The impaired physician reporting dilemma: Legal, moral, and ethical considerations for the practicing dermatologist

Abstract

Jim Smith, the founding member of a five-person private practice dermatology group, is turning 72 years old. When he turned 70, he decreased his hours from 4 full days a week to 3 days a week. He does not plan on reducing his hours again, and jokes that he hopes to die ‘‘with my boots on at the office.’’ The four younger partners have recently noticed that when they are covering his patients, his medical judgment is impaired. He has prescribed Bactrim for a patient with mild acne, has been treating a severely involved 30-year-old psoriatic with only mild topical steroids even though the patient requested a biologic after reading about these medications online, and has prescribed a potent topical steroid for a patient with facial dermatitis. In addition, he desiccated and curetted a recurrent basal cell carcinoma on the face of a 40-year-old woman. The younger partners met to discuss how to deal with the obvious changes in the way Dr Smith is now practicing. Before these aforementioned scenarios, he was considered one of the most respected dermatologists in the state.