Prevention system sought to boost quality care

Two experts call for a proactive rather than reactive approach to doctors whose problems are affecting their performance.

By Damon Adams, AMNews staff. Feb. 13, 2006.

At some point in their careers, one-third of physicians will have a condition that impairs their ability to practice medicine safely, putting patients in harm's way, two medical experts say.

Despite the large number affected, most doctors receive little help for mental illness, substance abuse and other problems. The serious conditions often are handled poorly at the hospital and practice level, according to the experts' article in the Jan. 17 Annals of Internal Medicine.

The authors are urging development of a national monitoring and prevention system to identify and help those whom they call problem doctors, to act before patient safety is affected.

"There are problems with doctors whose performance isn't where it ought to be. That's a system problem," said patient safety expert Lucian L. Leape, MD, adjunct professor of health policy at the Harvard School of Public Health. "We don't have good methods for identifying them, and we don't have good resources for getting them rehabilitated."

Dr. Leape and Massachusetts physician health expert John A. Fromson, MD, wrote the article to spark national debate about finding systematic solutions to problem doctors. Few organizations have formal programs to spot these doctors or monitor physician performance, the article said. And there are few national or state measures for checking performance or standards of conduct or competence.

Underlying causes for performance problems include mental and behavioral issues. For example, depression might be higher among physicians than the general population, and physicians have a higher suicide rate. About 8% to 13% of doctors have alcohol problems compared with 13.5% of the adult population. And 3% to 5% of physicians will exhibit disruptive behavior such as making sexual comments or throwing charts.