Map of life expectancy at birth from Global Education Project.

Tuesday, December 04, 2007

I'm shocked, shocked, to find that ass covering is going on here

No doubt you've heard the news that nearly half of physicians surveyed say they have known about impaired colleagues but have not reported them. The principal investigator finds this absolutely astonishing, but what astonishes me is that he finds it astonishing. Everybody who hangs around the profession knows this -- not only do doctors not report impaired colleagues, they give positive recommendations when incompetent physicians seek work elsewhere. What surprises me is that only 45% will admit to this, when the true figure is probably much closer to 100%.

What's even more astonishing about this survey is that only 1 to 3 percent of respondents admit to not telling patients or family members about errors they have made themselves. Hah! Pish tosh. Balderdash. It has been well established that physicians have a deeply ingrained culture of excusing and minimizing errors among themselves, and not telling patients when they screw up. What is really happening in this survey is denial -- physicians not recognizing their own behavior.

It does surprise me a bit that 25% say it's perfectly okay to refer patients to imaging facilities in which they have a financial interest, since that is actually illegal in most states. I would have expected them to give the "correct" answer. Even if they routinely violate the law it's rather brazen to admit it.

Still, this survey was a useful exercise. Efforts are underway to promote transparency and constructive handling of mistakes in medicine. Mistakes will happen, so the professional culture and institutions need to put a stop to the coverups that are currently routine -- so deeply ingrained in the culture that, as I say, only 3% of doctors even admit in confidence to what they actually do, probably because they don't even recognize it -- and allow errors to be addressed openly so that lessons can be learned.

Many physicians will say that the problem is fear of being sued. However, that fear is misplaced. There is little or no relationship between the likelihood of a patient initiating a lawsuit and the reality of negligence or incompetence. Mistakes are not necessarily negligent and don't normally incur liability. But patients don't like finding out that they have been lied to, and they don't like being treated inhumanely or disrespectfully. Those are the real factors that trigger most lawsuits.

So come clean Doc. It will make you a better doctor and a more humane healer. As for Doctor Doofus or Doctor Thirsty down the hall, turn him in and get him the help he needs. It's the right thing to do.

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