Pultizer Prize-winning American columnist Jimmy Breslin wrote a front page feature story on Melanie Cane the author of Poisoned Love. Click on the icon to read Jimmy Breslin's cover story:
Impaired Physician
In 1973, the American Medical Association recommended, in a landmark report entitled “The Sick Physician,” that state medical societies establish programs to identify and treat any impaired physician. Since that time, every state has established a program or committee to identify and treat an impaired physician. All states have Physician Health Programs, most of which are usually sponsored by state medical societies. The American Medical Association’s definition of an impaired physician is one who is “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 skill, or excessive use or abuse of drugs including alcohol.” Surprisingly, only 65% of physicians say they would report an impaired physician colleague to the state medical board or hospital administration. The poisoning I describe in my book Poisoned Love, occurred while I was a practicing physician. Clearly, I fit the definition of impaired physician.
Many physicians could be classified as an impaired physician. It is estimated that the current number of impaired physicians in the United States is about 17,000 out of a total of 840,000. Approximately 6% of physicians have drug use problems and 14% have alcohol problems. The impaired physician population mirrors the number of drug and alcohol abusers in the general populations. Considering the degree of responsibility entrusted in doctors, an impaired phsyician is cause for concern. Surprisingly, though, research indicates that the majority of those who are classified as an impaired physician who attend and complete a rehabilitation program do return to work. The rate of impaired physician attendees who successfully rehabilitate is around 70% as compared to the general population rate of 5-10%. This is likely due to monitoring as well as to highly motivated physicians who have a tremendous amount to lose professionally and personally if they relapse.
Substance Use disorders affect several domains in the life of an impaired phsyician, especially his or her ability to function at work and home. Detection of the impaired physician tends to be delayed because job performance is often the last dimension to suffer. Work related symptoms of the impaired physician include; late to appointments, increased absences, unknown whereabouts, unusual rounding times, (either very late or very early), increase in patient complaints, increased secrecy, careless medical decisions and chart keeping, increased irritability with, smell of alcohol, overt intoxification, needle marks, erratic job history. Problems at home for an impaired physician include withdrawal from family, friends and community, legal trouble like DUIs, and increase in medical problems, increased aggression, financial difficulties, deterioration of physical hygiene, and emotional disturbances such as depression, anxiety and mood instability.
If a colleague is concerned about an impaired physician, it is his ethical duty to act immediately and intervene. However difficult it might be to report a colleague, an impaired physician cannot be allowed to continue to put the lives of their patients at risk through negligence, misconduct, or avoidable harm. The colleague should report the impaired physician to a Physician’s Health Program, rather than the state medical board, and this can be done anonymously.
If an impaired physician voluntarily seeks treatment and monitoring, the PHP can then advocate for the physician before the state medical board. If however, the impaired physician is reported to the medical board before any involvement with a PHP, they are then required to have a formal disciplinary relationship with the medical board and are in greater danger of license suspension and revocation. As I describe in my book, Poisoned Love, when I was petitioning for reinstatement of my medical license, my lawyer argued that I should receive the same considerations as any other impaired physician.
An impaired physician needs to be completely detoxified and be clean form all substances before beginning a rehabilitation program. The goal of rehabilitating an impaired physician is to reverse the classification of “impaired physician,” while teaching how to avoid the pitfalls of addiction in the future. The people involved in rehabilitating the impaired physician also need to work with supervisory programs for licensure and career requirements of the impaired physician. Maximum confidentiality and privacy are the standards.
Post treatment options for an impaired physician are variable and often include out-patient or aftercare programs. Often an impaired physician is monitored by the PHP for 5 years, which includes monitoring of their bodily fluids, ongoing treatment, and their performance when they return to practicing.
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