Helping impaired doctors who need help

June 20, 2008

Ignoring the signs of a colleague's impairment-or your own-won't make it go away.

"Would you know if your doctor was addicted to drugs?"

That's what the public heard on CNN in March, as broadcaster Anderson Cooper aired an alarming story about the Medical Board of California's Physician Diversion Program-a program, the story alleged, that allows doctors to secretly get treated for addiction while they continue to operate on patients.1

If you've been struggling with substance abuse yourself, have a colleague who you suspect may be developing a substance use disorder, or have patients who broach the subject, it's crucial to understand that this is not the way physician health programs work.

This "help," and the reach of PHPs, extends beyond addiction to encompass all physical or mental conditions that can interfere with a physician's ability to function effectively. These can include diseases like Parkinson's or Alzheimer's, depression, anxiety disorder, or bipolar illness, and certain acute conditions, as well as behavioral disorders. "Our program even includes doctors who display excessive rage in the office or ED, or make inappropriate sexual advances to patients, colleagues, or students," says Jeffrey M. Kagan, an internist in Newington, CT, who has served on his area's Physician Health Committee for several years.

Connecticut's program recently underwent a name change: It's now known as Health Assistance Intervention Education Network (HAVEN), reflecting the fact that the program is now open to nurses, physician assistants, dentists, and other allied health professionals, as well as physicians. "Patient safety is our primary mission," HAVEN declares on its website. It also notes that "HAVEN will be a resource for the health care professional to seek help before patient harm occurs without fear of public disclosure or public regulatory action."2

As the number and scope of PHPs have grown, the traditional physician culture has been slowly eroding. There's evidence of greater acceptance of early intervention, sensational media reports notwithstanding, in response, perhaps, to PHPs' efforts to get the word out. The Physician Health Services (PHS) in Massachusetts, for instance, sends representatives to conferences, sends out newsletters, and makes presentations at some 40 healthcare organizations in the state each year.

Some of this "enlightenment" is no doubt self-serving: No hospital or medical group wants to be sued for allowing an impaired practitioner to continue seeing patients and possibly injuring one of them. That explains, too, why some state PHPs receive funding from malpractice insurers. But the Joint Commission on Accreditation of Healthcare Organizations has played a role as well.

In 2001 the Joint Commission issued a new standard that required hospitals to have a nondisciplinary health policy giving troubled practitioners a place they can turn to for help and be assured of confidentiality. Humane as these policies and programs are, however, they can only be of service to those who come to their attention.

Here, too, there's progress. In Massachusetts, a minority of referrals are from the state licensing board. The majority of cases are self-referrals or referred by colleagues, which suggests that most of the practitioners are coming forward before they face disciplinary action.

But you need to do your part, too. It's your responsibility to intervene when you have reason to believe that a colleague is struggling and needs support-before either the physician himself is hurt or, worse, a patient is harmed in some way. In many states, Massachusetts among them, that responsibility has a statutory basis as well.