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More than one-third of physicians do not fully agree with the concept of reporting colleagues whose ability to practice is impaired by substance use or incompetence, a survey showed.

When asked in a nationwide survey whether physicians should report such cases, 64% of primary care physicians and specialists said they "completely agreed," Catherine DesRoches, DrPH, of Massachusetts General Hospital in Boston, and colleagues wrote in the July 14 issue of the Journal of the American Medical Association.

Another 31% said they "somewhat agree" with the statement "physicians should report all instances of significantly impaired or incompetent colleagues," DesRoches said in an e-mail to 乌鸦传媒. That left just 5% who disagreed with the statement.

However, among the 17% who said they had encountered an impaired or incompetent colleague in the past three years, only 67% had actually reported the case through appropriate channels, DesRoches and colleagues wrote.

"This finding is troubling," they wrote, "because peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills, or attitudes are compromised."

In an interview, DesRoches said increased education about the importance of reporting compromised colleagues might be needed.

In addition, she told 乌鸦传媒, it should be made clear to all physicians that they have a responsibility to report such cases, even if they think someone else is taking care of the problem.

Adding a confidential feedback system, so physicians who report a colleague know their concern has been addressed, might also improve self-regulation, DesRoches added.

The AMA's Code of Ethics, the Charter on Medical Professionalism, and the European Federation of Internal Medicine all say that physicians have an ethical obligation to report colleagues impaired by substance use or physical or mental illness in all instances.

To assess physicians' beliefs on self-regulation, DesRoches and her colleagues sent surveys to a nationally representative sample of physicians practicing in the U.S. in 2009. The sample encompassed primary care -- family practice, internal medicine, and pediatrics -- as well as certain specialities -- anesthesiology, cardiology, general surgery, and psychiatry.

Overall, 1,891 (64.4%) physicians responded to the survey.

The 36% of respondents who did not subscribe to reporting their colleagues included those who said they only "somewhat agreed" with the professional commitment to report compromised colleagues, as well as those who disagreed either somewhat or completely.

DesRoches said this grouping was justified because only complete agreement was considered to be congruent with the standards set by the professional societies.

Graduates of U.S. medical schools and physicians practicing in hospitals, clinics, universities, or medical schools were more likely to completely agree with the statement that "physicians should report all impaired or incompetent colleagues." Those in solo or two-person practices were less likely to agree with that premise.

More than two-thirds (69%) of the respondents said they were very or somewhat prepared to deal with impaired colleagues in their practice, and 64% said they were prepared to deal with incompetent colleagues.

Among those presented with an opportunity to report a colleague, 67% actually did so.

Physicians working in hospitals or medical schools were more likely to report an impaired or incompetent colleagues compared with those working in smaller practices, similar to the findings on the respondents' attitudes.

DesRoches said a possible explanation could be that larger practice settings have better systems in place for reporting colleagues. In smaller practices, physicians may be unsure about how to report a problem.

Among respondents who had an opportunity to report a colleague, the most common reasons for not doing so were a belief that someone else was already addressing the problem (19%), a belief that nothing would happen as a result of reporting (15%), and a fear of retribution (12%).

"Despite any minor flaws, this research is proof that individual physicians cannot always be relied on to report colleagues who threaten quality of care," Matthew Wynia, MD, MPH, of the AMA's Institute for Ethics in Chicago, wrote in an accompanying editorial.

"Calls for more education, improved socialization into the norms and obligations of professionalism, and better protections for whistle-blowers should be heeded," he wrote.

"Yet the study ... is also a reminder that physicians are always seeking to perfect the complex web of interactive processes used for quality assurance in medicine. That, too, is in the nature of medical professionalism," Wynia commented.

DesRoches and her colleagues noted some limitations, including the possible underestimation of the frequency of failing to report impaired or incompetent colleagues, possible nonresponse bias, and the lack of confirmation of the assertions of impairment or incompetence.