Survey: Physicians falling short on professionalism

Despite widespread acceptance of ethical standards, doctors' actions often belie the consensus. Still, many say there has been much improvement.

By Kevin B. O'Reilly, AMNews staff. Dec. 24/31, 2007.

Doctors agree on the basic tenets of medical professionalism, but they frequently fail to live up to those ideals in practice, according to a survey of more than 1,600 physicians in the Dec. 4 Annals of Internal Medicine.

Nearly all of the physicians surveyed agreed doctors should use medical resources appropriately, tell patients the truth, minimize disparities, see patients regardless of their ability to pay, maintain board certifications, evaluate peers' care, avoid sex with patients, work on quality initiatives, disclose conflicts of interest, report impaired or incompetent physicians, and report medical errors.

But more than half of doctors told investigators that they failed to report a serious medical error they observed, or a colleague who was impaired or incompetent, to authorities in the last three years. And more than a third of the doctors said they would order an unnecessary magnetic resonance imaging scan to mollify an insistent patient.

Lead author Eric G. Campbell, PhD, was especially disappointed by the 24% of doctors who said they would refer patients to a facility in which they had a financial stake without disclosing the conflict. Such a referral could be illegal under Stark and anti-kickback rules.

"This is beating a dead horse," said Dr. Campbell, assistant professor of medicine at the Massachusetts General Hospital-Harvard Medical School Institute for Health Policy. "This shouldn't happen anymore."

Physicians, ethicists and regulators said the findings show that great progress has been made in spreading new norms of medical professionalism. But more should be done to reduce the legal and cultural impediments that often can dissuade doctors from doing the right thing, they said.