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Regulate Yourself: Physicians Underreport Impaired Colleagues

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study by the Journal of the American Medical Association (JAMA) suggests that physicians often do not report colleagues suffering from a disability. Patients are instead forced to rely upon their doctor’s own assessment of his health; this can endanger patients where the doctor is not fully cognizant of his abilities.

The medical profession has traditionally relied upon internal mechanisms to meet patients’ needs. Ethical codes require a doctor to report a fellow doctor who suffers from a disability or impairment that affects his ability to safely care for his patients. “Reporting incompetent or impaired colleagues is a clear-cut professional obligation,” according to Matthew Wynia, Director of the American Medical Association’s Institute for Ethics. Unfortunately, doctors are not following through on that obligation, even when the disability causes clear risks to patients.

Doctors often suffer from the same bystander effect as the rest of us — the most common explanation for failing to report a colleague was the belief that someone else was taking care of the problem. Additionally, doctors may believe that their colleague knows about the effect of his disability on his patients and would take time off if he believed it posed risks. They may also assume that he is already filing a disability claim, or may be reluctant to personally intrude, preferring to let their colleague’s social and financial safety nets handle it.

More revealing is the fact that 8% of respondents believed “it could easily happen to them.” A disabling condition that deprives one of work, livelihood, and earnings is very worrisome. These findings could reflect physicians’ own internal fears. They may feel that if they were disabled and could not continue working, their colleagues might doubt their medical abilities. They may fear losing their income or having to defend themselves from the pressure of the disability insurer. Most of all, they don’t want to put a colleague (and perhaps a friend) in that position.

A solution to this problem is to ensure that the physician remains cognizant of his own health and is able to recognize when he needs to take disability leave. Increased emphasis on own evaluation of disability, combined with a reporting obligation, could lead to better and safer care for patients.

The honest evaluation of one’s own disability and capability for safely fulfilling the duties of his own occupation may become an invaluable means for guaranteeing patient safety. As Dr. Wynia points out, “It’s not just a matter of doctors peeping over each others shoulders.”

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