The impaired physicians

INTRODUCTION
All people are vulnerable to illness – illness that can result in impairment in one’s personal, social or work life. As physicians, we are no exception – indeed, we may even be at higher risk for certain types of impairment than the general public. Studies have shown that, of all impaired physicians, at least one-half have problems with drugs and/or alcohol abuse.

CAUSES
Chemical dependency
Psychiatric illness
Adult Attention Deficit Disorder (ADD).
Psychosexual illness, including boundary violations
Neurological/cognitive impairment
Physical illness
Behavioral disorders

Perhaps you have known colleagues affected by difficulties to such an extent that they have interfered with family and social life and even work performance. Most likely, in such a situation, you have felt very concerned but quite helpless. So much is at stake – your colleague’s health, even perhaps his life; his or her family, career, reputation within the community; and your own friendship or professional relationship with the colleague. Perhaps you have weighed each of these things and decided that, in spite of your concerns, doing nothing was the only course possible, reasoning, what can you really do anyway?

GOAL
The information presented here is for the primary goal of convincing you that if you suspect a fellow physician is in trouble, there are actions that you can and must take as a concerned colleague. This is intended to explain and encourage those actions, and to offer resources that can be of help.

Q: WHAT IS PHYSICIAN IMPAIRMENT?
A: The American Medical Association defines an "impaired physician" as one who is unable to practice medicine with reasonable skill and safety because of mental illness or excessive use or abuse of drugs, including alcohol. In general, physicians become impaired because of three major problems:
Substance abuse – Alcohol abuse is the most common problem. Abuse of narcotics, sedatives and other depressants as well as stimulants, including cocaine, may also occur. According to current estimates, both locally and nationally, 8 to 10 percent of physicians abuse alcohol and 2 percent abuse narcotics.
Psychological problems – Excessive stress, depression, anxiety and divorce are the most common issues.
Physical illness – Physical ailments, either temporary or long-term, can lead to incapacity.
Of these groups of illnesses, substance abuse is the problem for which physicians are least likely to seek help. The rest of the information presented here, therefore, is devoted to impairment caused by chemical dependency.
The physician who is impaired often acts in an unusual manner and exhibits behaviors that can serve as warnings if they are recognized and understood.
"Just not the same person we used to know . . . "
Loss of enthusiasm
Negative attitude
Cynical, fault-finding remarks
Sarcastic, complaining, antagonistic behavior
Involvement in internecine staff or administrative battles
Feeling like a tragic, overworked, misunderstood hero
Isolation, mistrust, abandonment of old friends
"We can’t trust his work anymore . . . "
Changes in work habits (disruption of consistent patterns)
Erratic productivity combined with crazy hours
Changes in handwriting
Wrong dates, word reversals, dosage errors
Change in prescribing habits
Changes in number of consults
Procedural errors
Errors of omission with alibis, cover-ups
Missed appointments, meetings, dropping of committees
Complaints from staff, patients, families
"She seems different somehow . . ."
Looks tired; admits to insomnia
Eyes don’t look right
Personal hygiene changes; looks seedy
May smell of stale alcohol or strong cologne
Tremulous or sweaty
At times, agitated or restless
At times, may look drowsy or doped up
Changes in speech (slurring, careful cadence, stammering or blocking, "tranquilizer lilt")
Increasingly forgetful
Changes in appetite or exercise pattern; recent weight change
Self-diagnosed health complaints; morbid health concerns
Depressed (agitated or retarded)
Anxious, mistrustful

Q: WHY GET HELP?
A: If you suspect a fellow physician has a problem, it is essential to realize that the problem will not go away on its own! The very fact that this problem exists means your colleague has not been able to get control of it. Nor are you, no matter how well-meaning and concerned, able to offer all the assistance needed.
Sometimes a friend’s well-intended attempts to help may actually have the effect of enabling the colleague to persist with the very behaviors that are causing the problem. Have you ever tried to "cover" or make excuses for a colleague who you suspected was having a problem?
Fortunately, impairment can be helped if approached properly. Whether the problem stems from substance abuse or from emotional or physical factors, there has been a great deal of experience in working with impaired physicians, and experts are readily available to help.
Early intervention is critical. When left alone, problems caused by impairment tend to worsen – they can lead to divorce, financial disaster, loss of employment, or suicide. Severely impaired physicians may be endangering the safety of patients and colleagues, as well as themselves, on a daily basis.
On the other hand, the earlier an impaired individual gets help, the greater the likelihood that help can be obtained confidentially, voluntarily and without jeopardy to the physician’s family, career or permanent health.
And, because the problem of impairment is so common among physicians, it is now increasingly acknowledged that they have a right to get help confidentially and to recover fully – including the right to retain or regain their privileges as physicians.

Q: HOW CAN YOU HELP?
A: Generally, impaired physicians do not seek help on their own. In fact, like other impaired persons, they usually deny that there is a problem.
Because denial is so common in situations of impairment, it is even more critical that you, the concerned colleague, take some action to see that help is made available to the physician who may need it. Remember that a failure to act on your part may have the effect of enabling the problem to continue.
There are several steps you can take that are confidential and that offer the opportunity for your colleague to get help.

First – Approach your colleague. Mention what you have noticed (the specific behaviors that have caused your concern), and ask for an explanation. Inquire directly if there is a problem.

Second – If your colleague denies there is a problem but you still suspect one, wait a while for him or her to resume the conversation. If the topic isn’t brought up again, and you still fear that a problem exists, call a reliable resource for advice. This step can be taken anonymously.

Third – Based on the above information, advice from reliable sources, and your own observations, decide if you still think there’s a problem.

Fourth – If you are convinced that your fellow physician does have a problem, you must act. Call for help. Remember, this kind of problem does not go away on its own – instead, it is likely to worsen – but if caught early, the potential for a successful outcome is far greater.

Finally I request all the fellow administrative physicians ,Cheif acadamic officers,CEOs ,Program directors and the other administrative staff
please do not fire or terminate the fellow resident physicians/physicians or other health care professionals premeturely it is like a professional homicide.

It is a death sentence to their career.

If a physician wants to kill the fellow physician(when he/she is a patient)
who will save them, as you know they are also human beings and they are also equally vulnarable to all the problems or the diseases.
As you know health care professionals especially resident physicians and practcing physicians spend their life time reading and practicing medicine.
So please give them a chance to recover and explore the reasons why he is in trouble.

Once he or she realizes and the denial is broken he/she will definitely recover.

Please ...Please......Please.........save the wounded healers.

Research has shown that more than 90% of health care professionals especially resident physicians and other physicians recover if given a chance and their core issues were explored and treated appropriately.

As physicians it's our moral responsibility to save our fellow resident physicians,practcing physicians and other health care professionals.
Since our job is to save patients even if they happened to be physicians or any other health care professionals .


ADDITIONAL RESOURCES:
1. http://www.fsphp.org/6020.html
2. http://www.acponline.org/journals/news/may98/impairmd.htm
3. http://www.stfm.org/fmhub/fm2002/mar02/re3.pdf
4. http://www.aaos.org/news/bulletin/marapr07/managing11.asp
5. http://housestaff.medinfo.ufl.edu/policy/impairment.shtml
6. http://www.fredlaw.com/articles/health/heal_9409_kghmm.html
7. http://www.ccjm.org/abstracts/feb8abs2.htm
8. http://www.cpenashville.com/Page3.htm
9. http://www.smbs.buffalo.edu/GME/policies/pdf_policies/Impaired-Physic.pdf
10. http://ajp.psychiatryonline.org/cgi/content/full/160/5/850
11.http://ajp.psychiatryonline.org/cgi/reprint/160/5/850.pdf
12.http://www.jcipatientsafety.org/15416/