How often do derms report colleagues' misdeeds?

February 1, 2008

According to a Massachusetts General Hospital study recently published in the Annals of Internal Medicine, more than 95 percent of doctors surveyed said impaired or incompetent physicians should always be reported.

Key Points

According to a Massachusetts General Hospital study recently published in the Annals of Internal Medicine, more than 95 percent of doctors surveyed said impaired or incompetent physicians should always be reported. However, only slightly more than half - 55 percent of those who had personal knowledge of such physicians in the past few years - had always done so.

The study, which randomly sampled more than 3,500 doctors across the country four years ago, received nearly 1,700 responses.

The research also indicated that physicians could see themselves ordering tests which might be deemed medically unnecessary, if they were requested by the patient or in order to protect themselves in case of future problems.

We spoke to doctors around the country, and found that many feel, unfortunately, that doctors may not always feel free to make those reports.

The dermatologists responding to On Call were speaking about why doctors, in general, might feel a reluctance to report other physicians, not particularly how they would react to a specific situation.

Robert F. Schwarze, D.O., in Florissant, Mo., says part of the problem may be apathy, but he thinks it goes further than that.

"The thing is, I think doctors feel that they need to be really sure in their own mind before they start pointing the finger.

"Recently, we had a doctor who some people said drank sometimes. His patients complained he was yawning in the middle of the day. Did the yawning indicate drinking? How do you really know?

"Sometimes what appears obvious may not be obvious, and doctors want to be cautious - sure what they think is true - before saying something.

"I, personally, worry about mislabeling someone as an alcoholic or drug addict. If you see them popping something, it may be for their heart or diabetes," Dr. Schwarze tells Dermatology Times.

In practice for 17 years and past president of the Osteopathic College of Dermatology, Dr. Schwarze says that if a physician has problems, it's usually obvious to more than one person.

"Everybody I have ever seen with drug or alcohol issues has already been reported by the time I mention it at the hospital - they've already been reported. So I wonder if people don't report incidents because they've already been reported."

In Chicago, Kevin S. Pinski, M.D., says the issue is a very personal one.

"There's no question in my mind that it is incumbent upon us to police our own field. If we don't, it gives the profession a bad name and, ultimately, reflects back on us.

"But I think some people probably don't want to get involved; to a certain extent, that's human nature with many things," he says.

"Secondly, they may feel guilty turning in somebody from their own 'family.' You see that in many other professions, as well - the legal profession, sports."

An associate professor of dermatology at Northwestern University, Dr. Pinski says that, while understandable, that attitude can still hurt the image of medicine.

"It absolutely will. It may also force some other governing body to come up with ways to police us. We've already got enough government bureaucracy and oversight," Dr. Pinski says.

Amy B. Lewis, M.D., in Brooklyn, N.Y., thinks part of the problem is that doctors are targets for outsiders.