Can medicine self-regulate?
Even though many US states demand that
doctors report colleagues whose performance is impaired by alcohol or drug use
or by physical or mental illness, a survey in a recent issue of JAMA suggests
that a third of them would not do it.
Catherine M. DesRoches, of Massachusetts
General Hospital, in Boston, found that only 64% of American physicians agreed
with the professional commitment to report physicians who are significantly
impaired or otherwise incompetent to practice. About 17% of the physicians surveyed had dealt with an
impaired colleague, but on 67% of these had blown the whistle.
Overseas doctors and underrepresented
minority physicians were significantly less likely than other physicians to
report. The most frequently cited excuses included the belief that someone else
was taking care of the problem; the belief that nothing would happen as a
result of the report; fear of retribution; the belief that reporting was not
their responsibility; or that the physician would be excessively punished.
“These… raise important questions
about the ability of medicine to self-regulate,” say Dr DesRoches and her
colleagues. “More than one-third of physicians do not completely support the
fundamental belief that physicians should report colleagues who are impaired or
incompetent in their medical practice. This finding is troubling, because peer
monitoring and reporting are the prime mechanisms for identifying physicians
whose knowledge, skills, or attitudes are compromised…
“Reliance on the current process results in
patients being exposed to unacceptable levels of risk and impaired and
incompetent physicians possibly not receiving the help they need.” ~ JAMA, July 14
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