Impaired Doctors – Five Tips From the ACP

July 15, 2019

Written by Clay Smith

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Helping impaired physicians is part of our profession’s self-regulatory duty. The goal is to ensure patient safety, help physicians get help, and restore them to practice whenever possible.

Why does this matter?
Physician impairment encompasses any condition that would interfere with the ability to care for patients, which may be due to substance abuse, mental illness, fatigue, or other loss of cognitive or motor skills. We, as a profession, have a duty to our patients to make sure they get the best care, which may mean we need to ask for help or assist a colleague who is having trouble.

Doc’s using the wacky weed
This is a position statement from the American College of Physicians on physician impairment and rehabilitation. Here are my take home points, the statements, and my commentary.

1. We have to police ourselves.

   • “The professional duties of competence and self regulation require physicians to recognize and address physician illness and impairment.”

   • Comment: Sometimes we have to report a colleague who is blind to his or her impairment. It’s even better to recognize you have a problem and seek help for yourself.

2. The past informs but should not necessarily dictate the future for physicians.

   • “The distinction between functional impairment and potentially impairing illness should guide identification of and assistance for the impaired physician.”

   • Comment: The ACP is clear that illness does not equal impairment. Some state medical boards ask about prior history of mental illness or substance abuse. The ACP advocates that the focus should be on current impairment and functional impact on patient care more than past problems.

3. PHPs must ensure high quality treatment and monitoring of impaired physicians.

   • “Physician health programs (PHPs) should be developed systematically, informed by available evidence and further research.”

   • Comment: PHPs vary in their effectiveness to monitor physicians undergoing rehabilitation. PHPs usually divert voluntary participants from disciplinary action by the state medical board. But there is a lack of consistency state to state in how physician impairment is handled, which is not ideal.

4. PHPs must protect patients from impaired doctors but be fair to the doctors who need help.

   • “PHPs should meet the goals of physician rehabilitation and reintegration in the context of established standards of ethics and with safeguards for both patient safety and physician rights.”

   • Comment: PHPs have power, which has potential to be abused. PHPs should avoid conflict of interest, namely getting a kickback by mandating referral to a specific treatment center or longer treatment duration for physicians with whom they have a financial tie.

5. Preventing physician impairment is far better than treating it once it’s happened.

   • “Maintenance of physician wellness with the goal of well-being must be a professional priority of the health care community promoted among colleagues and learners.”

   • Comment: As we discussed last week, promoting physician wellness is good for patients and is a smart financial decision for institutions. Many factors that contribute to burnout, and potentially impairment, must be addressed at a systems and organizational level rather than just at an individual level.

Source
Physician Impairment and Rehabilitation: Reintegration Into Medical Practice While Ensuring Patient Safety: A Position Paper From the American College of Physicians. Ann Intern Med. 2019 Jun 4. doi: 10.7326/M18-3605. [Epub ahead of print]

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Reviewed by Thomas Davis