We all know that there is honor among thieves, but apparently a similar code exists among physicians, both good and bad. The nature of the pledge? Not do no harm or respect patient autonomy, but “don’t ask, don’t tell.” And not the military variety.

According to a recent report in JAMA this week, one-third of physicians fail to report colleagues who suffer from drug, alcohol or other mental illness issues that may impair their ability to adequately treat patients. As described by Modern Healthcare, ” 5% of all doctors surveyed knew of an impaired or incompetent doctor but failed to alert proper authorities.”

Why this code of silence? Perhaps physicians do not want to be their own morality police. Perhaps they fear blowing the whistle on their peers for questionable behavior will have the mirror turned back on their own behavior. Maybe it is often difficult to draw the line between the physician who often is the life of the party at hospital social events and who chronically has one to many drinks and one who appears to show up to work with a hangover, or even worse drunk.

In any case, it would be foolish to think that physicians are the only profession who turn a blind eye to peers who suffer from addictions and illnesses that impair their practices, but rarely do those impairments put lives in jeopardy. (Impaired lawyers can just as seriously screw up cases and accountants can result in IRS audits or worse.)

No doubt it is difficult to stand up to a peer and especially a friend and tell them that they have a problem and that they are putting patient’s lives at risk, but better that then knowingly letting them do it, violating medical ethics, and being culpable in the process.

Summer Johnson, PhD