Physicians’ willingness to report impaired colleagues

Abstract

We surveyed physicians to determine what factors were associated with their reporting of impaired colleagues to Physician Health Programs (PHPs). We conducted a cross-sectional mail survey of 1000 randomly selected practicing physicians in the United States. A survey instrument asked the physicians whether they would report 10 hypothetical impaired colleagues to a PHP. The results show that a majority of the physicians would report physicians to PHPs, but were more likely to report hypothetical physicians involved in substance abuse than those who were emotionally or cognitively impaired $(p<0.001)$. Respondents who felt they had a societal obligation as opposed to an obligation to protect the rights of the individual $(p=0.006)$ were more likely to report hypothetical physicians. Those respondents who stated they knew of guidelines on reporting impaired physicians had more frequently reported impaired colleagues $(p<0.001)$. We conclude that physicians should be educated on the availability and functioning of PHPs and the ethical and legal obligations of assisting impaired colleagues.

Introduction

It has been estimated that 8–12% of all practicing physicians at some point in their career will develop a disorder involving substance abuse (McCall, 2001), which was the original definition of physician impairment (American Medical Association Council on Mental Health, 1973). More recent definitions of impaired physicians include those physicians who have physical or cognitive impairment or sexual misconduct (Poma, 2000).

Many colleagues may find themselves facing an ethical dilemma of having to choose between protecting the privacy of the impaired physician on the one hand and the safety of patients on the other (Collins, 1998). Physicians may fail to report an impaired colleague due to potential adverse social, financial and legal consequences (McCall, 2001). In order to overcome these problems, physicians’ health programs (PHPs) have been established in 46 of the 50 states (Rice, 1999) in the US. PHPs monitor physicians with substance abuse or psychological difficulties, and provide psychiatric and/or medical assistance to impaired physicians (Roberts & Specker, 1999). PHPs, however, vary considerably with respect to their independence.

Although physicians are felt to have the ethical (and in some states, legal) duty (Rice, 1999) to report impaired colleagues, the social stigmatization of both the impaired physician and the accusing physician may be preventing them from doing so. Impaired physicians who are not reported by colleagues may not be seen in PHPs (Wijesinghe & Dunne, 1999). As there are no data to indicate how likely physicians are to report their impaired colleagues, we surveyed physicians about their views on the reporting of impaired colleagues to PHPs.