In 1972, the American Medical Association issued the following definition of impairment:

"The inability to practice medicine with reasonable skill and safety to patients by reason of physical or mental illnesses or alcoholism or drug dependency."

With this definition, professionals could identify an impaired physician and behaviors specific to the profession. Any one symptom is not singularly diagnostic of any one illness; however, a combination of signs likely signifies a problem physician. Early detection, intervention and treatment are necessary to reduce the risks to patients and the chance of liability litigation.

According to statistics, the impaired physician is first identified by someone in the home, generally the spouse. If intervention does not occur at this level, the impairment usually progresses to the point of interfering with the physician’s profession. Some common signs of distress at the office and hospital include:

Office

• Disruption of appointment schedule
• Hostile, withdrawn or unreasonable behavior toward patients and staff
• Excessive ordering of supplies of drugs by mail or from local druggists
• Patient complaints regarding physician’s behavior
• Unexplained absence from office or absence due to frequent illnesses
• Inappropriate orders, prescriptions or treatments

Hospital

• Making rounds late or inappropriate or odd behavior during rounds
• Decrease in quality of performance (e.g., incomplete charts)
• Increase in number of quality assurance errors
• Reports of behavioral changes from hospital personnel
• Reports from emergency room staff of unavailability or inappropriate response to telephone calls
• Attending emergency patients while appearing under the influence
• Frequently late for surgery and meetings
• Reports of incoherent phone orders, slurred speech, etc.

Physical Appearance

• Deterioration in appearance and dress habits
• Wearing long sleeves in warm weather
• Frequent or unusual accidents

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Physicians who may be disruptive may exhibit some of the following:

Inappropriate anger or resentment

• Intimidation
• Abusive or demeaning language
• Blaming or shaming others for mistakes or errors
• Unnecessary sarcasm or cynicism
• Threats of violence, retribution or litigation

Inappropriate words or actions directed at others

• sexual comments or harrassment
• seductive or aggressive behavior or ethnic slurs

Inappropriate response to patient needs or staff requests

• Late or unsuitable replies to pages or calls
• Unprofessional demeanor or conduct
• Uncooperative, defiant approach to problems

If you are concerned about a physician and don't know what to do, call Candace Backer at the ISMA PAP for assistance Monday through Thursday at (800) 257-4762 or (317) 261-2060.

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