Commentary

Physician impairment: A need for prevention

Current Psychiatry. 2018 September;17(9):41-44

References

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Some warning signs of impairment include a lack of personal hygiene, emotional lability, sleep deprivation, inattention to our pages or phone calls, and increased professional errors.¹¹ When it comes to addressing such impairment, previous research and literature has focused on how to monitor ourselves and our colleagues; anything less would put the reputation and integrity of the medical profession at risk.³ This has led to a culture of doing nothing but work until things go too far, and then reporting the problems. But what about intervening before things get too far?

Duty: To ourselves, our colleagues, and our patients

There has been much discussion on how to report impaired colleagues, but little on how to help and support ourselves and our colleagues before things escalate into serious problems. And this lack of discussion is at the detriment of individual practitioners, their families, and patients. Physicians-in-training, including psychiatric residents, are at particularly high risk for developing stress-related problems, depression, and substance misuse.¹² Occupational demands, self-criticism, and denial of one’s distress are common among physicians, as is self-treatment with drugs and alcohol.¹³

We all know by now that doctors and physician health programs (PHPs) have a duty to report impaired colleagues who continue to practice despite reasonable offers of assistance. There are an abundance of PHPs that are in place to assist with such situations. The American Medical Association’s official position on reporting impairment is outlined in Policy H-275.952.⁷ There also is the Federation of State Medical Boards. Its policy states that PHPs have “a primary commitment to [help] state medical boards … protect the public … [These] programs [should] demonstrate an ongoing track of record of ensuring safety to the public and reveal deficiencies if they occur.”¹⁴

Legal and ethical issues, however, complicate interventions for colleagues who need assistance.¹⁵ Despite the existence of PHPs, it would be much easier—not to mention helpful—to help a colleague by carrying out early interventions.

Discussion: Prevention as a solution

More emphasis should be placed on prevention. That’s where self-care and well-being come into play. Awareness of and sensitivity to physician vulnerability, early detection, and prevention of impairment are important.

Continue to: There has been a paradigm shift in focus...

Physician impairment: A need for prevention

References

Duty: To ourselves, our colleagues, and our patients

Discussion: Prevention as a solution

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