaining third did not. Two subgroups, graduates of non-US medical schools and underrepresented minorities were less likely to report. The main reasons cited for not taking action were a belief that someone else was taking care of the problem, the belief that nothing would come of reporting, and third, fear of retribution.
In the article’s conclusions, the authors state that “reliance on the current process [of self regulation] results in patients being exposed to unacceptable levels of risk and in impaired and incompetent physicians possibly not receiving the help they need.” This statement adds credence to the undercurrent in the media that physicians have been coddled and need much stricter regulation. Commentaries about this article have been recently published in many newspapers and other media outlets across the country.
Sadly omitted from the authors’ conclusions was any acknowledgment of the existence and vital role that a strong Physicians Health Program can play. The premise underlying the PHP concept is that of doctors helping doctors, with an emphasis on compassion. This study reveals a great reluctance to report a fellow physician to authorities. However, colleagues can anonymously refer a physician to their PHP without any risk of personal exposure. MPHP invites anyone to call us in confidence with concerns as to substance abuse, mental health issues, or behavioral issues.
Moreover, healthcare professionals who report their concerns about an impaired or incompetent physician to the board are protected by Missouri statute, as long as the information is provided “in good faith and without malice”. The law protects the person who reports or provides information to the board from “action for civil damages”. It further guarantees representation by the state attorney general should such action be attempted. 2
1 JAMA, July 14, 2010--Vol. 304,No. 2, 187-193.
2 Missouri Revised Statutes, Chpt. 334, Section 334.128