Quality Medical Treatment — An Exercise in Responsibility

Following published reports and extensive media coverage regarding egregious behaviors in the medical profession, public awareness of physician and hospital errors has increased. Despite that increased attention, data suggests that the rate of reporting by physicians is lower than it should be.

In the JAMA July 14 issue, one of the major themes covered was research articles and commentary on the Physician Peer Review process and its effectiveness. The medical peer review is the process by which a committee of physicians examines the work of a peer and determines whether the physician under review has met the accepted standards of care in rendering medical services. This process is put in place specifically to assure physicians that their statements will remain confidential when commenting on the behaviors of their colleagues (many of whom are a physician’s primary referral sources).

An original research study titled “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues” found that overall, “…physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority; however, when faced with these situations, many do not report.

The study reported in JAMA was a questionnaire-based study sent to a randomized group of 3500 physicians in the fields of family practice, internal medicine, pediatrics, anesthesiology, cardiology, general surgery and psychiatry (excluding certain physician specialties and hospitals).  Some of the results in the report suggest:

• 64% of the total physicians that responded to the survey completely agreed that physicians should report all impaired or incompetent colleagues.
• Women were more likely than men to agree with that statement.
• Graduates from US medical schools were also more likely to agree with that statement when compared with non-US medical schools.
• Physicians were more likely, in university or medical schools, to report all impaired or incompetent colleagues when compared to solo or 2-person practices (the least likely to report).
• Among the specialties, anesthesiologists and psychiatrists were the most likely to be prepared to deal with impaired or incompetent colleagues and pediatricians were the least likely to feel prepared to report.
• Physicians practicing in medical school and university settings were significantly more likely to report than those in other practice settings.

While 64% of physicians, overall, reported being prepared to deal with colleagues who were incompetent in their medical practice, only 17% of physicians reported having knowledge of an impaired or competent colleague in or around their practice. Among the 17% that had knowledge, the most frequently cited reason for not reporting was the belief that someone else was taking care of the problem, that nothing would happen as a result, or simply, fear of retribution.

The study has not accounted for every reason that a physician may not report fellow physicians. For example, it is entirely plausible that a physician with knowledge of an impaired or incompetent colleague did not have reliable and accurate information to allege such an incompetency on their peer. Notwithstanding such shortcoming to the published research, the suggestion is clear: there needs to be stronger external regulation in the medical profession to ensure that internal regulations are working as expected. A commentary in the JAMA issue suggests that reporting systems should be better maintained to protect confidentiality and raise confidences among the physician community that real action and investigation will be taken when reports are made.

Professionalism dictates that physicians and physicians groups work together to establish the highest level of care a patient can receive. Patients also have a duty to make informed and educated decisions about physician choice. So, when considering a particular physician or a method of treatment recommended by a health care professional, be your own advocate by:

• Be an active participant in the decision process
• Speak out – ask questions and insist on well explained answers
• Insist that health care professionals speak with you in non-medical language so you may fully understand them
• Investigate physician credentials and experience
• Insist on background information from your physician
• Insist on knowing the physician’s level of experience in performing a given procedure or in treating a particular disease
• Ask your physician for research and information to better and fully inform you before you make decisions
• Seek 2nd opinions for any recommendations involving serious surgery or treatment