Why doctors often don’t report their colleagues’ mistakes

Many physicians decline to report blunders committed by incompetent, impaired or mentally troubled colleagues, some physicians and health experts say.

That is why it was surprising in January when two local physicians, Jason Miller and Mark Puccioni, sued Children’s Hospital & Medical Center, its leadership and surgeon Adam Conley in part because, the doctors allege, the surgeon is incompetent. The defendants have denied the accusation , saying the two surgeons have business motives for their suit.

Every profession has people who aren’t good at their work, are impaired by substance abuse or struggle with performance-crippling burnout. It’s no surprise, then, that the medical community has weak performers, but unknowing patients nevertheless count on them — sometimes desperately — to heal their physical or psychological problems.

“I do understand the reluctance to report” weak or unethical doctors, said Dr. Les Spry, a Lincoln kidney specialist and a past president of the Nebraska Medical Association. “But I do remind doctors that there’s a duty to report.”

Among the reasons for reluctance are fear of retaliation or alienation by members of the medical community, the bureaucratic hassle of getting involved and the understanding that everyone commits errors.

Few complaints lead to sanctions.

There were no disciplinary actions taken last year by the Iowa Board of Medicine after physicians filed complaints against other physicians. Physicians had filed 13 such complaints and, in all, health professionals, patients, patients’ families and others filed 516 complaints against doctors.

It’s not clear how many doctor-against-doctor complaints were made in Nebraska last year because that isn’t tracked here, the Nebraska Department of Health and Human Services said. But there were 12 actions taken against doctors after 300 complaints from a variety of sources, such as patients and families. Disciplinary measures can include probation, suspension, fines and other things.

Jay Wolfson, associate vice president of USF Health in South Florida, said in an email that most doctors “are reluctant to report an incompetent doc because of the fraternity mentality that still exists.” Sign up for the Live Well Nebraska newsletter

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Wolfson said they also might feel that “there but for the grace of God go I.” Also, it’s sometimes hard to pin blame for a bad outcome on one person, and patient compliance with instructions can be a factor in disappointing results.

But there are times within institutions and medical communities, Wolfson said, in which physicians might “gang up” on somebody they do not like, “either because of clinical variances, behavioral issues — or because there may be a perceived economic threat.”

A Johns Hopkins Medicine surgeon, Dr. Marty Makary, wrote in his 2012 book, “Unaccountable,” that physicians generally have good intentions and sound training. But despite swearing to do no harm, Makary wrote, “on the job they soon absorb another unwritten rule: to overlook malpractice in their colleagues.”

Evelyn McKnight was one of at least 99 people who contracted hepatitis at the Fremont Cancer Clinic because of contaminated syringes and saline bags in the early 2000s. Six died of hepatitis C. They were being treated by a cancer specialist, Tahir Javed, who eventually fled to Pakistan.

McKnight said patients, nurses and lab personnel had begun talking with health care professionals in the area about dubious practices at the clinic. But doctors are not required in Nebraska to report concerns unless they have “firsthand knowledge” of illegal or unethical behavior.

Spry said doctors may report without firsthand evidence, but the complaint would be treated as hearsay.

McKnight said reporting incompetence or illegal practices to the State Health Department is simply the right thing to do if the medical community is getting numerous complaints about a professional’s practices. “I think that’s just ethical behavior,” she said.

Spry said that in talking to med school classes or young doctors, he makes the point that a doctor can lose his license if he doesn’t report bad behavior. “We don’t tell medical students enough about jurisprudence,” he said.

Nevertheless, Spry said, doctors with busy practices don’t want to spend a lot of time reporting and testifying about another doctor’s incompetency, drinking problem or mental illness. Doctors wonder, he said: “How much do I have to get involved? How much of a pain is this going to be?”

A doctor might also report an impaired or bad physician to a hospital chief of staff, division chief or chairman of credentialing, Spry said, but an investigation by the hospital could be done only if the doctor in question has hospital privileges.

Dr. Susan Goold, a University of Michigan professor of internal medicine, said it’s “unusual to sue a hospital to get them to fire a doctor.” The Omaha surgeons’ lawsuit doesn’t cite reasons for the alleged incompetence.

“I don’t think the profession has been nearly good enough at self-policing,” said Goold, who was on the American Medical Association Council on Ethical and Judicial Affairs from 2007 to 2014. The emphasis should be on trying to improve and correct a doctor’s performance, she said.

Dr. Donald Frey, a professor of family medicine at Creighton University, described an odd period in his career 30 years ago when he was practicing in West Virginia. The opposite of reluctance to report took place. Rival doctors in the city of Clarksburg reported minor differences of opinion and claimed they were “major quality issues.” Frey said they also encouraged patients to report dissatisfaction with the rival to the state board of medicine. Frey wasn’t involved in the skirmish.

“This went on for only a few years, and one of the physicians eventually left the community,” Frey said in an email. “The whole episode didn’t do the community any good, and certainly didn’t serve the patients well.”

The American Medical Association has been involved in a nationwide survey of doctors to assess levels of physician burnout and depression. The AMA wouldn’t discuss it because it hasn’t been reported yet in a medical journal.

Spry said some doctors’ effectiveness can be impaired by depression, but they don’t like to admit to the levels of stress and burnout with which they are dealing. The profession is improving in this regard, he said. “So I think that we’re starting to recognize that a little more.”

Baltimore-based Makary wrote seven years ago that whistleblowing doctors sometimes become targets themselves. They can be assigned to more emergency calls, given fewer resources to work with, or “simply bad-mouthed and discredited in retaliation.”

Makary said he had seen doctors run out of their communities “because their honesty and outspokenness began to poke the bear.” Buy Now Thought to be brain dead, doctors took former Creighton Bluejays play-by-play announcer T. Scott Marr off life support. Before his family settled on a funeral home, they decided to see their dad one more time. When they got there, he was awake and speaking. Karla Perez was 22 weeks pregnant when she suffered a catastrophic brain bleed and was declared brain dead. Her unborn child was alive, but wouldn’t survive delivery. So family and doctors kept her on life support. Editor’s note: An earlier version of this story misidentified the surgeon named as a defendant in the lawsuit. Children’s denies allegations made in lawsuit by two surgeons

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