"Friends I Hope We'll Always Be..."

"If it is not seemly, do it not; if it is not true, speak it not."
-Marcus Aurelius

A story in USA Today reports the results of a survey of 1,662 physicians, of whom 96% agreed that "doctors should report impaired or incompetent colleagues to relevant authorities," while over half the group confessed that after encountering such tarnished peers they declined to denounce them.

The authors conclude that most physicians believe in following professional guidelines for behavior and in reporting those colleagues who don't, but are less likely to make the call themselves when they encounter a miscreant medic.

The implication of the article is that doctors don't follow their convictions because they're either morally lazy, afraid of retribution, or in cahoots with their colleagues to overlook each others' iniquities. Is this accurate, or an act of insolence?

Before commenting, let's have a look at what activities the "relevant authorities" have designated as offensive. Here is the list from my part of the world, taken directly from the Missouri State Board of Registration for the Healing Arts complaint form.

Substandard Medical Care
Professional Misconduct
Sexual Misconduct
Rude/Discourteous Behavior
Impaired by Alcohol/Drugs
Unsanitary Office Practices
Failed to Provide Medical Records
Inappropriate Prescribing
Patient Neglect/Abandonment
Billing for Services Not Rendered
Fraud
False Advertising
Other

Figlio di puttana! No wonder we're scared out of our scrubs! Rude/Discourteous Behavior? Unsanitary Bedrooms? Parent Neglect? False Advertising of Homework Completed? Oh, wait - I was thinking about the complaint form for reporting my kids to the Thought Police.

No sane physician would ever dispute the essence of this list, but I think it is important for the public to know that some of these transgressions are susceptible to such broad interpretation that it would be difficult for investigators to find the actual truth of the matter. This can lead to doctors and patients playing the game of "but if by chance we disagree, piss on you and here's to me."

Anyone can report a physician for one of the offenses listed above, therefore in order to play the game successfully, even the most upstanding practitioners should document every interaction with every human being they speak to while avoiding all physical contact with said humans, avoid upsetting these same humans, pick up trash off the floor, respond to crackpots and jerks with specious charm, and even mollify the bureaucrats of banality before discharging a noncompliant patient.

Hey, so what's the problem? This is how I practice every day. I'm used to it - how about you? I'm not certain what it would take to report a colleague to the State Board, though. Short of a crime or gross neglience, I doubt I would jump at the chance to fill out our state's complaint form. I don't want to take any chances on losing at the game.

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Why do I want to sit through an episode of House, MD and document every infraction of the above list?

Some patients are just impossible to please; I find the fact that there is an "other" option to be a somewhat terrifying carte blanche. I should certainly hope that whoever's reviewing these complaints has an ounce of common sense. In my own field, I've heard tales of patients filing complaints against pharmacists for "offensive behavior" or "excessive rudeness" when the patients were being turned away for constantly trying to get early refills on opioids or benzos. Some of them have the gall to call our corporate office because they had to wait for their prescriptions. Gasp.

Of course, this is about practitioners reporting other practitioners, but the point still stands. Any time such a subjective measure of performance is used, everyone involved has to be incredibly careful not to overstep the boundaries of reason. What doctor is going to snitch on a fellow in his practice because the waiting room is dirty?