Monitoring system needed to prevent safety hazard of problem physicians

Asserting that “physician performance failures are not rare and pose substantial threats to patient welfare and safety,” experts in medical error are calling on state medical boards and healthcare organizations to institute a formal monitoring and prevention system for catching “problem doctors” before they do further harm.

Research has shown that “the vast majority of mistakes and injuries can be attributed to faulty systems that cause injuries or lead even competent, careful people to make errors,” the authors write. And hospitals have begun to embrace principles of “human factors engineering” to correct these system-induced errors. But individual problem doctors still pose a considerable threat to patient safety.

“Performance problems are more widespread than people recognize; it’s not just the small number of doctors disciplined annually by state medical boards, which is something like a half a percent of the nation’s practicing physicians,” said Dr. Lucian Leape, co-author of the article and recognized as the founder of the “medical error movement” with his authorship of the landmark 1994 JAMA paper, “Error in Medicine’. “Up to one- third of doctors may have a condition that impairs their performance at some time during their career, and most of them get little help for it.” Leape is an adjunct professor of health policy at Harvard School of Public Health.

The article “Problem Doctors: Is There a System Solution?” appears in the January 17, 2006 issue of The Annals of Internal Medicine. The article is co-authored by Dr. John A. Fromson, an assistant clinical professor of psychiatry at Harvard Medical School and chairman of the department of psychiatry at MetroWest Medical Center. Dr. Fromson was responsible for setting up the Massachusetts Medical Society’s program for dealing with impaired physicians.

The authors describe a menu of underlying causes for physician performance deficiency including mental and behavioral problems such as depression, anxiety, substance abuse and personality disorders, physical illness, including age-related and disease-related cognitive impairment, and failure to maintain or acquire knowledge and skills. Contributing to these problems for physicians in particular are environmentally induced problems such as fatigue, stress, isolation, and easy access to drugs. While the rate of physical illness and alcohol dependence for physicians may be similar to the general population, there may be higher rates of mental illness. For example, the rate of suicide is 40 percent higher in male physicians and more than two-fold higher in female physicians than in the general population.

“The problem now is that typically little or nothing is done about recognized performance problems until someone is hurt or there is a malpractice suit. The doctor may then be warned by the chairman of the department, but it’s often informal and without specific remediation assistance,” said Leape.