Reporting Unethical or Incompetent Physicians

It can be difficult to know what to do when you hear that a colleague supposedly did something unethical or incompetent—especially if it’s heard secondhand.

According to Jo Shapiro, MD, senior faculty at the Center for Medical Simulation at Massachusetts General Hospital, and associate professor of otolaryngology–head and neck surgery at Harvard Medical School in Boston, that’s often the case. “Many times, a physician won’t actually witness a problematic behavior, but will instead hear it from a patient or colleague.”

James Stankiewicz, MD, ABIM, professor and former chair of the department of otolaryngology–head and neck surgery at Loyola University Medical Center in Chicago, said, “Unless a physician directly encounters an ethical or moral violation, they may be hesitant to challenge a colleague. They may not have access to a patient’s history and physical due to proprietary and confidentiality reasons.”

Another deterrent is the ramifications of notifying authorities. “A physician might be concerned that they could be sued for defamation of character or restraint of trade,” said Michael Setzen, MD, clinical professor of otolaryngology at Weill Cornell Medical College, in Great Neck, N.Y.

“There’s a broad mix of state statutes regarding whether or not the reporting physician’s (whistleblower’s) identity is protected,” noted Stephen McHale, MD, JD, resident physician in the department of otolaryngology–head and neck surgery, at the University of Kansas Medical Center, Kansas City, Kan. “One broad conclusion is that some states offer complete protection/anonymity, while others offer no anonymity whatsoever.”

Unethical versus Incompetent Behavior

A wide range of behaviors may constitute unethical conduct, which should be distinguished from incompetent behavior, said G. Richard Holt, MD, MSE, MPH, MABE, D Bioethics, professor emeritus and clinical professor in the department of otolaryngology–head and neck surgery and a faculty member at the Center for Medical Humanities and Ethics at The University of Texas Health Science Center at San Antonio. The former is a range of unprofessional behavior that goes to the core of physician professionalism and is associated with adherence to the tenets of a physician’s obligation—honesty, compassion, ethical decision making, to name a few.

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Incompetence, however, is a subset of unethical behavior in the sense that a physician fails to properly adhere to standards of care and lifelong learning, doesn’t stay up to date, and/or fails to follow professional and specialty guidelines, state medical board regulations, and laws of the land. All are important to maintain proper patient care and obligations to the profession and society, said Dr. Holt.

Considering serious patient complaints about another otolaryngologist requires thinking maturely and examining the facts. “First, establish the veracity of a patient’s complaint, then evaluate any documents that might indicate incompetence or unethical behavior, as well as the otolaryngologist’s own history, examination, and evaluation, to uncover the case’s facts,” Dr. Holt said.