The Impaired Surgeon

Abstract

Among the obligations and responsibilities of a surgeon is to practice in a competent manner. From a professional standpoint, competence is widely defined as the ability to practice with reasonable skill and safety, and a surgeon is impaired when she or he is not able to do so. There are a number of potential reasons leading to impairment, which may be temporary or a limitation throughout a surgeon’s professional career. Impairment may range from mild degradation of skills to complete incapacitation. The consequences of surgical practice with impairment are wide ranging and include patient-related harm and failure to provide exemplary care; personal consequences to the surgeon’s health and well-being; interpersonal issues with family, colleagues, and staff; and disciplinary and legal issues. This review covers substance abuse, personality issues (character impairment), medical school, residency, the practicing surgeon, the faculty member, boundary issues, aging, the individual surgeon, the department/hospital, burnout, prevention and recognition, individual/personal, organizational, the unprepared or "out-of-date" surgeon, prevention, and dealing with the unprepared surgeon. The figure shows an algorithm outlining the approach to the impaired surgeon. Tables list signs of substance abuse–related impairment, signs of character impairment, and signs of age-related impairment. This review contains 1 highly rendered figure, 3 tables, and 123 references