U.S. and U.K. doctors differ on reporting conflicts, errors, impaired colleagues

Physicians in both the U.S. and the United Kingdom report differences between their professional values and their actual behavior, according to new survey results.

Researchers collected responses from about 1,900 American physicians in various specialties and about 1,100 physicians in the U.K. to a series of questions about their professional values. The results, published online March 7 in BMJ Quality and Safety, revealed differences in beliefs and practices between the two countries, as well as gaps between physicians' values and actions.

For example, nearly a fifth of doctors in both countries reported direct personal experience with an impaired or incompetent colleague in the past three years, but one-third of those respondents had not reported the colleague to authorities. U.K. physicians were far more likely (34% vs. 12%) to list fear of retribution as a reason for their failure to report—an issue that has been previously noted in British medicine, the study authors said. The U.S. physicians were more likely to respond to incompetence by not referring patients to the colleague, an option which is often less available to U.K. physicians.

The doctors also differed on their acceptance of conflicts of interest: 83% of U.S. doctors reported receiving samples or gifts from industry (compared to 73% of British doctors), 47% thought business ventures with patients were inappropriate (60% in the U.K.), and 9% had actually provided care for a person with whom they had a direct financial relationship (1% in the U.K.). A majority, but far from all, physicians in both countries felt that physicians should put patients' welfare above their own financial interests (79% in the U.S., 82% in the U.K.).

U.S. physicians were more strongly in favor of disclosing their own financial relationships with industry and benefits and risks of treatment to patients than their British peers (65% vs. 59% and 88% vs. 74%, respectively). However, they were less likely to believe in disclosing all significant medical errors to affected patients, which was perhaps related to the fact that they were more likely to report not having disclosed an error due to fear of being sued (64% vs. 70% and 21% vs. 13%, respectively).

The results indicate that physicians in both countries share a core of professional values, but that they have some differences resulting from the contexts in which they practice, study authors said. Given that both countries are currently working on major health care reform, physicians should advocate for creation of health care systems that encourage behavior congruent with physicians' professional values, they concluded.