A new survey of doctors in the United States revealed that while the overwhelming majority think incompetent colleagues should be reported, less than half actually do so.
The study is the work of Dr David Blumenthal from the Massachusetts General Hospital, Institute for Health Policy, in Boston Massachusetts, and colleagues, and is published in the 4th December online issue of the Annals of Internal Medicine.
The researchers carried out the study because while the idea of improving standards of care through increasing professionalism among doctors has been gaining ground in medical organizations, the view of practising doctors and the extent to which they conformed with standards was unknown.
Blumenthal and colleagues invited responses from 3,504 doctors practising in family practices, internal medicine, pediatrics, surgery, anesthesiology, and cardiology, and received responses from 1,662 of them (58 per cent). The study was carried out between November 2003 and June 2004.
The questions covered various standards of medical professionalism such as those developed by the American College of Physicians and the American Board of Internal Medicine.
The results showed that:
- Over 90 per cent of respondents agreed with statements about principles proposed by professional bodies in 2002 regarding such things as the fair distribution of finite resources, improving access to healthcare and quality of care, managing conflicts of interest, and self-regulation among professionals.
- 24 per cent of respondents disagreed with the idea that doctors should undergo periodic recertification.
- A common theme found in the responses was that physicians did not always follow the standards they supported.
- For example, although 96 per cent agreed that doctors should report incompetent colleagues to the authorities, only 45 per cent of them had actually done so.
- Another example was that about one third of respondents said they would order unneeded MRI for back pain if a patient asked for it.
The authors accepted that the results might not be typical of all doctors, and especially of specialisms not covered.
They concluded however, that while doctors may generally agree with norms of behaviour set by the various professional bodies, they did not necessarily comply with them.
Commenting on their findings, Blumenthal said that:
“”I think human beings always fall short of their aspirations.”
However, he said he was encouraged that nearly all the respondents supported professional standards. At least “you don’t have to convince them about what they ought to be doing,” he said.
Some experts have suggested that doctors are scared of being sued if they report incompetent colleagues, and that what the profession needs is a whistle blowing system.
“Professionalism in Medicine: Results of a National Survey of Physicians.”
E. G. Campbell, S. Regan, R. L. Gruen, T. G. Ferris, S. R. Rao, P. D. Cleary and D. Blumenthal.
Ann Intern Med 2007; 795-802.
4 December 2007, Volume 147 Issue 11, Pages 795-802.
Written by: Catharine Paddock