Regulate Yourself: Physicians Underreport Impaired Colleagues
A study by the Journal of the American Medical Association suggests that patients must increasingly rely on their doctor’s honest assessment of his own health, rather than the supervision of his colleagues. Physicians are simply not reporting colleagues whose disability endangers patients.
Traditionally, the medical profession has relied on internal mechanisms to guarantee that patients’ needs are met. A number of ethical codes require a physician to report a colleague who is suffering any disability or impairment that leaves him unable to safely care for his patients. As Matthew K. Wynia, MD, Director of the AMA Institute for Ethics, noted in an interview with American Medical News, “[r]eporting incompetent or impaired colleagues is a clear-cut professional obligation.”
Unfortunately, physicians are not following through on that obligation, even when the disability causes an unquestionable risk to patients.
The most common explanation given for failing to report a colleague was the belief that “someone else was taking care of the problem.” Physicians may conclude that their colleague is already aware of the effect his disability could have on patients, and that he would take time off if he felt his condition merited it. They may even assume that he is already taking steps to file a disability claim. They may also be reluctant to intrude on a personal crisis, preferring to leave their colleague to his own social and financial safety nets, such as close friends, family, or disability insurance.
Perhaps more revealing is the fact that 8% of respondents “believed it could easily happen to them.” The thought of being deprived of one’s own occupation, livelihood, and income by the sudden onset of an impairment or disability is certainly troubling at best. Physicians may feel that, if they were disabled and could not safely continue working, their colleagues might doubt their personal fitness for the medical profession. Moreover, they may fear a loss of income or the intense scrutiny imposed by disability insurers and claims representatives. They cannot bring themselves to put a colleague—and perhaps a friend—in that position.
One solution is increased reliance on the physician’s own evaluation of his disability—he must remain cognizant of his own health, and recognize when it is appropriate to take disability leave. Combined with an ongoing reporting obligation, the result would be a higher standard of care and safety for patients.
While the medical profession has always been self-regulating, the regulation of self—the honest evaluation of one’s own disability and capacity for fulfilling the obligations of his own occupation—may become an invaluable means for guaranteeing patient safety. As Dr. Wynia points out, “It’s not just a matter of doctors peeping over each others shoulders.”
