4.5[*] Doctors Out of 10 Didn't Report Bum Peers

Nick Gillespie | December 4, 2007

Doctors still get high marks for professionalism and ethics in most surveys, but a new poll of MDs finds:

While 96% of respondents said doctors should always report impaired or incompetent colleagues, only 55% of those with direct personal knowledge of such doctors in the past three years said they always did so.

And while 93% of respondents said doctors should always alert authorities when they observe serious medical errors, only 54% of those who had such information in the past three years said they always did so.

"I think human beings always fall short of their aspirations," senior author David Blumenthal says. "The intent of the paper was not to criticize but to ... highlight the areas for improvement."

More here.

[*]: Early-morning, pre-coffee, elementary math mistake corrected thanks to reader MR.

Comments

|12.4.07 @ 8:31AM|#

If I understand correctly, there should be 4.5 (not 5.5) in the title? (still too bad, of course)

Sulla|12.4.07 @ 9:00AM|#

Huh, this clearly means the government should offer the proper incentives. Maybe $50K for turning in an incompentent colleague?
(just kidding)

|12.4.07 @ 9:15AM|#

So it isn't just the trial lawyers who drive up the cost of malpractice insurance.

|12.4.07 @ 9:38AM|#

Perhaps MDs are smarter than the rest of the populace and don't think that "The Authorities" will:
1. Gather facts first
2. Have a measured response based solely on the facts
3. Actually aim to improve things rather than just aim to look like they've done something.

|12.4.07 @ 9:42AM|#

I wonder how that compares to the percentage of cops who are willing to turn in other cops who regularly break the law themselves.

Episiarch|12.4.07 @ 10:04AM|#

Yeah, if fucking doctors (who literally have life and death responsibilities) don't report incompetence/negligence almost half the time, how high is it with cops?

AAARGGGHHH.

|12.4.07 @ 10:15AM|#

Ages ago, I heard of one doctor with such vices being called "007" by his colleagues because " he has a license to kill".

Dave Woycechowsky|12.4.07 @ 10:30AM|#

Who was the most successful serial killer of all time?

Hint: it wasn't one time law student Ted Bundy.

Shannon Love|12.4.07 @ 10:35AM|#

We have this problem in many fields. The fields require such a high degree of specialized knowledge and experience that few outside the field can judge the competence of those within. However, those in the field form an integral community so it becomes emotionally difficult and politically perilous to discipline members.

In the internet age, we could work around these limitations by forming peer review groups comprised of individual far removed from the target of review. For doctors, for example, the system could start with an anonymous voting system that would refer cases to the peer review. All identifying information for doctors, patients and locals would be stripped from the case and then it would be reviewed by a randomly selected panel of doctors drawn from across the country. If the anonymous review found problems then the case could be referred to a more open form of investigation.

Dividing the accusation from the review would dampen the effects of local politics and personal animosities. Stripping personal information from the cases would reduce other forms of bias.

Not a perfect system but better than the present one that places the whistleblower at as much risk as the accused or that allows the popular and political to destroy the innocent.

|12.4.07 @ 10:38AM|#

I wonder how that compares to the percentage of cops who are willing to turn in other cops who regularly break the law themselves.

Relatively high, I'm sure.

|12.4.07 @ 10:41AM|#

The medical doctors 'White Wall of Silence' is even stronger than the standard police 'Blue Wall of Silence'

Pulitzer Prize winner James B. Stewart's best-seller book, {"Blind Eye -The Terrifying Story of a Doctor Who Got Away With Murder"}, carefully details the career of a young American M.D. named Michael Swango... who literally murdered patients -- while his fellow doctors ignored strong indications of the crimes.

Nurses & patients alike saw the danger signs, but, according to Stewart, the fellow doctors scoffed and did nothing... as Swango moved from institution to institution.

After Swango's arrest, Stewart told the New York Times, "His case shows that the medical establishment will blindly trust the word of a fellow doctor over the word of other witnesses, and that the medical profession cannot adequately police itself."

|12.4.07 @ 11:07AM|#

Ages ago, I heard of one doctor with such vices being called "007" by his colleagues because " he has a license to kill".

In the same vein, my cousin is a nurse, and told me that people around the ICU call HIV patients "High Fives."

Get it? High Five! H-IV!

Other people's misery is so funny!

thoreau|12.4.07 @ 11:25AM|#

In university research labs, the last people you want to call are the safety officers. Leaving aside, for a moment, the politics between the whistleblower and the reported safety violator, there's also the fact that safety officers will inflict collective punishment on the entire department. They won't just identify the unsafe situation and fix it, they'll go around and enforce even the dumbest rules on EVERYBODY (including the whistleblower). If you don't want some idiot coming around and enforcing rules that have no real connection to safety, don't report an unsafe situation.

I don't know what it's like in medicine, but it wouldn't shock me if a similar dynamic was at work. Which would be a shame.

|12.4.07 @ 11:43AM|#

I had read a different (condensed) version of the article yesterday (see it here, and it said that the docs were given $20 dollars to complete the survey. My favorite line of the article was :

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

Nice

Tacos mmm...|12.4.07 @ 11:45AM|#

We have this problem in many fields. The fields require such a high degree of specialized knowledge and experience that few outside the field can judge the competence of those within. However, those in the field form an integral community so it becomes emotionally difficult and politically perilous to discipline members.

Much of medicine is also still a matter of professional opinion, and physicians sometimes have trouble telling their own professional opinions from God's ultimate truth. This tendency to confalte "competent" with "agrees with me" probobably taints a number of polls. The way to judge truly incomptetent physicians is to look at their outcomes compared to their peers in an organized, not anecdotal, way. I would tend to mistrust polls.

|12.4.07 @ 12:02PM|#

Because its such a black and white issue when someone is impaired and/or incompetent.

I mean, I can usually tell just by seeing someone down the hall. Can't you?

Dave Woycechowsky|12.4.07 @ 12:16PM|#

Because its such a black and white issue when someone is impaired and/or incompetent.

I mean, I can usually tell just by seeing someone down the hall. Can't you?

It is about as hard as figuring out which lawsuits are frivolous.

|12.4.07 @ 12:57PM|#

Get it? High Five! H-IV!

Wouldn't that be a High Four?

Matt Moore|12.4.07 @ 1:37PM|#

I think he meant Hi-V.

The 007, "license to kill" joke was on Grey's Anatomy.

Tacos mmm...|12.4.07 @ 1:45PM|#

The 007, "license to kill" joke was on Grey's Anatomy.

And if you've seen "Scrubs," you should remember Doug, the resident who killed most of his patients. These are trope characters, although there is some reality to the "dangerous intern."

|12.4.07 @ 2:32PM|#

Ummm, if a doctor reports on a colleague, they're likely to also be listed as a named defendant in the inevitable malpractice lawsuit, because lawyers like to throw in anyone even peripherally connected to a case, especially if they have deep pockets.

And, the first time a doctor gets hit with a completely frivolous, meritless malpractice case (and, this happens to virtually ALL doctors), a loathing for folks like John Edwards tends to set in, making one uninclined to make them even richer.

There are some scary doctors out there -- someone has to graduate in the bottom 1% of their graduating medical school class -- but those incompetents tend to quickly rack up a series of lawsuits without any help from their colleagues. I mean, if you botch a case, the patient tends to notice it, yeah?

Shannon Love|12.4.07 @ 2:33PM|#

Tacos,

The way to judge truly incomptetent physicians is to look at their outcomes compared to their peers in an organized, not anecdotal, way.

That can be very difficult because of variation in the nature and number of cases that doctors take. Some doctors informally specialize in difficult cases which means that even though they may be supremely competent their superficial success rate appears low.

It's the classic problem of how to the measure the unmeasurable. Creating objective metrics for something like clinical medicine is far, far more difficult than a naive observer might suppose.

Tacos mmm...|12.4.07 @ 4:07PM|#

That can be very difficult because of variation in the nature and number of cases that doctors take. Some doctors informally specialize in difficult cases which means that even though they may be supremely competent their superficial success rate appears low.

Indeed. Surgical oncologists, for example, routinely do procedures that the average general surgeon will not due to high complexity and possibility for a poor outcome. Obviously, what is meant by "peers" would vary from field to field. In surgery, one's peers might be anyone doing the same list of procedures in patients with similar operative risks. Internists could be compared to others of the same subspecialty in the same community. Even then, though, there are likely to arise serious descrepencies. You're right in that there really is no great way to identify poor physicians objectively, but I think it still stands that anecdote is the worst way to evaluate professional competence.

|12.4.07 @ 11:33PM|#

No doubt nobody's still reading this thread but ...

Q: Whaddaya call the guy who graduates last in his medical school class?

A: Doctor.

If you think you can handle the real insight into the alleged medical profession, check out the book "House of God" by Samuel Shem. You won't go near a hospital again.

|12.5.07 @ 4:51AM|#

Migth the low figure partly be the result of the doctors knowing that someone else has already outed the medical error?