How to Blow the Whistle on Impaired Colleagues

A recent survey published in Journal of the American Medical Association found that 64 percent of surveyed physicians agree with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice. But what that really means is that 36 percent -- more than one-third of surveyed physicians -- believe it’s acceptable not to report an impaired colleague. And the consequences are considerable.

“What we see more and more is this impact on patient safety, and how negligence as a whole, but also impacted by drug and alcohol dependence, is impacting patients in a negative way,” says Michael Duffy, managing partner with Duffy & Duffy. “Physicians do tend to protect each other. It tends to be an almost cultural thing within medicine.”

Occupational HazardDavid Sack, MD, is the founder of Promises Treatment Centers, which is well known in the medical profession for its doctor-specific substance abuse program. With regard to alcoholism, which is the biggest drug problem in the U.S., physicians are probably no worse than the general population, Sack says. Where physicians are especially vulnerable, he notes, is with prescription drug abuse.

“They have more access,” Sack explains. “It’s easier to write prescriptions for yourself, or under a pseudonym. They’re also more likely to be exposed to these prescriptions than someone in the general population, and I think we often forget that exposure is a risk factor.”

In addition, says Sack, it’s well documented that shift work and sleep deprivation contribute to drug abuse. People who work swing shifts or rotating shifts have a higher incidence of substance abuse, both to alcohol and amphetamine-type drugs that promote wakefulness.

“Until recently, physicians were forced to work very prolonged hours," he says. Now there are at least some caps on those hours, not because the hospitals got kinder to physicians, but because they got tired of being sued for errors.”

In addition, Sack points out that the risk of substance abuse is greater among certain specialties. For example, anesthesiologists are exposed to the inhalant medications they administer in operating rooms. That incidental exposure raises their risk of becoming addicted -- and increases their risk of relapse.

The Legal ImplicationsEmployers are responsible for the actions of their employees, Duffy says. If a medical practice employs a physician who is impaired and is injuring patients as a result of that impaired state, the practice is open to liability as well. For individual partners in the practice, their personal liability depends on the corporate structure of the practice, such as a partnership versus a corporate entity. But beyond the legal liability issues, Duffy says, there’s a moral and societal responsibility that physicians are overlooking.

“The Hippocratic oath says to remember that you’re a part of society,” he says. “Physicians who are putting themselves in this position, as well as those who protect the physician over the patient, lose sight of how society depends on them." Allowing society to trust physicians when they may not be worthy of trust impairs society’s association with physicians, and that hurts the medical industry as a whole, Duffy says.

Confronting the ProblemThe JAMA survey found that almost one-third of physician respondents said they felt unprepared to effectively talk about the problem with an impaired colleague. Sack says medical schools have been remiss in providing the necessary education for physicians to recognize and talk about these issues. Some states now require this kind of education as part of license renewal, he says. Physicians must take a minimum curriculum in addiction medicine. “But the truth is that it’s woefully inadequate for the magnitude of the problem,” Sack says.

If a physician is going to approach a colleague about an apparent problem, that conversation is likely to be ineffective if done lightly, jokingly or on the spur of the moment, Sack says. If a colleague is in trouble, it’s important to schedule a time to sit down with them and say, “I’m concerned about you, and these are the things that are making me concerned.” It could be failure to show up for rounds, slurred speech during a meeting, or keeping patients waiting in the office. The important thing is that the message cannot be delivered lightly, he adds.

“Physicians are often afraid their colleagues will become enraged and won’t talk to them,” Sack says. “And with people in the throws of addiction, that will happen. But if you’re concerned, you have to be willing to take the heat. You have to be willing to take it up with your partners in a group practice and say, ‘We just can’t ignore this.’ ”

Failure to do so can be devastating to the impaired physician -- and the practice.