Much has been written about handling problem patients and employees, but little information is available to clinicians regarding the handling of problem peers. New survey results indicate that just over two thirds (69 percent) of physicians feel they are very or somewhat prepared to deal with impaired colleagues, and 64 percent are prepared to deal with colleagues who are incompetent in their medical practice.

That leaves a sizable proportion of physicians unprepared to report, according to a JAMA article (2010; 304(2):187-193). Some physicians admitted having knowledge of incompetence or impairment of a peer but not reporting it. Among the reasons cited for not reporting colleagues, physicians said they believed someone else was taking care of the problem, thought nothing would happen, feared retribution, felt reporting was not their responsibility, or worried the physician would be excessively punished. These are worrisome findings, given that the study looked at specific problems, such as drug abuse by physicians. Still, one can understand why in the current litigious environment physicians may be reluctant to report a colleague, especially without conclusive evidence.

Of course, incompetence need not be extreme. Suppose a patient with severe psoriasis presented to you after years of treatment by a colleague who would not prescribe systemic therapy. Perhaps, despite a number of obvious signs, a local physician improperly diagnosed a case of cellulitus as athletes foot; without an emergency appointment and your quick initiation of therapy, the patient would have developed sepsis. Or maybe a patient has begged you to repair a botched cosmetic procedure, where poor results came from clear misapplication of a dermal filler.

Everyone makes mistakes, but instances like these may represent a pattern of medical misjudgment. Formal complaints against the respective physicians may feel heavy-handed, but if you are not prepared to report, at least consider alternative actions. Peer education may be an option, if you are comfortable reaching out to the physician in a non-accusatory, collaborative tone. Ultimately, you as a clinician have a responsibility to provide the best care possible to patients, and that means protecting them from avoidable mistreatment. Clinicians who stand idly by while peers dole out improper care risk long-term consequences for themselves, their patients, and their specialty.