Tuesday, April 5, 2016

Impaired Physicians —Tough Decisions for Administrators

Impaired Physicians
Like most major crises, handling physician impairment will resemble a runaway train if you don’t put policies into place before a problem arises. You and your physician partners will be miles ahead if you’ll take the time now to draft an impaired-physician policy and design procedures for dealing with the different causes and manifestations of physician impairment.

Hammering out such policies is not for the faint of heart, however. In fact, you will improve your chances for coming up with fair and workable policies if you bring legal counsel to the table. Just make sure that you find an attorney who has dealt with these specific issues before. Defining “impairment” requires a lot of thought— and familiarity with definitions such as that out- lined in the AMA’s policies.

For another useful resource, contact your hospital’s administration and get a copy of its policies regarding physician impairment and discipline. It can provide a starting place for crafting your own documents.

Along with the procedures, assign specific roles for the administrator and for the practice’s leading physicians. You don’t want to decide who will take on which responsibilities in the middle of a crisis.

Plan on spending some time and having some spirited conversations about controversial issues. But in the end, bring your final draft to a vote, and get a signed statement from each physician in the practice that he or she has read and will abide by the policies. Then hope that you will never have to invoke the rules in your practice.
According to the AMA, an impaired physician is a doctor “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.”

An administrator finds himself or herself in a unique position as a steward of healthcare services. To handle physician impairment effectively, he or she must consider more than the classic definition of impairment offered by the AMA. The administrator must see that:

Impairment causes can be broader than even the general terms (psychiatric/physical disorders, alcoholism, or drug dependence) specified by the AMA definition; and

An impaired physician can cause damage to individuals far beyond the patient. Colleagues, employees, and the healthcare community at large suffer injury at the public exposure of an impaired physician as well. Administrators who observe behavior leading them to suspect physician impairment will have to proceed with considerable care. What to do depends on factors such as:
  • The suspect physician’s position in the organization. Is he or she an owner? A senior member or leader? An employee? 
  • Does the organization have a written policy about physician impairment? Having decided to proceed, an administrator then can take these steps: 
  • Approach physician leadership—that is, talk to a doctor who wields significant influence within the group, whether a formal or “traditional” leader. 
  • Seek outside counsel—you can attempt to seek help anonymously from the state medical society or approach the group’s usual legal counsel to seek advice on how to proceed. 
  • Approach the offending physician—if you feel empowered to pursue this course, make sure you arrive at the meeting well-armed with examples and evidence to support your suspicions. 
  • Approach the offending physician’s family— in some (rather unique) circumstances, it may make sense to talk to the doctor’s family about your concerns. 
The worst course of action, naturally, would be to do nothing. But an administrator must understand the risks involved in addressing physician impairment—it can cost you your job.

A group practice leader’s wisdom and skill face some of their toughest challenges when a member physician shows signs of impairment. The challenges multiply for the “lay” administrator in a physician-owned practice. First, the administrator finds himself or herself in the difficult position of calling an employer to accountability. Second, the medical community has a long tradition that assigns near-absolute authority to physicians—an authority that non-physicians aren’t supposed to challenge.

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