Even though many US states demand that doctors report colleagues whose performance is impaired by alcohol or drug use or by physical or mental illness, a survey in a recent issue of JAMA suggests that a third of them would not do it.

Catherine M. DesRoches, of Massachusetts General Hospital, in Boston, found that only 64% of American physicians agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice.  About 17% of the physicians surveyed had dealt with an impaired colleague, but on 67% of these had blown the whistle.

Overseas doctors and underrepresented minority physicians were significantly less likely than other physicians to report. The most frequently cited excuses included the belief that someone else was taking care of the problem; the belief that nothing would happen as a result of the report; fear of retribution; the belief that reporting was not their responsibility; or that the physician would be excessively punished.

"These… raise important questions about the ability of medicine to self-regulate,” say Dr DesRoches and her colleagues. “More than one-third of physicians do not completely support the fundamental belief that physicians should report colleagues who are impaired or incompetent in their medical practice. This finding is troubling, because peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills, or attitudes are compromised…

“Reliance on the current process results in patients being exposed to unacceptable levels of risk and impaired and incompetent physicians possibly not receiving the help they need." ~ JAMA, July 14