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 Post subject: Study in Annals of Internal MED: Colleague errors unreported
PostPosted: Fri Dec 07, 2007 3:20 pm 
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Study finds 45 percent of physicians do not report errors by colleagues.

The Washington Post (12/4, A8, Lee) reports that "when it comes to dealing with colleagues' mistakes or incompetence, many doctors abandon the high standards they espouse," according to a new study published in today's issue of the Annals of Internal Medicine. For the study, lead author Eric Campbell, Ph.D., an assistant professor at Massachusetts General Hospital's Institute for Health Policy, and colleagues, surveyed 3,504 practicing physicians, and received responses from "more than 1,600 physicians." The researchers found that "45 percent said they did not always report an incompetent or impaired colleague to the appropriate authorities -- even though 96 percent agreed that doctors should turn in such people." In addition, "46 percent said they had failed to report at least one serious medical error that they knew about, despite the fact that 93 percent of doctors said physicians should report all significant medical errors that they observe." Campbell stated, "We found large gaps between physicians' espoused attitudes, and what they do in actual practice." Furthermore, he noted, not reporting "incompetent physicians and allowing them to practice will have an impact on the welfare of patients."

According to the AP (12/4), the researchers also found that 33 percent of the respondents "would order an unnecessary and expensive MRI scan just to get rid of a complaining patient." Twenty-five percent of them said that "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." Furthermore, 66 percent of respondents said that "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." In addition, about "28 percent of the responding doctors' patients were uninsured or on Medicaid."

USA Today (12/4, 8D, Rubin) reports that this is the first study which has attempted "to broadly assess doctors' support for, and adherence to, professional standards." The researchers surveyed cardiologists, anesthesiologists, surgeons, internists, and pediatricians, and found that among "the specialties surveyed, cardiologists were the least likely to say they always reported direct knowledge of a serious medical error." Furthermore, "by just 0.8 percent, cardiologists were second only to family practitioners in being least likely to report an impaired or incompetent doctor." Senior author David Blumenthal, M.D., a Harvard internist who directs Massachusetts General Hospital's health policy institute, points out that the "intent of the paper was not to criticize, but to...highlight the areas for improvement."

In a New York Times (12/3) health blog, Tara Parker-Pope wrote that ten percent of the respondents "admitted to violating patient confidentiality." An additional "15 percent said patients shouldn't be informed when medical mistakes occurred," and surprisingly, "nine percent of doctors said it was sometimes appropriate to have a sexual relationship with patients."

But some physicians said that "today's emphasis on patient satisfaction often puts doctors in a no-win situation when a patient insists on something that is unnecessary," the Boston Globe (12/4, Gil) reports. Consequently, "the physician must either waste resources, or risk an unhappy patient who might drop them as their doctor. This dilemma can be especially difficult for a doctor whose employer uses patient satisfaction surveys to help evaluate their work."

Yet, Modern Healthcare (12/4, Lubell) quotes Campbell as saying that the study's finding "raises serious questions about the ability of the medical profession to regulate itself."

WebMD (12/4, Zwillich) reports that the "reasons for the disconnect" between the beliefs and the actions of the responding physicians "are unclear, though researchers say many doctors may fear retribution or lawsuits if they expose bad behavior of colleagues." The researchers "also suggest that legal regulations governing doctors' ethics may not be strong enough."

Congressional Quarterly (12/4, Stanchak) adds that during "a forum Monday at the National Press Club to discuss the study's findings, James Thompson, CEO of the Federation of State Medical Boards, argued that doctors were penned in by the American healthcare system, fighting giant bureaucracies, while fearing legal action if they make" an error. According to Thompson, "We need to replace this system of punitive measures with non-punitive remediation." U.S. News and World Report (12/4, Comarow, Avery) also covers the story.

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