Doctors’ words, actions don’t always match

Physicians are among the most trusted professionals in America, but a new survey shows that when it comes to dealing with colleagues’ mistakes or incompetence, many doctors abandon the high standards they espouse.

The first-of-its-kind survey of more than 1,600 physicians, published Dec. 4 in the Annals of Internal Medicine, found that 45% said they did not always report an incompetent or impaired colleague to the appropriate authorities -- even though 96% agreed that doctors should turn in such people.

Moreover, 46% said they had failed to report at least one serious medical error that they knew about, even though 93% of doctors said physicians should report all significant medical errors that they observe.

“We found large gaps between physicians’ espoused attitudes and what they do in actual practice,” said Eric Campbell, the lead author and an assistant professor at Massachusetts General Hospital’s Institute for Health Policy.

“Failing to report incompetent physicians and allowing them to practice will have an impact on the welfare of patients,” Campbell added. “It’s clearly something that people should be aware of.”

The survey was conducted from November 2003 to June 2004 and funded by the nonprofit Institute on Medicine as a Profession, a think tank that promotes medical professionalism through a center at Columbia University. It found notable gaps between ideals and practice in the areas of self-regulation, managing financial conflicts and conserving limited resources.

For instance, a majority said they would refer patients to an imaging facility in which they had a financial interest, but only 24% would inform patients of that financial tie. Yet 96% told researchers that doctors should put their patients’ welfare above their own financial interests.

Also, more than a third of physicians, 36%, said they would order an unneeded MRI, or magnetic resonance imaging, test if it were requested by a patient with low back pain, though most doctors say they do not want to waste scarce resources.

And 93% said doctors should provide necessary medical care regardless of a patient’s ability to pay, but only 69% accept uninsured patients who are unable to pay.

The study’s authors and a panel of experts who discussed it last week in Washington said that not all the findings were negative and that some must be understood in context.

Donald Wesson, chairman of the American Board of Internal Medicine, said the fact that doctors nearly unanimously agree on standards means they do not need to be convinced that these issues are important. Some behaviors, such as caring for the poor, are determined by the policies of the organizations the physicians work for, the authors noted. And several experts lamented cultures in some medical workplaces in which doctors fear retribution for reporting a colleague or legal action for perceived failures in care.

“We need to change a system that currently encourages defensive medicine,” said James Thompson, head of the Federation of State Medical Boards.

David Blumenthal, a study author and the director of the Institute for Health Policy, said most physicians are trying to do the right thing, and he called for a renewed focus on professionalism, not simply more regulation.

“If the medical board and regulatory apparatus were monstrous, it wouldn’t solve our problems,” he said. “Sure, regulation has an important role. Yes, patient information has an important role. But in the end, if the profession doesn’t step up, we will all be the worse for it.”