Would You Report an Impaired Physician? Many Doctors Won't

Shelly Reese

Disclosures

April 11, 2018

In This Article

Helping Physicians Come Forward

What's more, even though a majority of Medscape respondents say they would report an impaired colleague, chances are those numbers are high, speculates Dr DesRoches.

"When you ask people a hypothetical question, you'll often get an idealized answer," she says. One third of the physicians she surveyed for the 2010 JAMA study who had direct personal knowledge of an impaired colleague during the previous 3 years failed to report them because they believed someone else was taking care of the problem (19%), didn't think reporting the problem would make a difference (15%), feared retribution (12%), felt it wasn't their responsibility to report (10%), or worried that the physician would be excessively punished (9%).

"What surprised me was how few physicians said they felt prepared to deal with this situation," she says. "Normally, physicians are a very confident group, but only two thirds of respondents felt they were prepared to deal with the situation, so it seems like there's an opportunity to start early and prepare physicians in residency and medical school to help them understand their responsibility and to act on it."

Dr Gallagher says that means reframing the definition of professionalism to better focus on patient safety. Medical schools need to train students to speak up, and healthcare institutions need to improve their peer review processes. Physicians often hesitate to voice their concerns because they fear that a colleague will be treated too harshly, that they will not get the assistance they need, or that the system will be biased for or against them in some way. To overcome those concerns, transparent, impartial systems that encourage proactive intervention are needed.

"If we could communicate how peer review works, physicians will have fewer reservations about coming forward," Dr Gallagher believes.

Peer reviewers also need to communicate results, Dr DesRoches says. In today's rapidly changing healthcare environment, physicians "feel under siege," she says. "They're burned out and fatigued, and the perception that reporting an impaired colleague amounts to 'unleashing the hounds' plays into that sense of feeling under siege."

"I think we need to be developing and evaluating systems that allow physicians an easy way to report someone, but we also need data around the effectiveness of the programs," she continued. Physicians are evidence-based decision makers, so "that data feedback has to be built into the loop."

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