The Impaired Physician

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The Impaired Physician

Clinical Fundamentals
Author Credentials 

Christina Cabrera-Muffly, MD
Assistant Professor
Department of Otolaryngology
University of Colorado
Aurora, CO

Module Summary

Physicians can become mentally or physically impaired during practice, which affects their ability to effectively treat patients. Impairment can stem from substance abuse, mental health issues, or physical conditions that affect cognitive, motor, or perceptive skills. Colleagues of an impaired physician have an ethical responsibility to identify impairment and assist in seeking care for their fellow physicians. This includes helping the provider recognize the impairment, encouraging self-referral for treatment, and may require reporting the physician to supervisors or medical licensing authorities. Intervention of the impaired physician should occur in a compassionate and confidential manner. Many physicians who have undergone successful treatment of the impairment are able to return to medical practice.

Module Learning Objectives 
  1. Identify types of physician impairment that can affect patient care.
  2. Describe how to recognize behaviors indicative of physician impairment.
  3. Identify the ethical responsibilities of both the impaired physician and their colleagues to patients and fellow physicians.
  4. Describe remediation strategies used in the treatment of impaired physicians.

Patient Evaluation

Learning Objectives 
  1. Identify behaviors that can indicate substance abuse or addiction in the impaired physician.
  2. Identify physical and mental impairments in physicians that can negatively affect patient care by an impaired physician.
References 
  1. Sudan R, Seymour K. The impaired surgeon. Surg Clin North Am. 2016 Feb;96(1):89-93. 
  2. Chapter 7: The Impaired Physician. The Ethics Committee of American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head and Neck Surg.1996 Sep;115(3):213-9.

Treatment

Learning Objectives 
  1. Describe treatment strategies used to treat impaired physicians with substance use disorders.
  2. State success rates of treatment for impaired physicians with substance use disorders.
  3. Recognize professional organizations involved in treatment of impaired physicians.
References 
  1. Sudan R, Seymour K. The impaired surgeon. Surg Clin North Am. 2016 Feb;96(1):89-93.
  2. Chapter 7: The Impaired Physician. The Ethics Committee of American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head and Neck Surg.1996 Sep;115(3):213-9.

Case Studies

  1. Over the past few months, you notice that one of the physicians in your group practice has become socially withdrawn and increasingly difficult to reach.  This provider, who was previously gregarious and reliable, no longer answers his pager or cell phone, has missed multiple staff meetings, and has even missed several patient clinics.  Patient complaints about this provider have increased, and one of the nurses tells you when he showed up for operating room cases yesterday, he had slurred speech and smelled of alcohol.  How will you address this situation?  What is your responsibility to the patients in your practice as well as to this provider? 
  2. A 50 year old female partner in your department was recently diagnosed with Multiple Sclerosis. Her symptoms include weakness of her right upper extremity, which is her dominant hand. She has been partnering with other surgeons in your group to complete her surgeries, and they report to you that she is unable to perform the key portions of these procedures. Clinically, her judgement is sound, and her ability to treat patients in the office is unaffected. As a department leader, how will you address this situation? What is your responsibility to patients, other providers in your practice, and to this provider?

Review

Review Questions 
  1. What types of impairments can affect a physician’s ability to provide patient care?
  2. What behaviors can indicate substance abuse or addiction in the impaired physician?
  3. If you identify a colleague as being impaired, are you obligated to address this problem?
  4. What strategies are helpful for addressing an impaired physician situation?
  5. What ethical concerns are involved in an impaired physician situation?
  6. Are impaired physicians ever able to return to patient care successfully?
References 
  1. American Academy of Otolaryngology–Head and Neck Surgery. (2012, October). Code of Ethics. Retrieved February, 2018.
  2. Federation of State Medical Boards of the United States, Inc. Policy on physician impairment. Retrieved February, 2018. 
  3. Sudan R, Seymour K. The impaired surgeon. Surg Clin North Am. 2016 Feb;96(1):89-93. 
  4. Chapter 7: The Impaired Physician. The Ethics Committee of American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head and Neck Surg.1996 Sep;115(3):213-9.