Physicians Often Do Not Follow Professional Standards

Physicians often fail to report a serious medical error or an impaired or incompetent colleague, although their professional standards require such actions, according to a survey published on recently in the Annals of Internal Medicine.

For the study, researchers led by Eric Campbell of the Institute for Health Policy at Massachusetts General Hospital from November 2003 to June 2004 mailed a survey to 3,504 U.S. internists, family practitioners, pediatricians, surgeons, cardiologists and anesthesiologists and received 1,662 responses. The survey asked respondents whether they agreed with 12 specific statements about fair distribution of limited resources, improvement of health care access and quality, management of interests and self-regulation by physicians (Kowalczyk, Boston Globe, 12/4). Physicians received a $20 check with the survey (AP/Boston Herald, 12/4).

According to the study, 46% of respondents said they failed to report at least one serious medical error, although 93% said that physicians should report such errors in all cases. Forty-five percent of physicians said that in some cases they failed to report an incompetent or impaired colleague, although 96% said that physicians should report such colleagues in all cases, the study found. In addition, the study found that:

  • A majority of respondents said that they would refer patients to a medical imaging facility in which they had financial ties, although only 24% would inform patients of their financial ties;
  • 96% of respondents said that physicians should place the welfare of their patients above their financial interests;
  • 36% of respondents said that they would order an unnecessary MRI for patients with back pain, although most said that they oppose unnecessary use of medical resources;
  • 93% of respondents said that physicians should provide medical care to patients who cannot afford to pay, and 69% said that they accept patients who lack health insurance (Lee, Washington Post, 12/4);
  • 98% of respondents said that physicians should seek to reduce health care disparities based on gender or race, although only 25% said that they have sought to identify such disparities (Stanchak, CQ HealthBeat, 12/3); and
  • Less than 1% of respondents said that they had lied to the family of a patient in the past three years, and 3% said that they had withheld information.

According to the Boston Globe, the study sought to measure the “success of a new movement called ‘medical professionalism'” — which maintains that “government regulation, financial incentives and public reporting alone will not improve the quality and efficiency of medical care” and seeks a modernization of the professional standards of physicians to address financial conflicts of interest, health care technology, medical errors and health care disparities (Boston Globe, 12/4).

Campbell said, “We found large gaps between physicians’ espoused attitudes and what they do in actual practice,” adding, “Failing to report incompetent physicians and allowing them to practice will have an impact on the welfare of patients. It’s clearly something that people should be aware of” (Washington Post, 12/4). In addition, Campbell said, “This raises serious questions about the ability of the medical profession to regulate itself” (CQ HealthBeat, 12/3).

David Blumenthal, a co-author of the study and director of the Institute for Health Policy, called for an increased focus on professional standards among physicians, rather than increased regulations, to address the issue. He said, “If the medical board and regulatory apparatus were monstrous, it wouldn’t solve our problems,” adding, “Sure, regulation has an important role. Yes, patient information has an important role. But in the end, if the profession doesn’t step up, we will all be the worse for it” (Washington Post, 12/4).

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