Carla K. Johnson, AP

A new survey finds that many American physicians fail to report troubled colleagues to authorities, believing that someone else will take care of it, that nothing will happen if they act or that they could be targeted for retribution. A surprising 17 percent of the doctors surveyed had direct, personal knowledge of an impaired or incompetent physician in their workplaces, said the study's lead author, Catherine DesRoches of Harvard Medical School.

One-third of those doctors had not reported the matter to authorities such as hospital officials or state medical boards. The findings, appearing in the Journal of the American Medical Association, are based on a 2009 survey of 1,891 practicing U.S. doctors.

Twenty-one years ago, a colleague smelled alcohol on a young physician's breath and anonymously reported him to the head of the residency program. A now-sober Dr. A. Clark Gaither is grateful. “I wish I knew who reported me,” Gaither said. “I'd like to give them a big ol' hug and thank them for saving my life.” Programs exist for retraining doctors with weak skills and getting addicted ones into treatment. But the survey results suggest doctors are not confident in the system, DesRoches said.

The American Medical Association and other professional groups say doctors have an ethical obligation to make such reports. And many states require doctors to tell authorities about colleagues who endanger patients because of alcoholism, drug abuse or mental illness. Despite that, many doctors do not know what to do or where to start, DesRoches said.

“I don't think there's any excuse for less than 100 percent of physicians holding true to these ideals,” said Dr. Matthew Wynia, director of the AMA Institute for Ethics. He called for better protections for whistleblowers and more education for doctors on how to report a colleague. The survey did not specify the type or severity of the impairment or incompetence.

For Gaither, the first confrontation with concerned colleagues was in medical school. He reassured his fellow students he was fine. Even the second confrontation, from the program head who had heard the report of Gaither's alcohol-scented breath, did not take. Gaither signed a contract promising to stay sober, go to Alcoholics Anonymous meetings and submit to testing. “I went home and drank that night,” he said. “I was thinking with an addicted brain, and I was an alcoholic.”

Finally, a third confrontation and the temporary loss of his training license forced Gaither into what he calls “a state of surrender.” With help from the North Carolina Physicians Health Program, he got into a residential rehab program. His last drink was January 21, 1990. Gaither, now 55, finished his residency and became a family doctor. He practices in Goldsboro, N.C., where he started a free mobile clinic for the uninsured.

In 2002, the North Carolina Academy of Family Physicians named him Physician of the Year. He thanked AA and all the colleagues who confronted him and supported him in his acceptance speech. He now urges others to report what they know. “It is our duty,” he said.

Dr. Warren Pendergast runs the North Carolina program, which cooperates with the state medical society and state disciplinary board. About 200 doctors a year are referred for alcoholism, drug addiction, anger-management problems and depression. Ninety percent of addicted doctors who've been through the program remain clean and sober five years after treatment, Pendergast said.

“They're motivated. They have a lot to lose,” he said. Their reputations and careers depend on their participation in treatment,” he said. Gaither, who speaks publicly about the program, said doctors worry that their troubled colleagues will lose their licenses and livelihoods if reported. “I ask them, ‘Would it be better if they lost their money, their marriage, their home, their cars, their license and then their life?’&rdquo he said. “Does that sound better than getting them the help that they need?”