RT Journal
A1 DesRoches CM, Campbell EG
T1 PHysicians’ experiences with impaired colleagues—reply
JF JAMA
JO JAMA
YR 2010
FD November 3
VO 304
IS 17
SP 1895
OP 1897
DO 10.1001/jama.2010.1560
UL http://dx.doi.org/10.1001/jama.2010.1560
AB 
In Reply:  We agree with the comments by Dr Merlo and colleagues and Dr Truex about the importance of referrals to PHPs and agree that a well-run PHP could have a number of positive effects. In response to Truex, it is possible that our survey item, through the use of the word report rather than refer, caused respondents to exclude the possibility of referring physicians to a PHP. Although this did not appear to be the case during survey pretesting or expert panel review, we cannot exclude the possibility. We agree that a culture of referral rather than reporting may improve the likelihood of getting impaired and incompetent physicians the help they need. This nuanced perspective suggests a need for systemic cultural change at the practice level and perhaps at the hospital level, whereby referral becomes the first option and reporting for disciplinary action may be a final resort.