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Page 1 of 2 The Impaired Physician
Physicians who are impaired for any reason must refrain from assuming patient responsibilities that they cannot discharge safely and effectively. Whenever there is doubt, they should seek assistance in caring for their patients. Every physician is responsible for protecting patients from an impaired physician and for assisting an impaired colleague.
Fear of being wrong, embarrassment, or possible litigation should not deter or delay identification of an impaired colleague. The identifying physician may find it helpful to discuss the issue with the departmental chair or a senior member of the staff or community. Impairment may result from use of habit–forming agents (alcohol or other substances) or from psychiatric, physiologic, or behavioral disorders. Impairment may also be caused by diseases that affect the cognitive or motor skills necessary to provide adequate care. The presence of these disorders or the fact that a physician is being treated for them do not necessarily imply impairment. Physicians should aid their impaired colleagues in identifying appropriate sources of help. While undergoing therapy, the impaired physician is entitled to full confidentiality as in any other patient–physician relationship. To protect patients of the impaired physician, someone other than the physician of the impaired physician must monitor the impaired physician’s fitness to work. Serious conflicts may occur if the treating physician tries to fill both roles.
Peer Review
It is unethical for a physician to disparage the professional competence, knowledge, qualifications, or services of another physician to a patient or a third party or to state or imply that a patient has been poorly managed or mistreated by a colleague without substantial evidence, especially when such behavior is used to recruit patients. Of equal importance, a physician is ethically obligated to report fraud, professional misconduct, incompetence, or abandonment of patients by another physician. Professional peer review is critical in assuring fair assessment of physician performance for the benefit of patients. The trust that patients and the public invest in physicians requires disclosure to the appropriate authorities and to patients at risk for immediate harm. All physicians have a duty to participate in peer review. Fears of retaliation, ostracism by colleagues, loss of referrals, or inconvenience are not adequate reasons for refusing to participate in peer review. Society looks to physicians to establish professional standards of practice, and this obligation can be met only when all physicians participate in the process. Federal law in most states provide legal protection for physicians who participate in peer review in good faith. Conversely, in the absence of substantial evidence of professional misconduct, negligence, or incompetence, it is unethical to use the peer review process to exclude another physician from practice, to restrict clinical privileges, or to otherwise harm the physician’s practice.
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