Impaired Physicians Research Articles

First Impaired Physicians Therapy Program Appears to Be Successful in Spain

First Impaired Physicians Therapy Program Appears to Be Successful in Spain

Impaired Physicians: Is There a Duty to Report to State Licensing Boards?

Impaired Physicians: Is There a Duty to Report to State Licensing Boards?

Impaired Physicians: Is There a Duty to Report to State Licensing Boards?

Impaired Physicians: Is There a Duty to Report to State Licensing Boards?

Physician Health Research Conference (Estes Park, Colorado--September 15-17, 1996): progress report one year later.

The 1996 Physician Health Research Conference was the first conference to focus exclusively on research issues and methods for impaired physicians. The conference was initiated by James Shore, M.D., professor and chairman of the Department of Psychiatry in the School of Medicine at the University of Colorado Health Sciences Center and superintendent of the Colorado Psychiatric Hospital, and Stephen Dilts, M.D., Ph.D., medical director of the Colorado Physician Health Program and clinical professor of psychiatry at the University of Colorado Health Sciences Center. Forty participants represented a wide range of national organizations. The conference was supported by contributions from the American Medical Association, American Psychiatric Association, Colorado Physician Health Program, Colorado Physician Insurance Program, and the Department of Psychiatry and Colorado Psychiatric Hospital at the Health Sciences Center. In addition, the conference was cosponsored by the American Academy of Addiction Psychiatry, the American Society of Addiction Medicine, and the Federation of State Physician Health Programs. This paper summarizes the formal presentations of the conference.

New hope for impaired physicians: helping the physician while protecting patients.

The medical profession has developed a greater awareness of the problem of substance abuse among physicians, and has responded by setting programs to confront impaired physicians about their problem so that they can overcome their resistance to treatment. Nonetheless, the most effective strategy is prevention: instilling physicians-in-training with a more cautious attitude towards drug and alcohol use.

Differential Therapeutics and the Impaired Physician

ABSTRACT The objective of this study was to determine the nature and degree of patient to treatment matching for a sample of physicians based on differential problem type and severity. Methods included a single assessment of variables using retrospective chart review. Subjects included 108 physicians (98 men and 10 women), who were sampled consecutively from assessments performed over a 2-year period. They represented a variety of specialties, and most were third-party referred, predominantly by state medical societies. Main outcome measures included demographic information, DSM-IV multiaxial diagnoses, the Severity of Substance-Related Disorder scale, and the type and intensity of recommended treatment. It was found that the physicians presented with a variety of conditions that were clustered into three categories: active substance use disorders (52.8%), substance use disorders in remission (17.6%), and psychiatric/behavioral problems (29.6%). An analysis of the appropriateness of matching types of treatment to these problem categories appeared to support a differential assignment process. A range in severity was also found within problem categories and was subsequently tested for correspondence with the range in intensity of recommended treatment. It was found that severity correlated strongly with recommended treatment intensity for all groups. In addition, multiple regression analyses showed that two factors, ability to sustain abstinence and emotional disturbance, were predictive of treatment intensity for the two substance use disorder subgroups (64% of variance accounted for). In the psychiatric/behavioral problem subgroup, such analysis demonstrated that the severity of difficulties with one's significant other was predictive of treatment intensity (89% of variance accounted for).

PHYSICIAN IMPAIRMENT BY SUBSTANCE ABUSE

Physician impairment by substance abuse represents a significant challenge to physicians, patients, and society as a whole. Although data is sparse, the prevalence of alcohol and illicit drug abuse among physicians is probably similar to that of the general population, while abuse of prescription drugs may be more prevalent. From a medicolegal standpoint, these issues are managed mostly at the state level and substance abuse is of increasing interest to credentialling organizations such as hospitals and managed care organizations. A variety of concrete steps can be taken to identify physicians with substance abuse problems and treatment approaches have been designed specifically for impaired physicians. With improved attention to the problem of physician impairment by substance abuse, the well-being of both physicians and their patients can be enhanced.

Substance abuse and dependence in physicians: the Missouri Physicians' Health Program.

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential voluntary program of early referral, intervention, treatment, monitoring, and advocacy has been highly successful. The average recovery rate in this study of 146 participants was 94%.

Confidentiality dilemmas in group psychotherapy with substance- dependent physicians

The purposes of this article are 1) to review federal and state laws relevant to confidentiality in group therapy with impaired physicians and 2) to provide empirical data concerning the actual confidentiality practices and experiences of group therapists treating chemically impaired physicians. In the clinical research phase, 25 state medical societies identified 45 rehabilitation centers as those to which the societies preferentially referred chemically impaired physicians. Fifty-one group leaders from 33 of these rehabilitation centers completed the survey questionnaire employed in this project. Because of the risk of potentially irreversible social and professional injury, physician patients were exceedingly concerned about breaches of confidentiality. Co-members' infractions most often involved the violator sharing with close friends and family members the name and abuse history of a fellow physician. In contrast, transgressors rarely leaked information about a co-member's drug-related illegal behaviour. Chemically impaired physicians would feel safer in sharing secrets in group therapy if more jurisdictions adopted legislation making co-members liable for violating confidentiality. Currently the pertinent body of law is confusing and inconsistent and provides little protection to impaired physicians who enter group therapy. The authors propose ideas for model legislation.

Chapter 7: The Impaired Physician

Chapter 7: The Impaired Physician

Chapter 7: The impaired physician

Chapter 7: The impaired physician

Physicians as patients--on the problem of the mentally ill physician

The phenomenon of mentally ill physicians is hardly noticed in Germany today-a fact that possibly indicates a taboo. This investigation is to reveal the importance of the subject by referring to the findings of several major studies. Epidemiological data turn out to be of little reliability regarding for instance the number of impaired physicians with a range between 0.5-46%. Addiction and substance abuse can be found in 90% of all cases of mental illness. Increased suicide (3-4x), divorce (20x) and addiction rates (according to some authors 30-100x) in comparison with the average population emphasise the necessity of further investigation. These facts imply the question whether doctors are mentally more vulnerable than their patients. Special difficulties in treating doctor-patients deserve attention as only little is known how appropriate "iatrotropic" (psycho-)therapy can be carried out effectively.

Quality improvement and substance abuse: rethinking impaired provider policies.

Substance abuse is known to be our nation's number one public health problem. Physicians and other health providers can develop chemical dependency problems that create significant quality assurance and risk management dilemmas. Not all of society understands drug dependence to be a treatable medical disease and behavioral problem. Sometimes impaired providers are ignored or punished rather than treated and rehabilitated. This results in an enormous waste of human and monetary resources. In the last 10 years, impaired physician programs have developed focus and credibility. But certain difficulties exist in these programs: namely, that such programs are affected by tensions between medical societies and state licensing boards; that substance-dependent providers escape detection by moving to other states; that existing impaired provider programs have limited practical application within the federal health care system; and that liability risks are incurred if institutions rely on impaired provider policies that do not include all members of the medical staff. Hence, we argue that existing impaired provider policies might be worth rethinking. To promote that dialogue, we offer a sample policy for consideration and review. It includes specific actions and procedures for the identification, referral, and reentry of impaired providers and allows for National Practitioner Data Bank reporting in that process. The Data Bank has been in place for only a few years and offers society and the health community a new opportunity to better control chemically dependent, licensed medical staff without dismantling existing impaired provider programs. The policies for managing chemically dependent health professionals are changing from a focus on stigma and prosecution to one of early identification, rehabilitation, and reentry. We hope to advance that process.

Physician health programs and the potentially impaired physician with a substance use disorder.

Physician health programs and the potentially impaired physician with a substance use disorder.

Chemically dependent physicians and informed consent disclosure.

Developments in law, professional guidelines, and public attitudes support informed consent disclosure by physicians who have been treated for chemical dependency. This view is built on the apparent materiality of the risk of relapse to informed treatment decisions by patients. Several considerations undercut this position. The probability is remote that a patient will be injured by a recovering physician who suffers an undetected relapse while being properly monitored. Monitoring by impaired physicians programs provides a more sensitive and specific mechanism for detecting relapsed physicians. Moreover, compromise of the privacy and employment rights of recovering physicians by consent disclosure is not justified if programs provide rigorous monitoring that protects the welfare of patients. Finally, required consent disclosure will reduce referrals of chemically dependent physicians to impaired physicians programs, thereby increasing the danger to patients. Limiting demands for required consent disclosure necessitates effective operation of impaired physicians programs.

Four Years Experience of a Hospital's Impaired Physician Committee

Physician impairment contributes to patient morbidity, malpractice claims, physician license loss and suicide. This paper describes four years of experience of the University of Maryland's Professional Assistance Committee. The committee is composed of medical staff members. Its mission is to help impaired physicians obtain assessment, treatment and monitoring, and to protect patients from harm. The committee has evaluated 23 cases over the past four years. Ten were credential checks, and 13 investigations of active problems. Eight of the 23 cases were for alcohol, eight for drug, and seven for behavioral problems. Only one person lost medical staff privileges. The committee has been well accepted by the medical staff and hospital administration and can be easily reproduced in other hospitals.

Management of the Impaired Physician

Educational objectives: To understand how an impaired physicians committee works and how to use it and to be familiar with the reentry process for recovering physicians and feel comfortable that the physician in good recovery is well monitored and an asset to our profession.

The Ethical Ophthalmologist: A Primer

This manual has been published by the Ethics Committee of the American Academy of Ophthalmology as a vehicle for the education of residents and fellows and as a guide for the practicing ophthalmologist. The authors' goal is to promote a discussion and understanding of the ethical issues facing ophthalmologists. In this regard, it fulfills its mission. The text is loose-leaf in format to allow for future changes and additions. Twelve chapters focus on one aspect each of professional activity or behavior, such as informed consent, patient rights and surrogacy, delegation of authority, research, new technology, collegiality, the impaired physician, commercial relationships, compensation, advertising, resource allocation, and obligations to patient, society, family, and self. The manual tackles some controversial topics such as issues of residency training, referrals to outside physicians and laboratories, listing of authors in research papers, managed care, methods of advertising, clinical trials, and conflicts of interest. The Ethical

Finding Effective Treatment for Impaired Physicians

ALMOST TWO DECADES after acknowledging that some physicians become addicted alcohol and other drugs, the Federation of State Medical Boards is refining policies aimed at providing impaired physicians with effective treatment. The federation broached the topic of physician impairment in the late 1970s by recommending that all state medical licensing boards have the power take disciplinary action based on impairment, not harm patients. But by the mid 1980s, federation officials felt a revision was in order. In addition developing a brief definition of impairment, the federation recommended that state boards be able direct their licensees into treatment programs and encourage treatment by exempting reporting requirements for those who complied with treatment provisos. Now, says James Winn, MD, the federation's executive vice president, it's time refine existing policies. The goal is to define not only the elements which are essential model [treatment] programs, but

Finding effective treatment for impaired physicians

Finding effective treatment for impaired physicians