A survey on the United States docs released on Monday revealed that there’s a wide gap between what doctors say they believe about practicing medicine ethically and what they actually do to fulfill them. The survey also disclosed that while the overwhelming majority thinks incompetent colleagues should be reported, less than half actually do so.

Published in the 4th December online issue of the Annals of Internal, the research work of Dr David Blumenthal from the Massachusetts General Hospital, Institute for Health Policy, in Boston Massachusetts, and colleagues, and Medicine, concluded that doctors often don't follow through on their own beliefs about protecting patients' privacy, avoiding conflicts of interest, or reporting incompetent or impaired colleagues.

The survey was carried out because while the idea of improving standards of care through increasing professionalism among doctors has been gaining ground in medical organizations and the view of practicing doctors.

The reasons for the disconnect are unclear, though researchers say many doctors may fear retribution or lawsuits if they expose bad behavior of colleagues. They also suggest that legal regulations governing doctors' ethics may not be strong enough. The questions covered various standards of medical professionalism such as those developed by the American College of Physicians and the American Board of Internal Medicine.

David Blumenthal and colleagues invited responses from 3,504 doctors practising family practices, internal medicine, pediatrics, surgery, anesthesiology, and cardiology, and received responses from 1,662 of them (58 per cent). The study was carried out between November 2003 and June 2004.

Blumenthal said, "I think that our findings go well beyond personal ethics."

According to the survey –

•    9 in 10 said doctors should put patients' welfare above financial considerations and should minimize racial health disparities.
•    Over 90 per cent of respondents agreed with statements about principles proposed by professional bodies in 2002 regarding such things as the fair distribution of finite resources, improving access to healthcare and quality of care, managing conflicts of interest, and self-regulation among professionals.
•    24 per cent of respondents disagreed with the idea that doctors should undergo periodic recertification.
•    A common theme found in the responses was that physicians did not always follow the standards they supported.
•    For example, although 96 per cent agreed that doctors should report incompetent colleagues to the authorities, only 45 per cent of them had actually done so.
•    Another example was that about one third of respondents said they would order unneeded MRI for back pain if a patient asked for it.
•    One-quarter of doctors surveyed said they would refer a patient to a medical facility with which they have a financial interest. In many cases these types of referrals violate anti-kickback laws.

The authors accepted that the results might not be typical of all doctors, and especially of specialisms not covered.

However, they concluded that while doctors may generally agree with norms of behaviour set by the various professional bodies, they did not necessarily comply with them.

"I think human beings always fall short of their aspirations,” said Blumenthal, commenting on their findings.

Nevertheless, he said he was encouraged that nearly all the respondents supported professional standards.

He said, “At least you don't have to convince them about what they ought to be doing."

Some experts have suggested that doctors are scared of being sued if they report incompetent colleagues, and that what the profession needs is a whistle blowing system.