MAYBE that second opinion isn’t worth the bother. A quarter of doctors who know that a colleague is underperforming or incompetent do not sound the alarm, a confidential survey reveals. They fear retribution, believe that no action would be taken, or assume that someone else is dealing with the problem.

Martin Roland of the University of Cambridge and colleagues confidentially surveyed 3000 US and UK doctors in 2009. The results suggested that almost 1 in 5 doctors had direct experience of an incompetent or poorly performing colleague in the previous three years. Twenty-one per cent of US doctors and 13 per cent of UK doctors admitted not telling patients about their or others’ mistakes for fear of being sued (BMJ Quality & Safety, DOI: 10.1136/bmjqs.2010.048173).

Niall Dickson, chief executive of the UK’s General Medical Council is worried by the survey. “Doctors have a clear duty to put patients’ interests first and act to protect them”, including raising concerns about colleagues, he says.