45% Of Doctors Do Not Report Their Incompetent Collegues

Researchers at Massachusetts General Hospital surveyed 1500 doctors, asking whether or not they reported incompetent colleagues. 90% said that they should always report incompetent doctors or serious medical mistakes, but 45% said that hadn’t always done so.

Some more findings from the AP:

  • A third of surveyed doctors said they would order an unnecessary and expensive MRI scan just to get rid of a complaining patient.

  • A quarter said they would refer patients to an imaging center in which they had a financial interest without revealing the conflict of interest, which could violate certain laws.

  • Two-thirds of the doctors said they accepted patients who are unable to pay, and three-fourths said they had volunteered without pay at least once in the last three years. Overall, 28 percent of the responding doctors’ patients were uninsured or on Medicaid.

  • Fewer than 1 percent said they had lied to patients, and 3 percent reported withholding information from patients or family that those people should have known. Eleven percent reported breaching patient confidentiality.

We are reminded of the wisdom of George Carlin, “Somewhere out there is the worst doctor in the world. And someone has an appointment with him tomorrow.”

Docs Don’t Always Turn in Bad Colleagues [AP]
(Photo:Pfau)

Comments

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  1. Coder4Life says:

    The first one I can kind of see. If a patient is insisting there is something wrong and they cannot find anything. If they are able to send them off to do a CT Scan or MRI and prove to them nothing is wrong or just to get them to calm down. Then yes that might be fine. I have had doctors do that to me, in the recent period.

    I have gone in complaining of paint and complications and they have done many tests and can’t find anything but I am still having problems so thier idea, go do a CT Scan we’ll see everything and now yes everything is ok what do you want us to do?

  2. Beerad says:

    @Coder4Life: Really? I thought the first one was pretty alarm. I mean, “unnecessary and expensive” tests? MRI’s ain’t cheap, ya know. I guess if you’re the one bearing the cost that’s fine, but please don’t clog up my already-expensive insurance coverage with frivolous procedures.

    I think two’s actually not that bad at all. As long as the doctor is using sound professional judgment in referring you, who cares if he’s one of a dozen doctors with an investment in the imaging facility? It’s an issue if the doctor is steering patients toward unneeded treatments or providing worse care by sending you to a shady facility (which are separate issues from disclosure), but I wouldn’t want to discuss my personal finances with patients either.

  3. Beerad says:

    @Beerad: Er, that’s supposed to be “alarming” in the first sentence.

  4. Beerad says:

    @Beerad: Dang it! I meant second sentence. Okay, any further errors y’all are just going to have to deal with. Sorry for the multiple posts.

  5. alexanderpink says:

    Hmm, as a medical student and future doctor I am quite sure I would report any incompetent doctors or dangerous mistakes to the medical board. There is a lo pressure for conformity with the system (like in any profession, I imagine), and this probably contributes to the problem. Additionally, so many doctors have had malpractice suits brought against them on specious legal grounds that this further contributes to siding with their colleagues. In relation to point 1 – most patients would hassle you if you did nothing after finding nothing wrong, and this is preferable to prescribing unnecessary drugs such as antibiotics or pain meds, etc. If no other cause can be found for their complaint, and the imaging study would possibly (not probably) elucidate a cause of their symptoms, it may be acceptable. It is illegal to refer a patient to another physician or center for which compensation is provided. The fact that it still happens is unsurprising, as is the case whenever money is involved. I am shocked that any doctor would lie to a patient or withhold pertinent information. In some Asian countries there is a paternalistic view of doctors, and family will often request the afflicted family member not be told of their condition to avoid adding to their suffering, but this is obviously not shared culturally in America. This may be the reason for this response, but I did not RTFA. Patient confidentiality is in relity probably breached at far higher levels than 11%, but probably for what most people consider reasonable reasons and mostly benign (second opinion, case discussion, etc.), though this does not excuse it. In my limited experience though HIPAA is taken very seriously.

  6. BigNutty says:

    You could get the same results with many different professions. There will always be good and bad in everything.

  7. iamme99 says:

    Not surprised. They got their “good ‘ol boy” network like lawyers, etc. I would guess that if you report others, TPTB at the board level may be annoyed that you are making more work for them when they could be having a long expensive lunch or playing golf somewhere.

  8. shan6 says:

    The second one shouldn’t surprise any of us.

  9. SJActress says:

    Um, isn’t it “colleagues” and not “collegues”?

  10. spinachdip says:

    If Jack hadn’t ratted on his dad for being drunk during the surgery, his dad probably wouldn’t have ran off to Australia, and he wouldn’t have had to go pick up the body, and he never would have boarded Oceania flight 815. And without Jack’s leadership after the crash, the passengers on the flight would have perished on the beach and J.J. Abrams wouldn’t have a hit show.

    Which is to say, it’s important for doctors to report malpractice by their colleagues.

  11. The fourth bothers me the most.

    I suppose I should be more upset about the headline but it just isn’t surprising. After all, would we hear all these stories about incompetent doctors if their co-workers were reporting them like they should?

  12. chasbc says:

    Based on personal experience (i.e., not a scientific survey), I think the 90% is high, and that 45% is low, per IAMME99′s comment on the “gool ol’ boy” club. My father was a psychiatrist and major alcoholic. Talking to another psychiatrist once, he said, “I remember your dad and I were at a conference, and [he] was clearly [drunk - don't remember exact wording] at only 10AM. But what can you do?” I know lawyers have an obligation to report other lawyers who abuse drugs and alcohol; I assume the same goes for doctors. [I don't have any evidence that alcoholism affected my dad's practice, but I would assume it did to a small extent.]

  13. artki says:

    Bonus – from the end of the AP article

    > Researchers at Massachusetts General Hospital mailed a survey, and a $20 incentive check, to more than 3,000 doctors.
    ….

    > And that $20 check? Twenty-one doctors who didn’t answer the survey cashed it anyway.

  14. lalala1956 says:

    You guys do know that the estimated risk of cancer from a ct or MRI scan has been measured in the 1 out of 1,000 range for certain groups of people, right? There is definitely no excuse for giving a shot of radiation like that if it’s not necessary.

    All diagnostic tests that use radiation or a drug like a contrast agent do have adverse event risks.

  15. @alexanderpink: Second opinions and case discussions are typically NOT violations of patient confidentiality; confidentiality typically allows professionals (of any sort protected by confidentiality) to seek the opinions of other professionals protected by the same confidentiality provisions.

    Breaches of patient confidentiality typically come from doctors informing family members of the relative’s condition, either without their permission or against their express wishes. (Which is still something a lot of people consider benign in many situations.)

    Another constantly-occurring HIPAA breach is providing information about a patient’s condition (“stable” “critical” etc.) to callers or reporters, such as after a high-profile accident or incident, without patient consent. (Frankly, if they don’t have consent, they’re not really supposed to tell you if your spouse who just got in a car accident is in the ER when you’re frantically calling hospitals, but that would just be stupid.)

    “as a medical student and future doctor I am quite sure I would report any incompetent doctors or dangerous mistakes to the medical board.”

    I sincerely hope that’s true, but I also think 45% is low. There’s a lot of pressure on doctors NOT to report, both officially (resistant hospitals) and socially (ruining a colleague’s life). Many doctors and nurses don’t think it’ll happen to them, but many ARE pushed into positions where they simply don’t feel comfortable reporting. And there’s a reason that at many hospitals, the reports come from nurses, not doctors — the doctors simply feel too socially constrained to report other doctors, so it falls on the nurses. (Who are also, incidentally, far more easily fired for their actions, which is a very common occurrence.)

    (I teach medical ethics.)

  16. swalve says:

    Very scary. We should all do well to remember that doctors are micro-specialists. Many of them have been focusing on medicine to the detriment of almost all other human activities for the first thirty years of their lives.

  17. alexanderpink says:

    @ EYEBROWS MCGEE

    You are correct in your counterpoint, I was mistaken in wording and meant to say that sometimes doctors discuss other patients cases without the intent of facilitating treatment or in the course of normal care. You also make good points on other areas where common breaches of confidentiality may occur, and point out the difficulty in maintaining HIPAA compliance to a T in the face of situations like high profile patients etc. I think in high profile cases it is not a hidden fact that the person is a patient, so the status update is not disclosing any previously unknown information other than the persons acute state. And yeah, it would be pretty dumb if the ER couldn’t tell you if your loved one was in that hospital. As to your final point (the main point of this article), I think this is the same in all professions, but that it is a more serious issue in professions such as law, medicine, etc. which may have a direct impact on peoples being alive. I have never been one to conform, and I always try to do the just thing, so I would be one of the 55% of physicians who did report. I always think of that Hopkins whistle-blower case regarding residents hours ([ardmoreite.com]) when I see stories like this. As I said in the first post and you reaffirmed, there is a lot of pressure for conformity, but this may be changing as a new generation of doctors that was raised in a different culture takes shape.
    @ SWALVE
    Haha true enough…although you may be surprised to know that lots of doctors have done other things before, during, or after medical school. I have worked in almost every job imaginable to put myself through school. I also majored in philosophy in college instead of science. I have many friends who studied many different areas, friends who have done research, have worked for NGO’s, have been investment bankers, worked at hedge funds etc. But true enough, there are tons of dorky ass people who have very limited people skills in medicine. I would say 20% of the medical population falls into this category, with perhaps 40% total have limited people skills, and unfortunate situation given that such skills are vitally important to our profession and our patient’s care.

  18. Beerad says:

    @lalala1956: I’m certainly no doctor, but I don’t think MRI’s involve any radiation, and if this is something done to pacify the patient I doubt they’re giving the patient contrast just for the heck of it.

    I generally agree that giving the patient any sort of diagnostic involving radiation just to shut them up would be very, very bad. (Although x-rays involve radiation and I don’t know that I would consider that especially terrible).

  19. drunken marmot says:

    I can’t comment on the survey results, but from a patient’s POV, I prefer Tufts- NEMC. I think it is a far more seamless, patient driven hospital.

  20. gibbersome says:

    I’m a medical student who did round at UMass Gen this past year. Let me tell you that the pressure to look after your own is palpable. Doctors make mistakes, they’re only human and it’s unfair to expect them to be correct every single time. As such, I very much doubt doctors to report every single blunder committed by their colleagues.

    That said, I expect doctors that continue to make the same mistakes are usually booted out of a hospital before they cause more trouble, usually without blemishing their records. A bad lawsuit is bad for the doctor as well as for the hospital’s reputation. Of course such doctors can always go to another hospital and practice without much difficulty.