Study shows doctors often eschew watchdog role

With television shows such as “Nurse Jackie” and “Grey’s Anatomy” regularly depicting physicians and nurses with substance abuse problems, some patients might begin to wonder whether in real life anyone is monitoring the people who provide lifesaving care. Perhaps not. Or, if workers are being monitored, they’re not being monitored closely enough to fit some researchers’ way of thinking.

A doctor survey study published online Tuesday in the Journal of the American Medical Assn. suggests that workplace monitoring of impaired or incompetent physicians is not what you’d call common.

Conducted by a team from Massachusetts General Hospital in Boston, the study used data from a 2009 national survey of close to 3,000 physicians practicing in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics and psychiatry.

Physicians were questioned in three areas: about their responsibility to report physicians who were incompetent or impaired by drugs or alcohol, about their preparedness and comfort level in doing so, and about their experiences with colleagues with these issues.

“Self-regulation is the main way to protect patients from harm and make sure that impaired and incompetent physicians get the help that they need,” said Catherine DesRoches, lead author of the study, in a phone interview.

About 70% of physicians said they feel prepared to report impaired physicians, and 64% said they were prepared to report incompetent ones. But more than one-third, 36%, said they do not feel obligated by professional commitment to do so.

Physicians with less experience, 10 years or fewer, were most willing to report impaired or incompetent colleagues. Those with greater experience, 20 years or more, were less likely to feel that it was their responsibility to do so.

“It’s possible that there’s a real cultural issue here. It’s a topic that might not have been addressed back when they were in medical school, so they do not know how to handle it,” said DesRoches, an assistant professor at the Mongan Institute for Health Policy at Harvard Medical School.

Pediatricians and family practice doctors were the least likely to say they felt prepared to deal with impaired or incompetent colleagues; anesthesiologist and psychologists apparently felt most prepared.

“These [anesthesiologists and psychiatrists] specialties have really taken this issue on and have focused a lot on training physicians to deal with these situations,” said DesRoches. “They are more aware overall and know what to do more than physicians in other specialties.”

The survey also found that 17% of respondents had direct knowledge of an impaired or incompetent physician colleague in their hospital, group or practice in the last three years. Of these physicians, 67% had reported that person to a hospital, clinic, professional society or other authority.

Among physicians who had encountered impaired or incompetent colleagues and had chosen not to report them, the two most frequently cited reasons for not doing so were the belief that someone else was taking care of the issue and the belief that nothing would happen as a result of the report.

The way to help improve this problem, said DesRoches, is to improve the reporting system itself.

“By targeting these two main issues — the belief that someone is taking care of it or that nothing will come of the report — we can increase the numbers of physicians who are both willing to report and feel prepared enough to do so,” she said.

She proposes education on the responsibility of physicians to report impaired or incompetent colleagues and the development of systems that both ensure confidentiality and notify the reporter when the issue has been addressed.

Said DesRoches, “It’s concerning that there’s this somewhat large portion of physicians that don’t agree with the commitment to report when they have direct personal knowledge of a colleague that is in need. Since physicians themselves are the primary mechanism for detecting such colleagues, we must look to them to improve the situation.”