Doctors are still fearful of reporting underperforming colleagues, research reveals.

The study shows that almost one in five UK doctors has direct experience of an incompetent or poorly performing colleague in the past three years.

Nearly three out of four of these doctors said they had sounded the alarm, but one in three of those who had not done so gave fear of retribution as the reason.

The study authors canvassed the views of almost 2,000 US doctors working in primary care and hospital medicine, and over 1,000 of their UK peers, in 2009 about various aspects of professional behaviour.

Topics included quality and safety issues, conflicts of interest and attitudes to patients.

One in four doctors in the UK admitted they hadn’t sounded the alarm about the poor performance of a colleague because they thought someone else was taking care of the problem.

When it came to the quality of their own performance, twice as many US doctors agreed that periodic recertification was necessary. But only just over half of US doctors agreed with this, despite recertification having been in place for several years in the US. Revalidation for UK doctors is due to start in 2012.

Other findings in the study, published online in BMJ Quality and Safety, include only eight out of ten respondents in both countries strongly agreeing that patient welfare should come before their own financial interests; only six out of ten saying they should disclose any financial relationships they had with pharma companies to their patients; and, not all agreeing that it was “never appropriate” to have a sexual relationship with a patient.

UK doctors were also less likely than their US peers to completely agree that all the pros and cons of a procedure should be fully explained to a patient, but when things went wrong, UK doctors were more likely to agree that significant medical errors should be disclosed.

The authors concluded: “We believe that as well as promoting high standards of behaviour from within their own professional societies, it is important for doctors to advocate for healthcare system reforms that facilitate high standards of behaviour. Medical leadership in the UK has been described as conspicuous by its absence and a recent report calls on doctors to assume more active roles in defining the future characteristics of their profession.

“Especially at times of major healthcare reform, as both the USA and UK currently face, doctors have an important responsibility to develop their healthcare systems in ways which will support good professional behaviour.”

There was some evidence that doctors in both countries paid lip service to equality issues. The overwhelming majority of respondents agreed that they should strive to minimise disparities in care due to race, gender, or religion. But fewer than one fifth of doctors in either country had actually looked at data on health inequalities in their practice.

Niall Dickson, chief executive of the GMC, commented: “Doctors have a clear duty to put patients’ interests first and act to protect them; this includes raising concerns about colleagues when necessary. Our consultation on Good Medical Practice asks what more needs to be done to make sure doctors speak up about anything that puts patients at risk.

“The 2009 survey also found that twice as many US doctors supported the need for revalidation or recertification than their UK counterparts, although UK doctors were much more supportive generally of activities designed to improve the quality of care. This may be because doctors are more likely to see the need for something they are already doing. The authors make the point that doctors in the US are more familiar with recertification, which has already been introduced on a mostly voluntary basis in some specialities, whereas doctors in the UK are more used to programmes of quality improvement that have been rolled out across the NHS over the last 10 years. As we approach the launch of revalidation in late 2012, we will continue to work with our partners to ensure that revalidation makes a contribution to the delivery of high quality healthcare in the UK.”

Read the full study.