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Neuro Behavioral Med 3 > 42 - The Impaired Physician > Flashcards

42 - The Impaired Physician Flashcards

1
Q

What is the APMA definition of physical disability?

A

“Physical disability includes but is not limited to, deterioration through the aging process, or loss of motor skill that results in the inability to practice the profession with reasonable judgment, skill or safety.”

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2
Q

What is the APMA definition of mental disability?

A

“Mental disability is any psychological condition or habitual or excessive use of alcohol, narcotics, stimulants, or other chemical agents or drugs that results in the inability to practice podiatric medicine with reasonable judgment, skill, or safety.”

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3
Q

Describe the role of increased stress in impairment

A

“The end of a stress continuum leading from normal to increased stress to burnout to impairment.”

KNOW IT IS THE END OF A STRESS CONTINUUM***

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4
Q

Describe stress-induced addiction

A

“Addiction is a stress-induced defect in the brain’s ability to properly perceive pleasure. It involves physiological changes in brain chemistry.”

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5
Q

What are some recent headlines regarding the impaired physician?

A
  • Impairment Among Physicians is Growing: Why? (February 24, 2015)
  • Is Medicine Driving Doctors to Drink? (July 9, 2015)

It is getting WORSE, not BETTER

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6
Q

Describe the prevalence of impaired physicians

A

“At least one-third of all physicians will experience, at some time in their career, a period during which they have a condition that impairs their ability to practice medicine safely”

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7
Q

Describe the risk of burnout

A

“… physicians are at a higher risk of burnout than the general population of employed people in the US”

KNOW THIS - underlined

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8
Q

Describe the prevalence of burnout

A

Survey of 7,000 doctors

  • ***38 percent of doctors reported burnout symptoms
  • ***compared to 28 percent of the non-doctors
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9
Q

Which type of physicians tend to have the most burnout

A

Reuters adds that “frontline” physicians, such as ED or family practice doctors, were the most susceptible to burnout, while dermatologists and preventive care specialists reported the lowest rates of burnout.

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10
Q

Describe more statistics of burnout

A

Medscape Medical News’ recently released Physician Lifestyle Report 2015 shows that 46% of US physicians experience burnout, a rate that is up by 6% from 2013.

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11
Q

What is professional burnout defined as?

A

Professional burnout was defined as emotional exhaustion, decreased personal achievement, and depersonalization that included cynical or negative attitudes toward patients

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12
Q

Is burnout the same in men and women physicians?

A

More female physicians reported burnout (45%) than male physicians (37%), which may be attributed to the fact that women tend to enter generalist professions

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13
Q

Describe suicide risk in physicians

A

The researchers point out that the suicide rate among physicians is significantly higher than that of the general population

Firearms (48%)were the most common method of suicide followed by poisoning (23.5%), blunt trauma (14.5%), and asphyxia, which included hanging (14%).

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14
Q

Which field has the highest rate of suicide?

A

Impaired physicians are far more likely to commit suicide than their age-matched peers (40% for male physicians, 130% for female docs); anesthesiologists have highest rate

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15
Q

How many physician suicides occur each year?

A

Translates into 400 physician suicides per year

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16
Q

Describe how the rigor of medical school plays a role

A

“In past decades, the rigors of college, medical school,… and residency served to weed out many people with impairments. But over the past 2 decades, initiatives to keep students in the pipeline through remediation and wellness programs have, in some cases, merely delayed the onset of impairments until a physician begins to practice.”

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17
Q

Describe the relationship between medical students and depression

A

Med students are more likely to have higher levels of depression and suicide than age-matched peers

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18
Q

How many states have a physician health program to help impaired physicians?

A

47

Only CA, NE, and WI do not have programs

This is not going to be on the exam

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19
Q

Who does require a physician health program

A

JACOE certification

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20
Q

What is the purpose of physician health programs?

A
  • Identify impaired physicians
  • Evaluate, treat, and monitor
  • Protect the public from impaired physicians
  • Help the impaired physician achieve sobriety
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21
Q

How do we express the fact that physicians are just regular people?

A

“Physicians are impaired persons who happen to be doctors.”

“Impaired physicians” programs are now renamed “physicians’ health” programs (in 47 states) which recognize addiction as a disease, and as such, approach the problem from a therapeutic angle rather than a disciplinary one

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22
Q

What is the rate of addiction (drug and alcohol abuse) in physicians?

A

10-15%

Same as general population

23
Q

Describe the epidemiology of US adults who have abused or become dependent on alcohol in their lifetime

A

13% of US adults have abused or become dependent on alcohol in their lifetime

AMA-13% have abused drugs or alcohol, 6% are chemically dependent-this is roughly 60,000 physicians, only half of which are getting treatment

24
Q

What is the most common drug of abuse among physicians?

A

Alcohol

25
Q

Which doctors are most likely to abuse morphine?

A

“major opioid”

Anesthesiology

Not going to be on the exam

26
Q

Which doctors are most likely to abuse oxycodone?

A

“minor opioid”

FPs and OB/GYN

27
Q

Describe a recent study regarding addiction in health care workers

A

In a 2,600-word article on its front page, USA Today (4/16, A1, Eisler) reports that across the US, “more than 100,000 doctors, nurses, technicians and other health professionals struggle with abuse or addiction…” The majority of “the damage goes unnoticed or undocumented; oversight mechanisms to detect, report and address drug problems in health care settings are haphazard and limited.”

MORE THAN 100,000 **
Most goes UNNOTICED **

28
Q

What is the biopsychosocial disease model of addiction?

A

Suggests an interaction between genetic, medical, psychological, environmental and sociocultural factors that affect the development of addiction

29
Q

What are the signs that suggest a substance abuse disorder?

A
  • Domestic problems
  • Anger problems
  • Depression
  • Behavior problems
  • Irregular work hours
30
Q

What are the first signs you have an impaired physician?

A

Marital problems

31
Q

Describe common presentations of impaired physicians

A
  • “Disruptive physicians are those who exhibit abusive behavior that interferes with patient care or could reasonably be expected to interfere with the process of delivering quality care”.
  • Psychiatric problems, sexually harassing, anger problems
32
Q

Describe “self-reporting” statistics of disruptive physicians

A

A 2011 survey from the American College of Physician Executives (ACPE) and QuantiaMD found that more than one quarter of physicians said that they have been disruptive in the workplace.

33
Q

Describe statistics of disruptive physicians when others were surveyed

A

“Shots” blog reported that “more than half the doctors surveyed say they’ve witnessed other physicians yelling, flinging insults, refusing to cooperate with other healthcare personnel and refusing to follow established rules.”

34
Q

Describe the characteristics of physicians with substance abuse

A
  • Marital problems are generally the first indication of substance abuse
35
Q

What are personality characteristics of many physicians that may contribute to this

A
  • “Many physicians are so IDEALISTICand PERFECTIONISTIC and WORK-ADDICTED in the name of healing everyone else that they don’t know how to handle their personal and emotional lives.”
  • **That is, they have a strong drive for achievement, exceptional conscientiousness, and an ability to deny personal problems. **
  • Financial and legal stresses
  • “Much of this is a byproduct of the obsessive-compulsive traits engendered by the education and training process of medicine.”
36
Q

What is the triad of personality characteristics of physicians

A

Includes a triad of self-doubt, guilt over perceived deficiencies, and an excessive sense of responsibility

37
Q

Describe an intervention for impairment in physicians

A

A structured process in which the impairment of the person is confronted in a caring, objective, non-judgmental manner so that the person receives an evaluation for his/her suspected impairment

38
Q

Describe the JCAHO protocol for impairment

A

Organizations (JCAHO) has required that all JCAHO accredited hospitals establish “a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function.”

39
Q

What is the result of these JCAHO protocols

A

As a result, most states allow doctors to seek treatment for substance use disorders without being reported to the Board of Medicine if there is no evidence of patient harm

They will just have to go to a physician health program

40
Q

Why does this not really work so well?

A

Impaired are not reported because they are difficult to identify, hard to convince they need help, and often intervention occurs only when they hit “rock bottom”, that the addicted can’t be helped until they want to be helped

41
Q

What can the physician’s health program help with?

A
  • PHP can help before the medical board if self-reporting
  • If not, and complaint is filed with board, odds are much greater that disciplinary action and license suspension will occur
42
Q

Describe the services included in physician health program

A

“The service includes confidential psychotherapy and coaching, continuing medical education (CME) with credit that is focused on helping physicians integrate their personal and professional lives, dialogue programs about cultivating meaning in medical practice, **physician leadership development, and **marriage retreats.”

*** were underlined

43
Q

What is the goal of Physician Support Services?

A

“Rather than ignoring, stigmatizing, or penalizing distressed physicians, Physician Support Services pragmatically addresses the emotional, spiritual, family, and performance issues associated with physician burnout, while intentionally developing physician leadership.”

DON’T do the first part (ignore, stigmatize, penalize)

44
Q

Describe the views on reporting colleagues

A

“More than one-third of physicians do not completely support the fundamental belief that physicians should report colleagues who are impaired or incompetent in their medical practice.”

45
Q

What are reasons for NOT reporting?

A
  • Someone else was taking care of the problem
  • Nothing would happen as a result of the report
  • Fear of retribution
  • Reporting was not their responsibility
  • The physician would be excessively punished***

The last one is the most common and biggest fear ***

46
Q

Describe a failure to report

A
  • most state medical boards take the position that “failure to report (an impaired physician) could jeopardize the nonreporting physician’s own medical license.”
  • …report the concern to the appropriate local/hospital authority for investigation. This action will generally ensure compliance with state law.
47
Q

Describe the obligation to act on the recognition of impairment

A

The podiatrist has the obligation to act upon the recognition of impairment(s) in him/herself and in other health care providers and to ensure that the treatment of patients is not compromised because of such impairments.

48
Q

Describe the restrictions on impaired physicians who have been reported

A

The podiatrist who is physically, mentally, chemically, or emotionally impaired should withdraw from those aspects of practice that could be detrimentally affected by the impairment.

If the podiatrist does not withdraw, other podiatrists who know of the impairment have the duty to take action to prevent the impaired podiatrist from harming him/herself or others.

49
Q

Describe malice as a motive for reporting

A

It is the legal opinion that a person who furnishes information to an appropriate authority without evidence of malice is immune from civil liability

50
Q

What are the “Do’s” of intervention

A
  • Intervene early and assertively
  • If not timely, suicide is real possibility
  • Behavioral contracts spell out the consequence of noncompliance; namely, loss of license or hospital privileges
  • Usually, the physician can continue to practice, but often on probation or under some restrictions
  • Sign a behavioral contract for 3 to 5 years to monitor aftercare
51
Q

What may be required of physicians with a history of impairment?

A
  • Regular attendance at AA/NA meetings and adherence to their 12 step plans for recovery
  • Continuing psychotherapy
  • Drug treatment for co-occurring psychiatric disorder
  • Unannounced urine drug/alcohol screens
52
Q

What is the success rate of physician health programs in helping physicians return to practice?

A

90%

53
Q

Describe the betrayal of trust that is feared when reporting an impaired physician

A

“Referring a colleague is not betraying a trust, but acting responsibly to contain and prevent the problem of impairment. You are saving a career, and possibly a life, not ending it.” (Texas Medical Society)

54
Q

What does our profession have in order to help reporting?

A

Physicians’ Recovery Network (APMA)

1-800-488-4767

Neuro Behavioral Med 3 (16 decks)

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