The Impaired Physician: Identification and Treatment
Jose Artecona, M.D. Forensic Psyciatrist

Physician Impairment : Defined

" A physician who is unable, or potentially unable to practice medicine with reasonable skill and safety to patients because of physical or mental illness, including deterioration through the aging process or loss of motor skills, or excessive use or abuse of drugs including alcohol."

Types of Impairment

  • Substance abuse/Chemical Dependency (most common). Characterized by use of mood altering substances such as alcohol, cocaine, marijuana, opiates, barbiturates, etc.
  • The spectrum of ‘addictive diseases’ has been expanded to include compulsive gambling, eating disorders and compulsive sexual behaviors.
  • Psychiatric Illness (with or without concurrent chemical dependency) 6-20% of cases reported to state physician health programs.
  • Physician suicide between 28-40 per 100,000 versus 12.3 per 100,000 in general population).

Identification of Addiction in Physicians

o Irritability

  • Mood Swings
  • Negative Attitude
  • Argumentative
  • Inappropriate Anger
  • Overreaction to Criticism
  • Altercations with staff, peers, and patients
  • "Personality Change"

o Irresponsibility - Shifts Work Load - Manipulates Schedule

  • ER, OR, On-Call - "Hurry Up - Catch Up"
  • Hasty rounds
  • Short cuts

o Inaccessibility - Frequent Tardiness - Frequent Absence - "MIA"- Missing in Action

  • Frequent trips to bathroom, parking lot
  • Prolonged lunch break
  • Unavailable when on call - Frequent Beeper Failure - Frequent Illness

o Inability

  • Decreased Performance
  • Inappropriate Orders
  • Inadequate Charting
  • Frequent Malpractice Action
  • Frequent "Forgetfulness"
  • Deviation from Standard Procedures


o Drug Procedures

Use of excessive amounts - Unwitnessed wasting - Insufficient patient analgesia - Excessive spillage/breakage Identification of Addiction in Physicians
o Isolation - Odd Hours for rounds - Volunteers for Graveyard shift - Absent from Dr's Lounge - Eats alone - Avoids
o Departmental Meetings
o CME Events
o Medical Social Events
o Incidentals
o Disheveled appearance
o Tremors
o " Green tongue" from mints
o Bruises o Needle tracks
o Heavy drinking at staff or social functions
o Off- duty intoxication Identification of Addiction in Physicians
o Incidentals
o Runny nose, raspy voice, alcohol on breath
o Red,yellow or black and blue eyes
o Dilated or constricted pupils
o Staff, patient,or peer complaints
o Slurred speech on phone
o Black outs
o Subject of hospital gossip (marital problems, DUI, Financial Problems, "party" reputation)
o Other - Unexplained intervals between jobs - Frequent job changes - Frequent relocations - Indefinite references - Unusual medical history

o Early detection difficult

- Physicians tend to have negative consequences to family, community, finances, spiritual and emotional health, physical health first
- Job performance affected last therefore disease usually progressed

FOR MORE INFORMATION, CONTACT:

Jose Artecona, MD
pager 504-547-4328

ADDITIONAL INFORMATION:

PHYSICIANS HEALTH FOUNDATION OF LOUISIANA
Physicians Health Program
Address: 8032 Summa Avenue, Suite C
Baton Rouge, LA 70809
Telephone: 225 766-0421 or 888 743-5746 (888-PHFLPHP)
Fax: 225 819-0833
E-mail: mdecaire@phfl.org, golbrich@phfl.org, jalleman@phfl.org
STAFF
Michael R. DeCaire, MPA, Administrative Director
Gary D. Olbrich, MD, Medical Director
Julie M. Alleman, M.Ed., Case Manager

Presentation (Powerpoint)
Vicki Waters, MS, PA-C, Scott Basinger, PhD- "The Impaired Medical Professional"
From www.projectmainstream.net/mainstream/catalog.cfm?dest=dir&linkon=Section&linkid=55