Physicians’ Experiences With Impaired Colleagues

Abstract

To the Editor: The survey study by Dr DesRoches and colleagues reported data regarding physicians’ experiences with impaired colleagues. Although the authors concluded that a large number of practicing physicians do not support the current process of self-regulation, we believe that the discussion lacked consideration of relevant issues that would put these results into more meaningful context. The association between a state’s malpractice environment and likelihood of reporting an impaired colleague could represent cause or effect. Malpractice claims may be lower in states in which more impaired physicians are reported because such physicians could access the help they need before any patients are harmed. Thus, the quality of the state’s physician health program (PHP) may have a more meaningful effect on the reporting climate within a state. PHPs were implemented to help physicians access treatment while maintaining public safety. There are no national standards for PHPs, so the structure, size, and quality of the programs vary. For example, some PHPs mandate disciplinary action by the state board of medicine, whereas others allow physicians to obtain treatment confidentially and without punitive action (eg, Florida, Alabama). In addition, some states recently lost a PHP (California) or do not have a PHP (Georgia). In an observational study of 904 substance-impaired physicians enrolled in 16 PHPs, there was a 78% recovery rate. The survey used by DesRoches et al did not specifically ask participants about reporting colleagues to a PHP, which may reflect a need for increased awareness of such programs. Given that perceived lack of anonymity and efficacy were identified by the authors as possible barriers to reporting an impaired colleague, state PHPs may provide a valuable resource to impaired physicians and colleagues who are ethically charged with reporting them. It seems likely that rates of reporting an impaired colleague would be higher in states with a high-quality PHP. It is also notable that participants practicing less than 10 years were most likely to agree that physicians should report all impaired or incompetent colleagues (71%) and had the highest rates of actually reporting them (79%). These results may reflect increased education regarding this topic, with medical schools recently focusing more attention on patient safety, medical errors, duty-hour limits, and physician impairment. Continuing medical education regarding physician impairment may enhance knowledge, confidence, and ethical responsibility among physicians already in practice. Lisa J. Merlo, PhD, MPE lmerlo@ufl.edu McKnight Brain Institute University of Florida College of Medicine Gainesville Karl M. Altenburger, MD Professionals Resource Network Inc of Florida Fernandina Beach Mark S. Gold, MD McKnight Brain Institute University of Florida College of Medicine