White Coat, Black Art·DR. BRIAN'S BLOG

Surprising lack of confidence in doctors, U.S. poll suggests

Most surveys say Canadians put a lot of trust in their doctors, but Americans may not feel the same way. Dr. Brian Goldman has the results of a revealing new poll.
Morgan McCaul confronts Larry Nassar during her victim impact statement in Circuit Judge Rosemarie Aquilina's courtroom in January 2018, in Lansing, Mich. (Matthew Dae Smith/Lansing State Journal via Associated Press)

Doctors are up there on the list of Canadians' most respected professionals. One poll put them just behind farmers and well ahead of politicians. A recent U.S. survey by The Harris Poll suggests that a surprising number of Americans may feel otherwise.

The online survey of more than 2,000 U.S. adults was commissioned by the Federation of State Medical Board or FSMB. This is the organization that represents state medical boards that license and regulate doctors much like provincial colleges of physicians and surgeons in Canada.

Of the 2,018 Americans surveyed between October 5-9, 2018, 409 said they have experienced an interaction with a physician they believed was acting unethically, unprofessionally, or was providing what they believed to be substandard care. That's just under one in five Americans surveyed.

The poll had significant gender differences. Women were twice as likely (24 per cent) as men (12 per cent) to say they had experienced unprofessional conduct by a doctor.

There were age-related differences as well. Adults 18 to 34 years of age were most likely (22 per cent) to believe they had experienced misconduct, followed closely by those aged 55 to 64 years (20 per cent). The survey suggested that Americans aged 65 years and up were least likely (12 per cent) to have seen or experienced unprofessional behaviour by the doctor.

The survey also found that doctor misconduct was nearly twice as prevalent in the American South and Midwest regions as compared to the American Northwest.

In this November 2017 photo, Larry Nassar appears in court for a plea hearing in Lansing, Mich. Michigan State University has reached a $500 million US settlement with hundreds of women and girls who say they were sexually assaulted by Nassar in the worst sex-abuse case in sports history. (Paul Sancya/Associated Press)

The survey was prompted by California passing the first state law requiring physicians to inform patients if the state medical board has placed them on probation for sexual misconduct or other wrongdoing. The law is intended to speed up the discovery of sexual misconduct cases in the #MeToo era involving physicians such as former USA Gymnastics team doctor Larry Nassar, who pleaded guilty to seven counts of first-degree criminal sexual misconduct in 2018.

Given the new legal requirement to inform patients, the FSMB wanted to gauge national awareness of state medical boards and their role in regulating doctors.

The survey found that fewer than three in 10 Americans know how to find out if a doctor has been the subject of disciplinary action by the state board. Just over half of those surveyed did not even know that state boards license and regulate physicians. Close to a quarter thought it was the job of the American Medical Association to police doctors. 

Transparency of Canadian doctors' disciplinary records clouded

The survey was done in the U.S. You may be wondering how things compare in Canada. In 12 years hosting White Coat, Black Art and 35 plus years as a medical journalist I have never seen a Canadian survey like this one. I have seen many surveys that ask how much Canadians trust their doctor. To my recollection, none have asked if their doctor has behaved badly.

It is possible Canadian doctors behave better. It is also possible that we don't know the answer to that question because no one has ever asked in a survey. Perhaps Americans are more likely to complain because they're more likely to pay out-of-pocket for medical expenses.

It may also be that Canadian regulators are less transparent. In 2018, the Toronto Star published an 18-month investigation into doctor disciplinary cases. It found that Canada's regulators don't make public everything they know about doctors' disciplinary records.

Findings of professional misconduct are relatively uncommon in Canada. Often, such cases come down to the credibility of the complainant versus that of the physician. An even smaller number of physicians have been convicted in the courts of sexual assault and other criminal offences.

That lack of public candour may have an impact on patient safety. A 2016 CBC News investigation found at least 250 doctors across Canada have been disciplined for various patient boundary offences over a 15-year period. Fewer than one-third lost their licence, and about half of the 250 doctors continued to practise. Some doctors were cited more than once for inappropriate behaviour.

At the end of the day, in the U.S., nearly seven in 10 Americans did not know that the state licensing board is the best resource to contact if Americans have a complaint about a doctor's competence or conduct.

I doubt Canadians are better informed. A public campaign that promotes the idea that provincial colleges exist to protect the public by receiving and investigating complaints from patients and by educating physicians might help.

In my opinion, the greatest limitation of the current system is that it is driven by complaints from patients. Without those complaints, colleges may not know that they need to launch an investigation.

They might need to be more proactive at uncovering professional misconduct.

About the Author

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.

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