What should you do if you notice your colleague and mentor is having memory problems or showing signs of dementia? What action should you take if your partner is engaged in behavior that you suspect stems from an addiction to drugs or alcohol? What if you observe tremors, depression or unhealthy weight loss in another provider? What obligation do physicians have to take any action when a colleague shows signs of being impaired?
According to the AMA (Opinion 9.031), physicians have a responsibility, which stems from the obligation to protect patients from harm, to take action if an impaired colleague exhibits a condition that interferes with their ability to engage safely in professional activities. Timely intervention to assure that your impaired colleague stops practicing and receives assistance is recommended and, if the impaired colleague ignores offers of assistance, it may become legally and ethically necessary to report the impaired physician to a licensing body or other authority.
Although the ethical rules may be clear, it’s always harder in reality to deal with an impaired physician. There are many reasons to explain away the signs that a colleague is in trouble. While hospitals and larger practices often have formal mechanisms to deal with impaired physicians, smaller groups typically have no idea how to handle such a situation. This is especially true if the impaired doctor has seniority and/or decision-making authority over the practice.
Unfortunately, my practice has dealt with many impaired physicians. Whether it’s inappropriate addictive behavior, mental illness, or an accident that creates new limitations for a provider, every situation requires appropriate action. Waiting until the impaired physician is arrested, a patient is injured, or the reputation of the practice is irreparably affected is not an option. Early intervention can also minimize the potential for criminal charges, malpractice litigation, and loss of the physician’s medical license and/or medical staff privileges. All of these events can end a physician’s career.
There is no one approach to address the problems presented by an impaired colleague, but I suggest the following:
1. Arrange a meeting with the impaired physician alone or with other physicians in the practice to provide support and share concerns. The meeting should not be an attack or confrontation. Consider having a neutral party present, such as the practice’s accountant, lawyer, or consultant. This person should be someone who can help everyone stay calm and keep the focus on being supportive.
2. Present some options to the impaired physician. For example, if the physician is suffering extreme depression, perhaps offer the names of qualified therapists or available programs. Discuss a proposal for the physician to work a reduced schedule or to take a break from work, as appropriate. For addictions or more serious mental or medical health issues, the names of local assistance programs or providers may be appropriate, as well as a plan for an extended leave of absence. A concrete strategy can help an impaired physician accept that action is needed and available.
3. If the physician rejects all assistance, there may be a need to contact the licensing authorities, the hospitals, or facilities where the physician practices or even the police in order to protect patients, as well as the impaired practitioner. These decisions should be made with the assistance of counsel to assure that all options have been considered and to assess whether such approach is reasonable in light of available evidence. Clearly the most ideal approach is to preserve the privacy of the situation and the reputation of your colleague and practice.
Properly drafted employment and shareholder documents can help your practice plan for unanticipated events, such as an ill or impaired physician. Contracts can address issues such as time off for disability and termination or forced suspension for physicians who display signs of addiction or otherwise pose a risk to patients. Discuss these possible provisions with your health care counsel.
There is no easy or simple way to handle an impaired colleague. Physicians are only human and can succumb to the same physical, mental, and other issues they are trained to address. When an impaired physician poses a risk to patients and your medical practice, be prepared to take appropriate action.
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