A recent JAMA article reported on the extent to which physicians were willing to report their colleagues to the appropriate authorities when affected by mental illness, substance abuse, or just plain old incompetence (see: Survey: 36% of Docs Don’t Believe in Reporting Impaired Colleagues). Below is an excerpt from the article:
Physicians have an ethical obligation to notify authorities in those cases, but 36% of respondents in a newly published study said they didn’t agree they should always do so. The study, by researchers from the Mongan Institute for Health Policy at Massachusetts General Hospital, reflects the responses of 1,891 doctors in various specialties....Most of the respondents — 69% — said they felt prepared to deal with colleagues who were significantly impaired, and 64% said the same about incompetent colleagues. Of the 17% of physicians who said they had direct personal knowledge of an incompetent physician co-worker, 67% said they reported the colleague. There are a few different options for how a doc would go about reporting a colleague, including licensing boards, medical societies, clinical supervisors and hospital peer-review groups....Why wouldn’t a doctor report someone? According to the survey, due to the beliefs that someone else would do it and that reporting incompetence wouldn’t actually make any difference, in addition to the fear of retribution. The authors also noted that physicians who belonged to one- or two-person practices, are a racial or ethnic minority or who graduated from non-U.S. med schools were less likely to report a physician colleague. Those at hospitals or med schools were most likely to do so....But, [an expert on this topic] says, “Most ethical questions in medicine that seem murky seem much more clear when you ask what’s best for the patients.” And that requires impaired physicians be identified, assessed and, if possible, treated, whether they have outdated skills, are practicing outside their specialty, or have medical problems like sleep apnea or dementia. ([He] estimates some 8,000 practicing physicians suffer from some form of dementia.)
An interesting aspect of this story is why physicians working in one- or two- person practices were less likely to report an impaired physician than those in a hospital or medical school. I suspect the answer to this question is that the latter physicians work in large organizations with many layers of committees, rules, and procedures. When reporting an impaired colleague, they might be afforded more, but not total, protection from retaliation for such an action. Physicians in small practices are highly dependent on referrals from other physicians in the community. It is also likely that an impaired individual practicing in a hospital or medical school setting could hurt the reputation of the institution so that intra-institutional physicians have a greater stake in identifying such individuals.
I must admit that the first scenario that came to my mind when considering impaired physicians was drug and alcohol abuse with emotional issues as a close second. These are the types of cases I personally have observed in my career. I had not really considered the case of physicians suffering from dementia. I now understand that this is a significant issue with an estimated 8,000 in practice. Dementia may be harder to identify than, say, alcoholism, particularly in its early and mid-stages. However, who would be better suited for this task than physicians? This whole issue of physician impairment due to Alzheimer's disease is about to get a lot more complicated with the development of reliable imaging techniques for identifying the earliest forms of the disease (see: New Scan May Spot Alzheimer’s).