Magazine article Medical Economics

Impaired Physicians: Speak No Evil?

Magazine article Medical Economics

Impaired Physicians: Speak No Evil?

Article excerpt

Ethics sometimes takes a back seat to inertia, fear, or empathy for a fellow doctor, but patients may pay the price.

Would you report an impaired colleague to the state medical board or your hospital's chief of staff? Sixty-five percent of the physicians who responded to our 2002 Ethics Survey said Yes, they would report a doctor who was impaired by alcohol or drugs, or had a physical or mental illness that could affect his job performance or judgment.

Internist Catherine Landers of Skokie, IL, is one of those who take this stance. "If we don't police ourselves, someone else is going to do it, and they'll do it more harshly than we might. It's a matter of professional pride, as well. I don't want bad doctors to give all doctors a bad name."

But several ethicists and professionals who work with impaired physicians think our numbers may represent conviction more than action. It's easier to check off a box on a survey than to do the deed. "People tend to talk to friends and close colleagues rather than turn them in," comments Paul Root Wolpe, a bioethicist at the University of Pennsylvania School of Medicine. "They're more likely to report the physician if the person has caused a problem with one of their patients."

Three respondents in 10 say they'd take the course Wolpe outlines, approaching an impaired physician privately to discuss his problem. Of course, physicians would be more likely to talk to someone they knew well than to one they had had only occasional contact with.

"If a doctor had a reputation for alcohol or substance use, and I didn't use him as a consultant, I'd probably not get involved," says FP Craig Wax of Mullica Hill, NJ.

However, a staggering 95 percent of respondents say there is an ethical obligation to take some action if they believe a colleague is impaired. In part, this reflects a cultural shift in attitudes toward addiction. Rather than being regarded as a moral failing that makes an individual unfit to be a physician, drug or alcohol addiction is now seen as a curable illness. As a result, physicians have been increasingly willing to urge addicted colleagues to get treatment, says FP Martha Illige, medical director of the Aurora, CO-based Center for Personalized Education for Physicians. (CPEP does not treat impaired physicians, but helps those whose clinical skills aren't up to par.)

Reporting doctors to the authorities is another matter. Clearly, many physicians would rather not do something that could end a colleague's career or boomerang on them. But Wax and other respondents who hesitate to turn colleagues in say that if they believed someone was harming or endangering patients, they'd report him immediately.

LICENSING BOARDS TAKE A NEW STANCE

The AMA's Code of Medical Ethics leaves no such room for equivocation, stating that "physicians have an ethical obligation to report impaired, incompetent and unethical colleagues" and lists several guidelines to follow. Before reporting impaired physicians to the state licensing board, it says, doctors should try to get them into treatment programs or contact their hospital's chief of staff.

The reasons for using state licensing boards as a last resort may be disappearing, though. Many licensing boards will now refer impaired doctors who haven't injured patients to treatment programs without imposing sanctions on them, notes geriatrician Steve Miles, a professor of medicine at the University of Minnesota Medical School. The idea, he says, is "to get these docs diverted into treatment, instead of hiding out until they injure somebody."

Since physicians are still reluctant to go to licensing boards, doctors with substance abuse problems may also self-refer to "physician health programs," most of which are- run by state medical societies. Twelve states have laws allowing physicians to refer colleagues to physician health programs rather than licensing boards if they haven't hurt patients. …

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