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Physician Impairment

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  • Physician Impairment

    A friend of mine recently made partner in a group after several years. I think the group has like 4 docs or something similar with office based procedures mainly. There are a few office locations so each doc works with another maybe once or twice a week. Over the last few months, he has noticed one of the senior partners with intoxicating type behavior. He began to pay more and more attention and noticed more Of the same. Eventually, about two months ago, he was approached by staff/nurses as well to come help out with some hands on procedures as doctor senior partner was unable to perform the procedures. Apparently, this doc has had this problem for a while and the most clinical staff and Manager of practice, including other partners, are aware, but it is sort of hush hush. My friend and I discussed but I'm unsure what to advise him. I'm in a hospital with a chief of staff, who I can go to and even hospital admin, but here it is a small practice and He is pretty sure everyone knows. He only sees this senior partner maybe once a week due to his schedule. He also made partner not too long ago and is unsure whether bringing this up will ruffle feathers within the group and create issues for him. Thoughts on how to handle in a poiticaly correct manner?

  • #2
    Do you have access to legal services at your hospital? You may have some reporting obligations.

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    • #3
      I don't know if there is a perfect way of handling this, but there appear to be two issues - a toxic attitude, and an inability to perform procedures.  However, the issue central to these two impairments is that they can or do put patient care at risk.  That is and will always be the superior argument to be made in favor of an intervention, and it is why your friend should, without question, intervene in some fashion.  I would frame it as a two fold concern to other partners - to help this physician in any way possible, and to ensure appropriate patient care is taking place.  Damage to the practice is not something I would bring up, because that seems self-serving, and if dealt with corrrectly that issue will take care of itself.  I would also be armed with cold, hard, facts that speak to his impairment.  People aren't blind.  If your friend has seen it I'm sure the others have as well.  His tenure has no bearing on the logic of the argument; however, we are human beings and it may be wise to see if he can get an ally in someone more senior who he trusts before bringing it to the 3rd, non-impaired doctor.  Difficult situation.  I wish him the best.

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      • #4
        Agree with the above.

        This totally sucks and I would never want to be facing a situation to actually have to make this decision. However, we all know what the right thing to do is. Maybe the practice should approach him first, if he comes clean maybe there can be a decent path for him and if that doesnt work, well you tried and then take it to the next level.

        I cant believe they would allow him to practice? I agree its unnecessary to bring up damage to the practice but if I were a partner/owner you can bet that it matters. Thats serious and if claims could be made the group knew and did nothing and let pts in harms way, that could/should be the end for them. While self serving, sometimes that works for people. If its harmful to pts its harmful to the practice.

         

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        • #5
          I would definitely report. However, I'd give the physician the chance to report himself rather than turning him in. I believe they are given more leeway in those cases. One of my colleagues is on the board that decides how to handle physicians who are impaired. I feel like she said that some states are better than others in terms of how they handle it but ultimately that shouldn't stop you or him in getting him help. One of my co residents got treatment while in residency and so far it hasn't impacted his ability to work anywhere post residency and he's doing quite well from a sobriety standpoint.

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          • #6
            I Would definitely not send any emails (especially on the hospital account) or texts detailing any concern or suspicion-

            I wouldn't talk with anyone unless I committed to fully report.. if one of the nurses expressed their concern to me (I.e, now they documented I'm in the know) i would go straight to admin to report - not sure about state boards

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            • #7
              If staff is aware he is impaired they may face their own liability for failure to intervene, report, etc. It's truly bad form and not in the doc's best interests either that this has been allowed to go on for so long.

              Each state has different impaired physician programs, laws, etc. As does each hospital, I'm sure. I'm fortunate to work somewhere where we support physician recovery and in a state with one of the most robust impaired physician programs around. Physicians have very high rates of recovery when supported properly so it is a disservice to him not to intervene.

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              • #8
                I am unsure if we are talking about impairment from drugs or alcohol or a neurologic problem.  I have seen a number of doctors and nurses recover from substance abuse and have good careers.  Several docs that I know developed Parkinson's disease and they were actually slower to admit the problem and go out on disability.  Perhaps the most senior partner in the group needs to talk to this person and encourage him to get help.  If he refuses the entire group needs to meet with him.

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                • #9


                  I am unsure if we are talking about impairment from drugs or alcohol or a neurologic problem.  I have seen a number of doctors and nurses recover from substance abuse and have good careers.  Several docs that I know developed Parkinson’s disease and they were actually slower to admit the problem and go out on disability.  Perhaps the most senior partner in the group needs to talk to this person and encourage him to get help.  If he refuses the entire group needs to meet with him.
                  Click to expand...


                  That's what I was wondering as well

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                  • #10
                    Agree with above, there is a big difference between reversible impairment (drugs, alcohol) and a neurodegnerative disorder (any dementia, Parkinson's, etc.). I would recommend talking with the leadership in your group. If there is a risk management division in the group, perhaps a discussion with them.  If that does not work then the ethical thing to do would be to think about reporting to the state board. I would try to have specific examples of concerning things.  I would also recommend beginning the search for another job.  If the partners are NOT supportive then you (or your friend in this case) could potentially be held liable in a medical malpractice if you share patients with this questionable physician.  I would not want to continue sharing patients with a physician I had concerns about their capacity to treat.

                    Furthermore, when staff, especially nurses, ask your friend to help with a patient because of their concerns for patient safety, this should be documented and reported.  The nurses should be encouraged to report their concerns. Oftentimes they are more protected then even physicians with labor laws, etc.  Many hospitals will have a reporting tool that these nurses should be encouraged to report on.

                    I will not go into my personal experience with a similar situation with concern that some may figure out who I am on the internet.  However, I mentioned a similar situation in a thread last week.  Some people accused me of being ageist for thinking that physicians should be financially ready to retire at age 60.  The reality is that while some physicians can practice into their 80s, some cannot because of medical conditions.  This is a reminder of why everyone should be preparing for financial independence, but I know I am preaching to the choir on this forum.

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