Dr. David Sack - PhysiciansMoneyDigest.com
August 24, 2010
How to Blow the Whistle on Impaired Colleagues
By Ed Rabinowitz
A recent survey
published in Journal of the American Medical Association found that 64
percent of surveyed physicians agree with the professional commitment to
report physicians who are significantly impaired or otherwise
incompetent to practice. But what that really means is that 36 percent
-- more than one-third of surveyed physicians -- believe it’s acceptable
not to report an impaired colleague. And the consequences are
considerable.
“What we see more and more is this impact on patient safety, and how
negligence as a whole, but also impacted by drug and alcohol dependence,
is impacting patients in a negative way,” says Michael Duffy, managing
partner with Duffy & Duffy.
“Physicians do tend to protect each other. It tends to be an almost
cultural thing within medicine.”
Occupational Hazard
David Sack, MD, is the founder of Promises Treatment Centers, which is
well known in the medical profession for its doctor-specific substance
abuse program. With regard to alcoholism, which is the biggest drug
problem in the U.S., physicians are probably no worse than the general
population, Sack says. Where physicians are especially vulnerable, he
notes, is with prescription drug abuse.
“They have more access,” Sack explains. “It’s easier to write
prescriptions for yourself, or under a pseudonym. They’re also more
likely to be exposed to these prescriptions than someone in the general
population, and I think we often forget that exposure is a risk factor.”
In addition, says Sack, it’s well documented that shift work and sleep
deprivation contribute to drug abuse. People who work swing shifts or
rotating shifts have a higher incidence of substance abuse, both to
alcohol and amphetamine-type drugs that promote wakefulness.
“Until recently, physicians were forced to work very prolonged hours,"
he says. Now there are at least some caps on those hours, not because
the hospitals got kinder to physicians, but because they got tired of
being sued for errors.”
In addition, Sack points out that the risk of substance abuse is greater
among certain specialties. For example, anesthesiologists are exposed
to the inhalant medications they administer in operating rooms. That
incidental exposure raises their risk of becoming addicted -- and
increases their risk of relapse.
The Legal Implications
Employers are responsible for the actions of their employees,
Duffy says. If a medical practice employs a physician who is impaired
and is injuring patients as a result of that impaired state, the
practice is open to liability as well. For individual partners in the
practice, their personal liability depends on the corporate structure of
the practice, such as a partnership versus a corporate entity. But
beyond the legal liability issues, Duffy says, there’s a moral and
societal responsibility that physicians are overlooking.
“The Hippocratic oath says to remember that you’re a part of society,”
he says. “Physicians who are putting themselves in this position, as
well as those who protect the physician over the patient, lose sight of
how society depends on them." Allowing society to trust physicians when
they may not be worthy of trust impairs society’s association with
physicians, and that hurts the medical industry as a whole, Duffy says.
Confronting the Problem
The JAMA survey found that almost one-third of physician
respondents said they felt unprepared to effectively talk about the
problem with an impaired colleague. Sack says medical schools have been
remiss in providing the necessary education for physicians to recognize
and talk about these issues. Some states now require this kind of
education as part of license renewal, he says. Physicians must take a
minimum curriculum in addiction medicine. “But the truth is that it’s
woefully inadequate for the magnitude of the problem,” Sack says.
If a physician is going to approach a colleague about an apparent
problem, that conversation is likely to be ineffective if done lightly,
jokingly or on the spur of the moment, Sack says. If a colleague is in
trouble, it’s important to schedule a time to sit down with them and
say, “I’m concerned about you, and these are the things that are making
me concerned.” It could be failure to show up for rounds, slurred speech
during a meeting, or keeping patients waiting in the office. The
important thing is that the message cannot be delivered lightly, he
adds.
“Physicians are often afraid their colleagues will become enraged and
won’t talk to them,” Sack says. “And with people in the throws of
addiction, that will happen. But if you’re concerned, you have to be
willing to take the heat. You have to be willing to take it up with your
partners in a group practice and say, ‘We just can’t ignore this.’ ”
Failure to do so can be devastating to the impaired physician -- and the
practice.