Reasons for Not Turning In a Colleague
In elaborating on their answers, doctors who said they might not report a colleague provided a number of reasons:
How impaired is impaired? Many doctors implied there would be some sort of calculus to their decision. "How impaired?" "How occasionally?" "Has he or she produced harm?" Still others noted that their decision would be based on their own professional assessment of a colleague's impairment. "Depends on their ability to perform as required," wrote an anesthesiologist. A mental health professional said that the decision depends on how it "impacts their professional capacity to function." "Depends on my confidence level in their impairment," noted a pathologist.
The problem with those shades-of-gray arguments, says Michael Munger, MD, president of the American Academy of Family Physicians, is that "very few things in this life are truly clear-cut."
Just as a physician wouldn't wait for a suspect piece of equipment to fail before reporting the potential danger, "when we are dealing with the potential safety of patients and the impact on patient care as a whole, we must hold ourselves to the highest levels of professionalism. I know that's kind of hard-nosed, but it's important that we always keep this framed around patient care," he says.
Other Barriers to Reporting
Cause of impairment. Many physicians tell Medscape that their decision to report a colleague would depend on the cause. "Drugs or alcohol, probably, but if it was related to mental health, I won't report them," writes one pediatrician. "Mild impairment by illness is one thing, but gross impairment by drugs/alcohol should be reported," writes another. "Definitely for alcohol or drugs; for illness, I would first encourage them to take time off and get treatment," says a mental health professional.
That distinction is troubling, says Lisa Merlo, PhD, an associate professor in the department of psychiatry and the University of Florida College of Medicine and research director for Florida's Physician Health Program. "I think there is still some lack of understanding about what is impairing," says Dr Merlo, who says that training pertaining to substance use disorders should be incorporated into medical education.
Professionalism as a barrier. Many physicians say they would hesitate to report a colleague out of concern that they would be severely punished or would not receive the help they needed.
Thomas Gallagher, MD, associate chair of the department of medicine and a professor in the Department of Bioethics and Humanities at the University of Washington, says there are a lot of parallels between physicians' hesitation to report an impaired colleague and their reticence to reveal a colleague's medical error or point out an aging physician's deteriorating skills. Part of the problem, he says, traces its roots to the Hippocratic Oath and an overdeveloped sense of professionalism and collegiality.
"We rely heavily on our colleagues for patient care; there are often financial relationships—we rely on colleagues for referrals—and we worry about our own reputations among our peers," he says. Those relationships can make physicians reticent to speak up and are frequently compounded by numerous other forces. For example, doctors may feel they shouldn't report a potential problem because they don't know the whole situation, or they may excuse a physician's apparent impairment by laying blame on systemic problems, such as a stressful workplace.
Distrust of the system. In a similar vein, many physicians say they don't trust the system to address a colleague's impairment fairly and effectively. A general surgeon referred to formal reporting as "unleashing the hounds," and an internist stated that "the system is too punitive as it stands without me adding to physician suicide numbers."
Even some physicians who have reported impaired colleagues in the past lament that they did not feel they could predict the consequences of their actions. "The problem is the jeopardy in doing this. The problem is the authorities and how they handle it," writes an orthopedist who reported an impaired colleague. An emergency medicine physician agrees: "I have [reported an impaired colleague]; however, I feel the physician's problem was poorly handled by the state board. He did not get the treatment he needed, and he lost his license. Very sad case."
A family medicine specialist expressed a similar concern. "Our state boards can be very punitive, especially about mental illness, such as depression. Some people are forced into monitoring programs that are really set up for people with substance abuse, when that has never been an issue. I would try very hard to make sure that someone's career would not be unnecessarily adversely affected, while ensuring their safety and most especially patient safety."
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Cite this: Shelly Reese. Would You Report an Impaired Physician? Many Doctors Won't - Medscape - Apr 11, 2018.
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