THE medical profession occupies a certain exalted status of trust and confidence in American society but doctors are going to have to do better in policing their own if they want to keep it.
We make this observation because a first-of-its-kind survey of more than 1,600 physicians shows that while a majority espouse high ethical standards, a good number abandon them when it counts.
In the study, published in the Annals of Internal Medicine, nearly half of the physicians questioned admitted looking the other way when it came to dealing with colleagues' mistakes or incompetence.
The results of the survey, conducted between November, 2003, and June, 2004, to measure adherence to medical ideals and practice, are nothing short of astonishing. Forty-five percent of the respondents said they had had direct personal knowledge of a dangerously inept colleague but failed to report it to appropriate authorities.
Yet 96 percent of the physicians questioned agreed they should turn in such individuals as a matter of professional obligation. Similarly, while 93 percent of the doctors said they definitely should report all significant errors they observe, 46 percent admitted not reporting at least one serious medical mistake they knew about.
The lead author of the survey, Eric Campbell of the Massachusetts General Hospital's Institute for Health Policy, was struck by the fact that although "virtually all physicians believe doctors shouldn't waste scare resources" more than a third said they would order an unneeded MRI for a patient with low back pain who demanded one. From conserving limited resources to managing conflicts of interest and self-policing by doctors, the inconsistencies in acknowledged professional commitment and corresponding conduct abound.Another author, Dr. David Blumenthal, director of the health policy institute, said he didn't expect doctors to always live up to their beliefs. But he was surprised that 25 percent said they would refer patients to an imaging facility in which the doctor had a financial interest. Apparently all of the regulatory agencies and mechanisms in place are not enough to ensure that doctors consistently follow the professional tenets they say they value.
This disturbing gap between principle and practice is something every patient must recognize. After all, what good is all the work to improve patient safety when impaired doctors are allowed to continue practicing with no one the wiser?
In the final diagnosis, it's up to one of the most trusted professions in the country to focus on how to better practice the professionalism it claims to uphold. Anything less compromises the quality of medical care.
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