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Identifying and Assisting the Impaired Physician

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ABSTRACT

An impaired physician is one unable to fulfill professional or personal responsibilities because of psychiatric illness, alcoholism, or drug dependency. Current estimates are that approximately 15% of physicians will be impaired at some point in their careers. Although physicians may not have higher rates of impairment compared with other professionals, factors in their background, personality, and training may contribute and predispose them to drug abuse and mental illness, particularly depression. Many physicians possess a strong drive for achievement, exceptional conscientiousness, and an ability to deny personal problems. These attributes are advantageous for "success" in medicine; ironically, however, they may also predispose to impairment. Identifying impairment is often difficult because the manifestations are varied and physicians will typically suppress and deny any suggestion of a problem. Identification is essential because patient well-being may be at stake, and untreated impairment may result in loss of license, health problems, and even death. Fortunately, once identified and treated, physicians often do better in recovery than others and typically can return to a productive career and a satisfying personal and family life.

Section snippets

Magnitude of the Problem

The exact number of impaired physicians in America is unknown and will probably remain that way for several reasons. First, many impaired physicians are not correctly identified or treated. In addition, some that have sought help and entered treatment have done so confidentially and have avoided becoming a statistic because they are not brought to the attention of a state medical association or licensing group. Last, the general definition is imprecise, and impairment may not be an all-or- none

Development of the Problem

Predisposing factors for substance abuse and subsequent impairment may begin early for the health professional. Genetic predisposition toward substance abuse, rearing in a dysfunctional family, and possessing a strong internal drive for achievement and acceptance by others are not uncommon backgrounds for the aspiring professional student.21 Also, more than 70% of Americans drink alcohol and most substance abuse starts with alcohol during the teen years. Because of obvious selection criteria,

Identifying the Problem

Identifying impaired physicians is often difficult because the manifestations are so varied and protean. For example, early on, an observer might only notice patterns of high alcohol intake at social events or general irritability. Problems with personal relations may manifest as marital or interpersonal strife, or demonstrations of increasingly variable and inconsistent behavior toward others. In general, impact upon social and personal life, including family affairs, usually precedes observed

Providing Assistance

Knowledge of the varied manifestations of abuse and addiction or mental illness, as already listed, and an openness to accept the possibility of impairment is required before assistance is possible. The setting in which the problem is first noted often determines how assistance should be provided. For example, if problems are suspected, but do not obviously involve the workplace, a well-conceived, measured, but corrective response is appropriate and should begin with corroboration. A

Outcome

Compared with the general population, physicians impaired from substance abuse show better rates of recovery. The reasons for this include high levels of education, motivation, and functioning, and possession of a professional career that provides financial and personal resources that can support and sustain treatment and recovery. Those who are “only” alcoholics do best, with published treatment studies showing recovery rates of 74 to 95% with follow-up from 1 to 6 years.34., 35., 37., 38. On

Acknowledgments

We would like to thank Laura DiPette, past Director of the University of Texas Medical Branch EAP, for her editorial assistance and her Department’s committed work to assist impaired health professionals at all levels.

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    Copyright © 2001 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.