In my post last week about the Florida gun law, I mentioned that we get bad laws and other attempts to regulate and standardize physician behavior when we fail to do it ourselves.  That psychiatrists, eg, failed to report sexual misconduct is, I think unsurprising. Reporting your colleagues to authority bodies is hard.

This article from JAMA gives a little more insight into what people say keeps them from reporting:


One thing I’ve been thinking: reporting systems are fatally flawed.

Having difficulty putting this into coherent English. But, in order to work, any reporting system must be used. And if people are afraid to do that because they don’t trust whatever authority receives a report to deal with it appropriately and don’t trust their colleagues not to resent them or seek retribution, then people will report infrequently and only more egregious behaviors, and the reporting process will largely be punitive.  It’s a self-reinforcing spiral.

If you want to build a system where people report, you first have to build a system where transparency, open & critical peer-to-peer feedback and self-policing are expected, valued, and encouraged by everyone. Remediation when needed must be both effective and normalized.  And if you have all that, do you still need the reporting system?