What Doctors Believe—and What They Do

They set a high bar for ethical and professional behavior, says a large poll, but often scurry beneath it.

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Even though everybody gripes about healthcare, physicians rank just behind firefighters in "most-admired" polls. A new survey of more than 3,500 doctors could chip away part of that pedestal we put them on, however. The results, to be published tomorrow in the Annals of Internal Medicine, reveal a disconnect between how much the 1,662 physicians who responded said they subscribe to generally recognized professional standards of competence and ethical behavior on the one hand and how they reported they act on the other.

A few examples:

• 93 percent said doctors should report all significant medical errors they see; 46 percent indicated they had neglected at least once to do this. Similarly, 96 percent said physicians should report impaired or incompetent colleagues, but 45 percent said they had looked the other way at least once in the previous three years.

• 96 percent said patients' welfare should trump physicians' financial interest, but 24 percent said that if they had a financial stake in an imaging facility, they would refer patients there.

• 77 percent said they should have to be retested periodically, but just 33 percent had gone through recertification in the previous three years.

And so on. Well, said the study authors, at least doctors agree standards should be high. But the lead investigator, in a separate statement, noted glumly: "This raises serious questions about the ability of the medical profession to regulate itself." (I was sort of encouraged that they 'fessed up to errant behavior.)

With power comes responsibility. "Do as I say and not as I do" isn't good enough for this profession.