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Impaired Physicians a Menace to Patient Safety

Increased efforts to find, treat impaired doctors show mixed results

By Henry J. Fishman, M.D.
ConsumerAffairs.com

October 9, 2007

• Impaired Physicians a Menace to Patient Safety • Sleepy Doctors a Menace on the Road, Study Finds --- • Malpractice News

When you see a doctor, you invest a lot of faith in his or her judgment and abilities. Sometimes it can be a matter of life or death. But what if your doctor is an alcoholic, a drug addict, or has serious psychiatric problems?

It’s possible, and you wouldn’t even know.

In the last 30 years or so, medical professionals have increasingly grappled with the problem of impaired physicians – medical professionals who are afflicted with some of the same pain and torment as their patients.

Dr. Gerald Perman, a Washington, DC psychiatrist, sees these problems firsthand. As a member of the District of Columbia Medical Society’s Physicians Health Committee, he works with physicians who have problems that could endanger their patients.

“Usually the things that bring a doctor to the attention of a physician’s health committee are problems like alcohol abuse, other kinds of substance abuse, psychiatric illness sometimes, depression, and some of the issues that can go along with aging,” Perman said.

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Identifying doctors who have these kinds of problems isn’t always easy. It’s up to colleagues to speak up when a doctor has a problem. And patients play a role too.

“If patients smell alcohol on the doctor’s breath, if the doctor falls asleep during the evaluation, if doctors get very angry with their patients, in a way that is inappropriate, then patients should certainly report that,” Perman said.

It’s sometimes hard to know where the stresses of a busy medical practice end and impairment begins. It’s up to the physicians health committee to make that determination, and Perman says there’s a system in place to be fair to both the doctor and the patient.

Normally, when a doctor is referred to a physician’s health committee, the members will contact the doctor and ask for a meeting to go over the concerns that have been expressed.

“If the physician agrees to work with us, we will present a five-year contract for the physician to sign,” Perman said.

The contract calls for the Doctor to submit to periodic drug tests, enter a rehab program, or seeking appropriate treatment. If a doctor cooperates and successfully completes treatment, the physician’s health committee will then serve as the physician’s advocate, helping them restore hospital privileges and meet other professional requirements.

Why would a doctor agree to do this? For one thing, it’s all confidential. No one – not even the patients – has a clue the doctor has a problem or is in treatment. Perman says it has to be that way.

“On the one hand, patients may feel like they should be informed right away that a doctor has a problem, but that would preclude doctors from seeking help begin with,” Perman said.

But the confidentiality of physicians health programs has its critics.

In July 2007, The Medical Board of California voted to phase out its impaired physicians program. The board concluded that running the confidential program that supports and monitors physicians who have drug, alcohol or mental problems was inconsistent with its mission to protect the public. The board's vote came after a June review -- the fifth audit of the program in its 27 years -- concluded the program is not protecting patients.

Still, there are plenty of success stories. Massachusetts reports a 75 percent success rate. And in Washington, DC, many impaired physicians who are in recovery serve on the Physicians Health Committee – helping their colleagues.

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