Ethical Issues in Dealing with Impaired or Incompetent Colleagues

Ethical Issues in Dealing with Impaired or Incompetent Colleagues

·        Summary:

o  Collective responsibility as important as individual

o  Maintenance of public trust vital

o  Better team work and error reporting will help

o  Self regulation: use it or loose it

·        Issues:

o  Trust of patients in doctors: patients in vulnerable position

o  Beneficence

o  Legal requirement to report impaired or incompetent doctor

o  Collective responsibility: to patient population as a whole

o  Uncertainty: may explain but not excuse failure to act 

o  Professional etiquette (often disguised as „clinical freedom‟) – not wanting to interfere in other‟s livelihoods 

o  Loyalty to the group: key to cooperation but should be overridden by maleficence

o  Pattern of error not a single mistake is indicative of incompetence 

·        Criteria for whistle-blowing:

o  Evidence of severe harm

o  Good chance of reducing harm

o  All other avenues explored

·        Ethical institutions

o  Encourage reporting of error (ie about safety not culpability)

o  Mechanisms for self/peer assessment

o  Internal complaints mechanisms (with protection)

o  Guard against malicious complaints

·        Culture within a group:

o  Less competent influencing each other

o  Professional isolation (big risk factor for incompetence)

·        Hard to pin down doctors because:

o  Lack of benchmarking (little medical practice has been validated)

o  Clinical freedom

o  „Half of all doctors are below average‟

o  The learning curve: period of necessary and acute incompetence 

·        Informed consent: what is it reasonable for patients to know about their doctors (eg individual success rates) vs. doctors right to privacy