Everybody, or almost everybody, hates to report friends and colleagues for misconduct. This is the anti-snitch reflex, a strongly programmed response from childhood. Telling authorities about the misconduct of others sets off internal alarms that have been installed by parents and peer groups, ensuring that we feel terrible if we “tattletale.” This is betrayal, a violation of loyalty, and most of all, a breach of the Golden Rule: we’d never want anyone to snitch on us.
For professionals, however, this reflex is false, mistaken and even deadly. The duty to report dishonest public employees, crooked cops, unethical lawyers, conflicted accountants, self-dealing business executives, fraudulent researchers and others in the workplace—even if they are colleagues and friends—trumps childhood codes, personal loyalty and general discomfort. There is nothing noble or admirable about allowing innocent people to entrust their life and livelihood with untrustworthy professionals. Nevertheless, a disturbing large proportion of all professionals can’t bring themselves to do the right thing when it comes to the core ethical duty of stopping workplace dishonesty, incompetence or corruption when it involves a colleague.
A recent survey of doctors is not comforting, but it confirms the problem. Published online in the Journal of the American Medical Association, the study used data from a 2009 national survey of close to 3,000 physicians practicing in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics and psychiatry. They answered queries about their duty to report other physicians who were incompetent or impaired by drugs or alcohol, their comfort level in doing so, and their experiences encountering the issue.
About 70% of physicians said they would report impaired physicians, and 64% said they would blow the whistle on incompetent ones. More than a third, 36%, said they did not have a professional commitment to “snitch.”
Pediatricians and family practice doctors were the least likely to say they felt prepared to deal with impaired or incompetent colleagues; anesthesiologists and psychiatrists apparently felt most prepared. The survey results showed that 17% of respondents had encountered an impaired or incompetent physician colleague in their hospital, group or within in the previous three years. Of these physicians, 67% said they had reported colleague, which is only slightly better than the 64% predicted by the survey’s responses to hypothetical situations.
The respondents who chose not to report the incompetent or impaired doctors in their midst tended to explain their non-action by citing their belief that someone else was going to report and the belief that a report would be futile. Prof. Catherine DesRoches of Harvard Medical School, who was the lead author of the study, concluded from this that the problem was the reporting system itself. “By targeting these two main issues — the belief that someone is taking care of it or that nothing will come of the report — we can increase the numbers of physicians who are both willing to report and feel prepared enough to do so,” she told the Los Angeles Times.
Wrong. Prof. DesRoches apparently doesn’t recognize rationalizations when she sees them. These are classic ones—“Somebody else will do it, so I don’t have to,” which falsely justifies ducking personal responsibility, and“It’s futile, so why bother?” which allows the shifting of blame to others, or “the system.”. The reason a third of doctors don’t report is that they have been taught since childhood that it is wrong to be a snitch, and such a deep and long-held belief can’t be dislodged by a training session or a pamphlet. Prof. DesRoches says she wants to see more education on the responsibility of physicians to report impaired or incompetent colleagues and the development of systems that both ensure confidentiality and notify the reporter when the issue has been addressed. This can’t hurt. Still, these measures won’t deal with the underlying ethical problem, which is a miswired ethics alarm. Most of those 36% of doctors know they have a duty to report. They just don’t want to do it, because deep down, they think being a snitch is wrong, and they don’t want to be one.