Historically, physicians’ health and capability to practice were determined at the time of training and when applying for board certification and staff privileges and then presumed to be self-regulated after that. Disabled or impaired physicians were assumed to be able to determine when they needed to temporarily or permanently seek some type of care or limit their medical practice for the safety of their patients.
Experience has taught that impaired physicians often do not recognize and report their own impairment and their colleagues are often also ineffective at identifying and reporting impairment reliably. Concerns about damaging personal relationships, being accused of acting out of self-serving motives, and fear of liability limit colleagues willingness to identify impaired doctors. In fact, conflict of interest or the appearance of a conflict of entrance interest maybe hard to deny if litigation occurs.
In addition, physicians fear that the consequences of reporting impaired physician colleagues to state licensing boards, insurance companies, and other credentialing organizations will be too severe to fit the level of impairment. In many states, the State Medical Society has created physician health committees to receive complaints of impairment and evaluate them fairly, balancing public safety concerns with physicians’ rights to defend themselves against accusations of impairment.
State physician health committees are generally distinct from state licensing boards and are sometimes separate entities.
Independent experts can be used to evaluate impairing conditions and recommend treatment. State health committees can include the findings and treatment recommendations of an independent expert in a contract with an impaired physician, which can form the basis of an agreement to permit the physician to continue to practice subject to the individualized contract.
If a physician violates the contract, he or she can be referred to the state licensing board for disciplinary action. This way, the substance abusing physician, the medically ill physician, or the psychiatrically impaired physician can practice safely within a monitoring and treatment agreement that protects public safety. A properly trained independent expert physician can also be retained by a hospital or health system that seeks independent advice on reporting, remediation, or other issues related to impairment. This helps hospital systems determine when to report and, if independent, can be used to defend against accusations of bias or discrimination.
Independent experts can also conduct investigations if necessary and report formally to the hospital administration. Independent experts, if qualified, can later be used as expert witnesses during litigation if needed.
In conclusion, despite risks and potential liability, hospital and healthcare networks can uphold the highest levels of patient safety by using well-established policies and procedures to fairly deal with accusations of physician misconduct or impairment or allegations of physician illness affecting clinical care.
About the author;
David Steinman, MD, DFAPA, is a board certified psychiatrist and a consultant and expert witness in matters relating to physician impairment. More information is available at www.davidsteinmanmd.com He can be reached at firstname.lastname@example.org
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