· It is estimated that one half of all Americans (including physicians) will likely develop a mental disorder at some point in their life (Kessler, et al., 1994). Additionally, approximately 30% of a noninstitutionalized sample of individuals between the ages of 15 and 54 reported experiencing at least one psychiatric disorder within a 12-month period, most commonly major depression, alcohol dependence, social phobia, and simple phobia (Kessler, et al., 1994).

· It is not uncommon for health care professionals to view themselves as immune to developing physical, emotional, and substance abuse disorders. However, impaired professional practice among physicians is quite significant.

· When impaired, a physician’s capacity to effectively treat patients becomes seriously compromised. As such, the impaired physician may directly cause harm to patients, and indirectly cause harm to the medical profession and society more generally. As a result, professional impairment issues are specifically addressed in the Medical Code of Ethics.

· Physicians should be aware that by virtue of their professional training, they are not necessarily immune to developing a psychiatric disorder, but may even be at an increased risk for developing emotional disorders, substance abuse disorders, and other forms of distress and impairment due to the very nature of their professional duties.

· Prevalence of Physician Impairment

Burnout is common among practicing physicians, rates ranging

from 25% to a staggering 60%!

v Shanafelt, Bradley, Wipf, & Back (2002) obtained completed surveys from 115 internal medicine residents. 76% of responding residents met criteria for burnout (Maslach Burnout Inventory). Among this group, there was a significant elevation in both self-report and positive assessment of depression.

v Those who met burnout criteria were more likely to report having engaged in suboptimal patient care practices:

“I found myself discharging patients to make the service manageable because the team was too busy; I did not fully discuss treatment options or answer a patient’s questions; I made treatment errors that were not due to lack of knowledge or inexperience; I ordered restraints or medication for an agitated patient without evaluating him or her; I did not perform a diagnostic test because of desire to discharge a patient; I paid little attention to the social or personal impact of an illness on a patient; I had little emotional reaction to the death of one of my patients; and I felt guilty about how I treated one of my patients from a humanitarian standpoint.

v Compared with non-burned-out residents, burned-our residents were likely to self-report providing at least 1 suboptimal patient care at least monthly (53% vs. 21%).

v For the entire group of residents, the following stressors were reported:

Inadequate sleep (41%)

Working shifts longer than 24 hours (40%)

Inadequate leisure time (42%)

v Those who were burnout also rated feeling uncertain about the future and feeling that their personal needs were inconsequential as major stressors.

v Coping strategies: talking with a family member or significant other (72%), talking with either residents or interns (75%)

Burnout can lead to significant distress and professional impairment, sometimes resulting in an inpatient hospitalization.

v Nace, Davis, & Hunter (1995) examined the charts of 92 physicians admitted to a private psychiatric facility between the years of 1986 and 1991. 56% of impaired physicians were admitted for substance abuse treatment and total of 64% warranted a substance use disorder diagnosis. Substances abused by physicians were alcohol (49%), opioids (20%), sedative/hypnotics (18%), and stimulants (13%).

v 44% were admitted for the treatment of a psychiatric disorder: depression (n = 25); bipolar disorder (n = 6); dysthymia (n = 6); adjustment disorder (n = 1); anorexia nervosa (n = 1); and delusional disorder (n = 1).

v 59% of all the physicians examined were diagnosed with a personality disorder including, obsessive-compulsive personality disorder (n = 21), personality disorder NOS (n = 14), narcissistic personality disorder (n = 11), passive aggressive personality disorder (n = 7), borderline personality disorder (n = 1), and antisocial personality disorder (n = 1).

· Implications - Despite carrying both ethical and legal ramifications, the research indicates that many physicians are unwilling to report an impaired colleague (Angres & Busch, 1989).

v If you become aware of impaired professional practice…what should you do?

v Colleagues who suspect impaired practice could:

· Speak directly with the physician you are concerned about

· Speak with the physician's family or personal friends

· Consult with the physician's colleagues and/or supervisors

· Consult with a member of the Professional Assistance Committee (PAC)

· Consult with a clinician in the Faculty and Staff Assistance Program (FASAP)

· Consult with a clinician at Student Mental Health (SMH)

· Report your concerns to the Medical Board of the Hospital

· Report your concerns to the Board of Physician Quality Assurance (BPQA)

For more information, visit www.fasap.org or www.jhu.edu/sap or call:

Faculty and Staff Assistance Program (FASAP)

410-955-1220

Professional Assistance Committee (PAC)

410-955-9222 (Stephen Achuff, Chair)

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Prepared by Deborah Hillard, Psy.D., FASAP Clinician, 2/03