Many professional medical organizations ethically require doctors to report other doctors who are incompetent or impaired by substance abuse or mental health problems, but as one recent survey found, more than a third of doctors don't turn in their colleagues.
Researchers from Massachusetts General Hospital surveyed nearly 3,000 doctors across multiple specialties, and of the almost 2,000 who responded, 31 percent objected to the idea that they should have a responsibility to report physicians who are incompetent or impaired.
The survey also found that 17 percent of doctors had encountered an impaired or incompetent colleague over the past three years, but only two-thirds of them actually turned those doctors in. Only 69 percent of doctors said they know how to go about reporting a compromised colleague.
Lead study author Catherine DesRoches of the Mongan Institute for Health Policy at Massachusetts General Hospital told ABC News the fact that more than a third of physicians don't agree that they have a responsibility to report doctors with problems is a "signifcant number" she finds troubling.
"Self-regulation is the primary mechanism we use to make sure doctors that shouldn't be practicing are not practicing," said DesRoches. "That's a key to protecting patients."
"This is a very important study, because it reminds us that we're probably not doing what we should be doing," said Dr. Virginia Hood, president-elect of the American College of Physicians and professor of medicine at The University of Vermont School of Medicine.
"Our primary responsibility is always patient safety and what's in the best interest of the patient, and when it appears that we're not doing what we should be doing, it's a matter of great concern," she added.
Doctors who are members of underrepresented minority groups, graduates of foreign medical schools and doctors in smaller practices were less likely to report an impaired or incompetent fellow doctor.
There were three main reasons many doctors did not turn in their colleagues.
"Twenty-three percent believed someone else was taking care of the problem, 15 percent didn't think anything would happen and 12 percent feared retribution," said DesRoches.
The 36 percent of doctors who did not subscribe to reporting their colleagues included those who said they only "somewhat agreed" with their professional obligation to report compromised colleagues and also those who disagreed either somewhat or completely.
"We just took 'completely agrees' and lumped everyone else into a 'don't completely agree' group," said DesRoches.
The reason for that, she said, is because only complete agreement is considered to be consistent with ethical reporting standards set by professional medical societies.
She also acknowledged that if these doctors were lumped into the "agree" grouping, many more of them would have been in agreement with their ethical obligation to report an incompetent or impaired colleague.
In an accompanying editorial, Dr. Matthew Wynia of the American Medical Association's Institute for Ethics argued that the authors see the glass as half-empty.
"A solid majority of physicians (64 percent) 'completely' agreed that they are obliged to report all significantly impaired or incompetent colleagues and, presumably, some number of those who did not agree completely would have agreed 'somewhat,'" he wrote.
DesRoches also notes some of the survey's limitations, including the effect nonresponders could have on the results.
"We did weight our results, but these adjustments are not perfect," she said.
She also acknowledged that evaluating incompetence is very subjective.
At least one other doctor agreed, saying that incompetence is not easy to judge.
"It's rare that you see a doctor who is completely incompetent," said Dr. Rick May, vice president for clinical consulting at HealthGrades, an independent group that rates health care practitioners and institutions. "What's more common is that you see a physician who's incompetent when it comes to using a certain medication or performing a certain procedure."
Doctors who do encounter these situations may take steps to address the problem, but will stop short of reporting a colleague. This, May said, could contribute to the researchers' findings about doctors failing to turn in other doctors.
"If I see a doctor who's incompetent with a drug or a procedure, I'm more likely to pull the colleague aside and talk to that person about using that drug or procedure," he said.
"They take their responsibilities to patients very seriously. When it comes to alcohol or drug abuse, they're going to make sure that doctor doesn't see patients and they'll take action immediately," he said.
While they're ethically obligated to report a physician with substance abuse problems, doctors also have a reponsibility to help others who need it.
"Physicians need to make sure we get help for our colleagues who may not be doing as well as they should. We want to maks sure people get treated and do the right thing," said Hood.
Despite the survey's flaws, experts agree that one finding is particularly sobering.
"A concerning aspect for me is that a significant proportion of doctors didn't really know how to go about addressing issues of incompetent of impaired physicians," said May.
"We are trying to get better processes in place in hospitals and large clinics, and we need to develop ways to help small practices as well," said Hood. "We also need to train our medical students and residents and expose them to the issue and educate them on the ways to handle it."
DesRoches also said that external regulation needs to be stronger and there should also be a confidential feedback mechanism so doctors know what happens when they do turn colleagues in.
"Right now, it goes off to to the state licensing board and doctors may never know what happens," she said.
It's also important for patients to realize they have the power to report an incompetent or impaired physician.
"If the doctor is in a hospital, they should go immediately to hospital administration and express their concerns," said May. "Outside the hospital, it might be appropriate to talk to a doctor's partners or talk to their primary physician and ask for advice, or go to the state medical board."