Prescriber intimidation study underscores whistle-blower's role

Regarding "Survey examines intimidation by prescribers" (Article, April 26): This survey, referred to by the president of the Institute for Safe Medication Practices as "more of a straw poll than a scientific study," has generated at least some of the attention it apparently was intended to generate.

A national recognition and correction of problem behavior by physicians, such as that described by the study, is long overdue. One hopes that the initiative for proactively identifying and routing out unprofessional, inappropriate behavior by physicians, no matter who it is directed toward, would come from medical staffs and medical societies, rather than hospitals, lay organizations, government or the courts.

Also, the design and commissioning of the study may be construed as suggesting that the failure of hospital personnel to address concerns regarding patient safety is mitigated if they felt intimidated by the interpersonal style of the physician. I suggest that, generically, the proposition that one person's professional responsibilities can be mitigated by the remote interpersonal behavior of a second individual -- especially when the second individual has no supervisory or fiduciary authority over the first -- is a frightening redefinition of professional responsibility.

It is imperative to make it clear that this kind of mitigation can not be supported in a field where personal responsibility and personal integrity is as crucial as it is in medicine. If we are going to offer staff understanding and support, it should be support to speak out against inappropriate behavior.

Lastly, this survey highlights the need for serious investigation of the extent to which "intimidation" is used in the field of medicine to prevent not only paramedical personnel from addressing safety issues, but to prevent physicians from addressing safety issues, such as inadequate practices by hospital personnel and administrators, insurance companies, and other physicians.

There is little doubt that the medical profession -- and, more to the point, the patients who depend on it -- would benefit from more professional, courageous behavior by its members. There is also little doubt that there would be more of both if whistle-blowers were respected and protected, rather than persecuted without consequence or support -- in many cases, not only from the law, but from hospital staff or medical societies. If we want to see a change in the behavior of others, it may well have to start with a change in our own behavior.

Harry Horner, MD, Waynesboro, Va.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/05/24/edlt0524.htm.