The Impaired Physician: How to Identify Our Colleagues Who Need Help and Assist in the Path to Wellness

Impairment in physicians is defined as an inability to safely practice medicine with reasonable skill secondary to mental illness, substance use, or physical illness (Myers, 2008) In a national sample surveying the presence of substance use disorders in physicians, 12.9% of men and 21.4% of women met diagnostic criteria for alcohol use disorder(Oreskovich, et all, 2015). The consultation-liaison (CL) psychiatrist is likely to be front-line in evaluation and be asked to provide expertise on guidelines for management. These assessments may pose significant challenges in reporting obligations and in maintaining boundaries with patients who may be professional colleagues. Additionally, the physician-patient may be given the status of a "very important patient" (VIP) with associated administrative scrutiny and pressure for process changes in the approach to care. For CL psychiatrists practicing in academic centers, trainee involvement may add an additional layer of complexity.

In this symposium, we will utilize a case-based and interactive format to discuss the management of the impaired physician when they are admitted to the medical hospital and how the CL service plays a role in providing appropriate psychiatric care.

Dr. Priya Gopalan will provide an overview of the definition of the impaired physician, epidemiology, and factors contributing to impairment. [20 minutes]

Dr. Neeta Shenai will review a case of an impaired physician due to depression and suicidal ideation and discuss questions the CL team addressed. [20 minutes]

Dr. Julie Graziane will review the topic of physicians and substance use disorders in a case-based format. She will also review the legal implications and reporting requirements to the state medical boards. [20 minutes]

Dr. Darcy Moschenross will review cases of patients with family members who are physicians and discuss trainee supervision when treating physician colleagues. [20 minutes]

Attendees will receive practical guidance on how to care for patients who are physicians, maintain and strengthen medical communities despite having to consult on colleagues, and advance knowledge through the incorporation of trainees into the management of these complex cases. Additionally, state- and nation-wide resources related to physician licensure as it pertains to physician impairment will be reviewed.