2017 HSC Section 2 - Practice Management

IMPAIRED AND INCOMPETENT PHYSICIAN COLLEAGUES

of the more frequent reasons for non- reporting. This study has several limitations. First, because of reliance on voluntary disclosure of failure to report im- paired and incompetent colleagues, these failures may be viewed as nega- tive, and the results likely represent a lower-bound estimate of the actual frequency of nonreporting. Second, al- though the response rate was rela- tively high for a physician survey, non- response bias might exist. Attempts weremade to adjust for the possible bias through weighting, but such adjust- ments are imperfect. Third, the accu- racy of the respondents’ beliefs about whether their colleagues were, in fact, impaired or incompetent cannot be verified. Physicians may have made er- roneous judgments about their col- leagues’ functioning and competence. It is possible that what a physician re- ported as incompetence may have been, for example, a difference of opinion re- garding a diagnosis or treatment plan. Survey methods do not allow determi- nation of exactly how often this mis- classification happens. REFERENCES 1. Leape LL, Fromson JA. Problem doctors: is there a system-level solution? Ann Intern Med . 2006;144 (2):107-115. 2. American Medical Association (AMA). Code of Medical Ethics. AMAWeb site. http://www.ama-assn .org/ama/pub/physician-resources/medical-ethics /code-medical-ethics.shtml. Accessed February 16, 2010. 3. Massachusetts General Laws, chapter 112, §5F. State of Massachusetts Web site. http://www.mass .gov/legis/laws/mgl/112-5f.htm. Accessed Febru- ary 16, 2010. 4. ABIM Foundation, ACP-ASIM Foundation, Euro- pean Federation of Internal Medicine. Medical pro- fessionalism in the newmillennium: a physician charter. Ann Intern Med . 2002;136(3):243-246. 5. Kurlander JE, Morin K, Wynia MK. The social- contract model of professionalism: baby or bath water? Am J Bioeth . 2004;4(2):33-36. 6. Wynia MK. The short history and tenuous future of medical professionalism: the erosion of medicine’s social contract. Perspect Biol Med . 2008;51(4): 565-578.

Overall, this study calls into ques- tion the willingness and ability of physicians to identify and report col- leagues whose ability to practice medicine is impaired by alcohol or drug use or by physical or mental ill- ness, as well as those incompetent to practice because of deficits in knowl- edge and skills. These findings fur- ther suggest that a large number of practicing physicians do not support the current process of self-regulation: it is underused and appears to have several major shortcomings, includ- ing a perceived lack of anonymity and efficacy. All health care profes- sionals, from administrative leaders to those providing clinical care, must understand the urgency of prevent- ing impaired or incompetent col- leagues from injuring patients and the need to help these physicians confront and resolve their problems. The system of reporting must facili- tate, rather than impede, this pro- cess. Reliance on the current process results in patients being exposed to unacceptable levels of risk and in impaired and incompetent physicians 7. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000. 8. Swidey N. The revolutionary. The Boston Globe . http://www.boston.com/news/globe/reprints /010404_the_revolutionary/. January 4, 2004. Ac- cessed February 16, 2010. 9. Campbell EG, Regan S, Gruen RL, et al. Profes- sionalism in medicine: results of a national survey of physicians. Ann Intern Med . 2007;147(11):795- 802. 10. Neff KE. Understanding and managing physi- cians with disruptive behavior. In: Ransom SB, Pin- sky WW, Tropman JE, eds. Enhancing Physician Per- formance: Advanced Principles of Medical Management. Tampa, FL: American College of Phy- sician Executives; 2000:45-72. 11. Barnard A. Doctors’ behavior gets new scrutiny. The Boston Globe . August 18, 2002:A1. 12. Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a

possibly not receiving the help they need. Author Contributions: Dr DesRoches had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: DesRoches, Fromson, Birnbaum, Iezzoni, Campbell. Acquisition of data: DesRoches, Campbell. Analysis and interpretation of data: DesRoches, Rao, Fromson, Birnbaum, Iezzoni, Vogeli, Campbell. Drafting of the manuscript: DesRoches, Fromson, Birnbaum, Campbell. Critical revision of the manuscript for important in- tellectual content: DesRoches, Rao, Fromson, Birnbaum, Iezzoni, Vogeli, Campbell. Statistical analysis: DesRoches, Rao. Obtained funding: DesRoches, Campbell. Administrative, technical, or material support: Campbell. Study supervision: DesRoches, Iezzoni, Campbell. Financial Disclosures: None reported. Funding/Support: This study, which is the second in the series, was supported by a grant from the Insti- tute on Medicine as a Profession. Role of the Sponsor: The Institute on Medicine as a Profession had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, re- view, or approval of the manuscript. Additional Contributions: We would like to thank our expert advisory panel for their invaluable feedback on our survey instrument. David Rothman, PhD (Presi- dent, Institute on Medicine as a Profession), pro- vided feedback on the design and conduct of the study, as part of our expert panel, but had no role in the col- lection, management, analysis, and interpretation of the data or in the preparation, review, or approval of the manuscript. state medical board. Acad Med . 2004;79(3):244- 249. 13. Samkoff JS, McDermott RW. The hospital and the impaired physician. Pa Med . 1990;93(2):40-42. 14. Sharpe VA, Faden AI. Medical Harm: Historical, Conceptual, and Ethical Dimensions of Iatrogenic Illness. New York, NY: Cambridge University Press; 1998. 15. Fromson J. Addressing clinician performance prob- lems as a systems issue. In: Youngberg B, Hatlie MJ, eds. The Patient Safety Handbook. Boston, MA: Jones & Bartlett; 2004:423-430. 16. Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. A national survey of physician-industry relationships. N Engl J Med . 2007; 356(17):1742-1750. 17. Number of paid medical malpractice claims, 2008. The Henry J. Kaiser Family Foundation Web site. http: //www.statehealthfacts.org/comparemaptable .jsp?ind=436&cat=8&sort=a&gsa=2. Accessed June 8, 2010. 18. Korn EL, Graubard BI. Analysis of Health Surveys. New York, NY: John Wiley & Sons Inc; 1999.

©2010 American Medical Association. All rights reserved.

(Reprinted) JAMA, July 14, 2010—Vol 304, No. 2

43

Made with FlippingBook flipbook maker