Dilemma:

If a physician friend or colleauge were impaired (alcohol, drugs, or illness) or was no

longer competent, and he or she ignored your warnings to get help, would you report that
person to a superior or to the state medical board?
For- Turn them into the state medical board or your
supervisors(superiors)

Against- Dont turn them in, and try to talk to them,

and help them with their problem, instead of turning
them into your supervisors and state medical board

Slide 2
Articles from medical journals and medical institutions
1-The US National Library of Medicine, a part of the National Institutes of Health wrote that Psychological and
emotional impairment among physicians represents a serious, widespread, and difficult problem. For unclear
reasons, it has been problematic to effectively identify and treat this group of professionals whose performance is
so intimately associated with the health and wellbeing of the general population. The severity of the problem, the
resistance to treatment which seems evident from the data presented, and the fact that most of the conditions
afflicting physicians are treatable and reversible, compels us to seek a viable solution. Diligence in the pursuit of
understanding and correction of the dilemma is a social and personal imperative.
2-AHC Media wrote an online article going into more of the signs of an impaired physians and the defenition of
one- Physician impairment has become an increasingly recognized problem in medicine. A physician or other
health care professional becomes impaired when one or more problems cause him or her to be dysfunctional, with
recurring problems in the quality of patient care, other professional activities, education, or private life. Denial of
the impairment by the physician, the physicians family, and the community is common. All states now have
programs to identify and help impaired physicians. This article will focus on impairment caused by alcohol and
drug addiction. The American Society of Addiction Medicine has defined addiction as "a disease process
characterized by the continued use of a specific psychoactive substance despite physical, psychological, or social
harm." Addiction is the cause of physician impairment in up to 85% of evaluated cases. Unlike traditional
definitions, which focused wrongly on cultural, moral, and legal issues, addiction today is considered to be a
disease entity an affliction, not a human foible. The terms "progressive" and "fatal" are entirely appropriate to
emphasize its seriousness.

Slide 3
The American Medical Association wrote an Code of Ethics which are basically a guideline for healthcare practicioners to follow. Physicians have
an ethical obligation to report impaired, incompetent, and/or unethical colleagues in accordance with the legal requirements in each state and
assisted by the following guidelines:
Impairment. Physicians responsibilities to colleagues who are impaired by a condition that interferes with their ability to engage safely in
professional activities include timely intervention to ensure that these colleagues cease practicing and receive appropriate assistance from a
physician health program (see Opinion E-9.0305, "Physician Health and Wellness"). Ethically and legally, it may be necessary to report an
impaired physician who continues to practice despite reasonable offers of assistance and referral to a hospital or state physician health program.
The duty to report under such circumstances, which stems from physicians obligation to protect patients against harm, may entail reporting to the
licensing authority. Incompetence. Initial reports of incompetence should be made to the appropriate clinical authority who would be empowered
to assess the potential impact on patient welfare and to facilitate remedial action. The hospital peer review body should be notified where
appropriate. Incompetence that poses an immediate threat to the health and safety of patients should be reported directly to the state licensing
board. Incompetence by physicians without a hospital affiliation should be reported to the local or state medical society and/or the state licensing
or disciplinary board. Unethical conduct. With the exception of incompetence or impairment, unethical behavior should be reported in accordance
with the following guidelines and, considering, as necessary, the right to privacy of any patients involved: Unethical conduct that threatens patient
care or welfare should be reported to the appropriate authority for a particular clinical service. Unethical conduct that violates state licensing
provisions should be reported to the state licensing board. It is appropriate to report unethical conduct that potentially violates criminal statutes to
law enforcement authorities. All other unethical conduct should be reported to the local or state professional medical organization. When the
inappropriate conduct of a physician continues despite the initial report(s), the reporting physician should report to a higher or additional authority.
The person or body receiving the initial report should notify the reporting physician when appropriate action has been taken. Physicians who
receive reports of inappropriate behavior, including reports submitted anonymously, have an ethical duty to critically, objectively, and
confidentially evaluate the reported information and assure that identified deficiencies are either remedied or further reported to a higher or
additional authority. Information regarding reports or investigations of impairment, or of incompetent or unethical behavior should be held in
confidence until the matter is resolved.

Slide 4
1.

The Health Law Firm wrote an online article saying that turning the impaired physician into the medical board is the wrong move. There
has been a concerted effort among hospitals to identify and take action against "disruptive physicians." This has been encouraged by the
Joint Commission. Often a complaint will be made to the state licensing board or regulatory authority and investigated as an alleged
violation of the medical practice act or as other grounds for discipline. Far too often a physician will be intimidated into reporting himself
or herself to a treatment and monitoring program for impaired physicians in order to avoid an investigation or complaint. Most often, this
is the wrong move to make. We have seen, first-hand, attempts being made to label a physician as a "disruptive physician" because he or
she refused to allow unnecessary and expensive invasive procedures to be performed on his/her patients by another physician in a hospital
setting. We have seen attempts made to label a doctor as a "disruptive physician" because he refused to provide a drug seeking addict
(who was hospitalized after a gunfight with police) with additional narcotics. We have seen attempts made by an economic competitor of
a physician, who had been able to obtain election as president of the medical staff, to label a physician as a "disruptive physician" in order
to drive her off of the hospital staff, thereby eliminating her competition with him. We have seen competing medical groups form an
alliance with administrators at a for-profit hospital, to label a physician competitor as a "disruptive physician" and enlist the aid of nursing
staff to document every alleged transgression of the physician. We have experienced instances where hospital nursing staff was instructed
to scrutinize every act of a surgeon on the staff and to write up every perceived action of this doctor that might possibly be considered to
be inappropriate any respect (even "rudeness"). We have represented surgeons labeled as "disruptive physicians" because they cancelled
an elective surgery after the scheduled surgery on their patient was delayed three hours because hospital staff did not come in on time and
other surgeries started late. Often physicians reacting to protect their patients from other physicians, or who may attempt to correct
incompetent nursing staff, are labeled as "disruptive" because of their comments or actions. Physicians who are somewhat demanding or
who are perfectionists (as many, naturally, are), are often unfairly labeled as "disruptive." We have seen the most highly skilled
subspecialists, whose only major concern is their patients care and safety, branded as a "disruptive physician" by hospital staff. Almost all
of the alleged "disruptive physicians" we have represented or been consulted by have been neurosurgeons, orthopedic surgeons or trauma
surgeons. We have also seen the label applied to physicians most often in smaller, more rural hospitals and communities where the

Slide 5

Competent- having the necessary ability, knowledge, or

skill to do something successfully

Impaired-weakened or damaged

Superior-higher in rank, status or quality

Colleauge-a person with whom works, casually in a

profession or business

Drug-medicine or other substance when ingested or

otherwise introduced into the body, has a physiological
effect

Alcohol-a drink that contains a substantial amount of

Ethanol, a depressant which in low doses causes
euphoria, reduced anxiety, and sociability, and in higher
doses causes intoxication(drunkeness), stupor and
unconsciousness

Vocabulary

Slide 6- Citations
Citations
1. http://www.medscape.com/features/slideshow/public/ethical-dilemmas
2. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medicalethics/opinion9031.page
3. http://www.ncbi.nlm.nih.gov/pubmed/7117830
4. http://www.ahcmedia.com/articles/81751-impaired-physicians-in-the-ed-don-8217-t-ignore-the-signs
5. http://www.thehealthlawfirm.com/resources/health-law-articles-and-documents/disruptive-physicianlabel.html