Only 64% of the docs in the survey completely agreed with their ethical requirement to report colleagues. Of those docs who knew of an incompetent or impaired colleague, 67% reported them to an appropriate authority (e.g., hospital, state agency). For those in solo or 2-person practices, the percentage dropped to 44%. (There are more specific findings reported in the article.) These results, which are similar to some studies in the psychology literature, gave me pause (although I didn't stop eating my eggs). They mean that patients may not be getting adequate protection and that doctors who suffer from drug or alcohol abuse or mental illness may not be getting the help they need.

Why don't physicians report colleagues? That's a complex question. The top reason offered by participants in the JAMA study was the belief that somebody else would deal with the problem. In psychology, we call this diffusion of responsibility. Other reported reasons were the belief that nothing would be done, and a fear of retribution. (It's important to note that the researchers gave these choices to their respondents and asked for ratings, but did not give them the chance to write about other reasons.)

One factor that the study authors didn't ask about was feelings of personal loyalty. Think about it: Your friendships are very important, and if a colleague at work has become your friend, you work with them all the time, and you think they're generally good at what they do, it's going to be really hard to "rat them out." You may also depend on your colleague for referrals.

Here's one implication I thought about over my coffee: We may not be able to rely on our physicians for adequate information about other docs. Let's say you're being examined by your family (and solo practitioner) doctor, Sarah Tonin. You ask her if Dr. Opie Itt is a good specialist to see. Your doctor says, "Yeah, Dr. Itt is very good." Extrapolating from the JAMA study, if Dr. Tonin was aware that Dr. Itt is abusing drugs and/or not practicing competently, there may be a greater than 50-50 chance that she wouldn't mention it. In this scenario, everybody suffers.

Plagiarism

This summer I'm preparing to teach a freshman seminar at UCD, and I've been wondering how much I should get into issues of plagiarism. In advanced courses I require my students to read about plagiarism, to know how important it is to only take credit for their own work and words, and to know that penalties for plagiarism in academia are severe. But I wondered about first-semester freshmen. Do I need to introduce them to this form of academic dishonesty so early, comprehensively, and forcefully? Can't I wait a bit? How do I explain how serious plagiarism is? How do I introduce the discussion and make it relevant for them?

I got my answer to all these questions in a series of front-age stories in the Denver Post about Scott McInnis, a former Colorado congressman who is running for governor. Apparently, Mr. McInnis was paid a lot of money to write some essays about water policy and allegedly plagiarized these essays. The Denver Post articles also allege that Mr. McInnis tried to blame somebody else for the plagiarism. The McInnis campaign has argued that this kind of thing goes on all the time in politics, that he had permission of the person he plagiarized from, and that it's a non-issue. The article talked about ghost-writing, which is an accepted practice in politics and other fields, although unacceptable in academia. The issues raised are relevant, interesting, debatable, and worthy of discussion; I can't wait for the semester to begin!

The bottom line: There will always be a need for professionals (politicians, physicians, psychologists, professors, and even professionals that don't start with the letter p) to be trained in ethics. Ethical responsibilities are not necessarily self-evident, comfortable, or easy, and professionals need to go through a process that we have called ethical acculturation, which means integrating new professional responsibilities with existing moral ideals and virtues.

Is ethics education effective? This is an important and complex empirical question; we certainly have to measure the effectiveness of what we do. I'm sure I'll be writing more about this in future posts. For now, let's just say that there will always be a need improve our methods and do a better job of ethics education.

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Mitch Handelsman is a professor of psychology at the University of Colorado Denver and the co-author (with Sharon Anderson) of Ethics for Psychotherapists and Counselors: A Proactive Approach (Wiley-Blackwell, 2010).