Most physicians agree on the right things they should do, but may not
always do them in actual patient care, according to the first survey on
professionalism in medical practice funded by the Institute on Medicine as a
Profession, an organization affiliated with Columbia University.
Eric Campbell, Ph.D., presents survey findings and notes the gaps
between respondents' attitudes and behaviors on the same principles of
Credit: Jun Yan
Eric Campbell, Ph.D., an associate professor at the Institute for Health
Policy and the Department of Medicine at Massachusetts General Hospital and
Harvard Medical School, and colleagues asked 3,504 practicing physicians about
their attitude and action in areas of medical professionalism ranging from
conflicts of interest to professional self-regulation. They found fairly
consistent agreement with the guidelines of professionalism advocated by
leading medical associations, though large gaps exist between these guidelines
and actual behaviors reported in the survey. The study was published in the
December 4, 2007, Annals of Internal Medicine.
The researchers limited their stratified random survey sample to currently
practicing U.S. physicians specializing in internal medicine, family practice,
pediatrics, anesthesiology, surgery, and cardiology. The response rate was 52
percent, or 1,662 responses out of 3,167 eligible participants. About
one-quarter of respondents were female, and 72 percent were white.
The survey first asked physicians whether they agreed with a number of
statements regarding professionalism as the norms of medical practice. These
statements are based on a set of principles in medicine that have been
established by the American College of Physicians and the American Board of
Internal Medicine. Most of these statements, including "Physicians
should minimize disparities in care due to patient race or gender" and"
Physicians should put the patient's welfare above the physician's
financial interests," drew more than a 95 percent positive response as
respondents said they "agree somewhat" or "agree
completely" with these statements. The only statement for which
agreement fell below 80 percent was "Physicians should undergo
recertification examinations periodically throughout their career" (77
The second part of the survey questioned physicians about their own
behaviors and how they correspond to these principles using examples of
specific situations. For example, a survey question asked whether the
physician would inform his or her patient of potential financial conflict of
interest before making referrals to a care facility. Some of the self-reported
behaviors were consistent with the attitude of professionalism—almost
all respondents reported being honest with a patient or patient's family on
medical issues, and few said they have breached patient confidentiality.
However, large gaps were exposed in other responses to professional
behaviors. One of the principles least applied by physicians was fulfilling
professional responsibilities, including self-regulation. Forty-five percent
of the respondents who knew of another impaired or incompetent physician in
their hospital or group practice in the past three years did not always report
the person to the institution or proper authorities, even though 96 percent
had agreed, in the first part of the survey, that such colleagues should be
David Blumenthal, M.D., M.P.P.: "Measurement is the beginning of a
systematic process of improvement."
Credit: Jun Yan
Similarly, 46 percent of the respondents who had direct knowledge of
serious medical errors in the past three years failed to report the errors at
least once, while 93 percent had agreed with the statement saying that
physicians should do so.
While almost 90 percent said they felt "very prepared" or"
somewhat prepared" to critically evaluate new clinical knowledge,
only one-third had undergone a competency assessment by a provider
organization or health plan, and 10 percent had served as a reviewer for a
Almost a quarter of the respondents said they would refer patients to a
local imaging facility in which they had a financial investment, while not
telling the patient about this potential conflict of interest.
"Measurement is the beginning of a systematic process of
improvement," the senior author of the study, David Blumenthal, M.D.,
M.P.P., said at a press conference announcing the results. "Neither
regulations nor competition are sufficient to ensure that we have an adequate
and functioning health system," said Blumenthal, a director of the
Institute for Health Policy at Massachusetts General Hospital and a professor
of medicine and health care policy at Harvard Medical School. He called on all
physicians to apply the ideals of professionalism in patient care in today's
difficult health care environment.
"Social desirability and bias might result in an overreporting of the
endorsement of attitudes and an underreporting of behaviors that are not
consistent with social norm," Campbell acknowledged.
An abstract of "Professionalism in Medicine: Results of a
National Survey of Physicians" is posted at<www.annals.org/cgi/content/abstract/147/11/795>.▪