by
Brendon Nafziger, DOTmed News Associate Editor | July 14, 2010
Doctors with foreign medical degrees, underrepresented minorities and those who plied their trade in solo or two-person practices were somewhat less likely both to report and to say they completely agreed with reporting.
The authors suggested a variety of reasons to explain differences in willingness to report. Doctors with foreign degrees could, because of their outside status, be more fearful of retaliation, DesRoches said. And physicians in small practices depend on referrals, and might not want to risk their reputations. They could also be more isolated, and have a harder time keeping their reports anonymous.
"If you're in a small practice in a small town, it could be very easy to figure out who reported," DesRoches said.
To boost willingness to report, DesRoches said it's important for medical groups to get the message across to doctors that even if they believe someone else has reported on a problem doctor, it's still their responsibility to do so. Also, medical regulating bodies can set up confidential feedback mechanisms to let doctors know that their reports were followed up on and not just lost in a bureaucratic black hole.
"And then finally, ensuring and really beefing up the confidentiality of these systems," DesRoches said, "so physicians who do report don't have to be afraid of damage to their reputations or damage to their referral network." This could be accomplished by, for instance, educating patients, nurses and others to also report.
An editorial accompanying the article, while generally agreeing with it, disputed some of the interpretations of the data. Physicians in small practices, for example, might not report on colleagues because they're friends or don't have a clear authority to report to. Also, failing to report on a doctor because someone else is taking care of it could be a "reasonable" interpretation of the situation.
"Still, it is impossible to escape the implication that these survey results constitute a frontal assault on a basic premise of medical professionalism," writes Dr. Matthew K. Wynia, director of the Institute of Ethics at the American Medical Association. "Despite any minor flaws, this research is proof that individual physicians cannot always be relied on to report colleagues who threaten quality of care."
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