Would you turn in an incompetent colleague?

A recent report published in the Journal of the American Medical Association (JAMA) revealed that many medical doctors have direct, personal knowledge of an impaired or incompetent physician in their workplaces but won’t report them.

Doctor thinkingThe researchers, led by Catherine DesRoches of Harvard Medical School, surveyed 1,891 practicing US doctors in order to “understand physicians’ beliefs, preparedness, and actual experiences related to colleagues who are impaired or incompetent to practice medicine.”

A majority of the doctors surveyed (64%) said they agreed that it was important to report other MDs who were “significantly impaired or otherwise incompetent to practice.” But just 69% said they were prepared to really do anything about the situation if it came up in their practice.

More shocking was the revelation that 17% of the doctors had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice. But of those, a full one third (33%) had not reported the colleague to the relevant authority.

The reasons they gave for their silence were the belief that someone else would take care of the problem (19%), the belief that nothing would happen as a result of the report (15%) and fear of retribution (12%).

The actual numbers might be even higher since, of the 2,938 physicians contacted, only 1,891 agreed to take the survey — the other 36% might have decided the questions were a bit too delicate to answer.

As bad as this sounds, I wonder how it differs from the chiropractic profession (or any health care profession). Granted, an incompetent chiropractor is far less of a threat to a patient’s well being than an incompetent MD, but what do we do when we realize a fellow DC is significantly impaired? If we know a colleague is drinking or using drugs during work, or is otherwise unfit to care for patients, do we report him or her to the board?

I realize that there have been many (far too many) cases where chiropractors have “tattled” on their competition for the most trivial infractions of the rules, but that’s a far cry from accusing another practitioner of being incompetent.

This is one of those grey areas that require soul searching and total honesty. If we truly believe that a colleague might do any harm to patients or to the profession as a whole, we owe it to those patients and chiropractic to take a courageous stand. We might try approaching the doctor and discussing the situation with him or her, offering to assist in getting the person proper help overcoming the problem. If that doesn’t work, we may have no choice but to file a complaint with the state board.

SOURCE: “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues,” JAMA. 2010;304(2):187-193. doi:10.1001/jama.2010.921

40 percent of malpractice claims are for diagnostic errors

By Terry A. Rondberg, DC

Journal of the AMA - logoA commentary published in the July 28 issue of the Journal of the American Medical Association (JAMA) revealed that diagnostic errors are the single largest contributor to medical malpractice claims, accounting for about about 40% of all claims and costing approximately $300,000 per claim.

The authors — Mark Graber, MD, of Stony Brook University Medical Center; and Hardeep Singh, MD, MPH, of Baylor College of Medicine — pointed their fingers at everything BUT the practitioners themselves.

“The great majority of diagnostic errors have root causes that derive from the properties of the healthcare setting, organization and practice,” Dr. Graber said. “By working together, cognitive scientists, informaticians, clinicians, and human factors engineers have a unique opportunity to decrease the likelihood of diagnostic error to the extent that the five principles we outline in JAMA can be incorporated into every new medical home.”

The authors discussed a new model of primary care, called the patient-centered medical home, developed and endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association.

The model facilitates partnerships between individual patients, their personal physician, and, when appropriate, the patient’s family. Care is assisted by physician “extenders,” nurse empowerment, information technology, and other means to assure that patients get care when and where they need and want it in a culturally and linguistically appropriate manner.

The medical home model places emphasis on team-based care, and primary care teams could include not only physicians but also nurses, allied health professionals and personnel, the authors explained.

In this model, the medical doctor would be the gatekeeper and decide what role the “allied” health professions would have. “The physician could take a leadership role, while the entire group collectively takes care of the patient,” explained Dr. Singh.

It’s always heartening to see the medical profession recognize and admit the problems inherent in the current disease-oriented system, such as misdiagnoses, prescription errors, unnecessary surgeries, etc.

Still, I’ll continue to work toward the time when we supplant the old paradigm of labeling and treating conditions and symptoms with the new holistic view of the human body as a complex system of energy patterns that responds to non-invasive care such as chiropractic and other “energy medicine” approaches. And I especially look forward to the time when we don’t label all wellness and healing modalities as “medicine!”