Impairment is the term used for doctors who have substance abuse problems or other personal problems which affect their competency in treating patients.

A simple example is that a doctor fails to return phone calls for weeks even though the patients have time-sensitive needs. Those needs can include help with symptom management for serious or life-threatening conditions, prescription refills which are essential to the patient’s maintenance or even intimidating patients by becoming angry or using disparaging language.

Impairment also can be subtle but significant. A doctor who is experiencing  cognitive decline may make mistakes that otherwise never would have happened. Another doctor would be able to notice that kind of change sooner than a patient would.

Doctors in solo practices or those with two or three doctors have to depend on each other but also have more interaction. For these practices, confronting impairment is as painful professionally as it is possible to be.

There are obvious and subtle clues leading other physicians to recognizing impairment although they can take some time to surface. It is likely that many patients have been affected before colleagues realize something is very wrong.

This Journal of the American Medical Association study shows that:

• 64% of more than 1, 000 doctors participating in a survey agreed with the principle that they had a professional obligation to report “significantly impaired” physicians or those otherwise incompetent to be treating patients. The participating specialties were among those most often in contact with patients.

• Only 69% of them said that would be ready to confront impairment within their own practices. (Ed. Note: This is a much higher percentage than this editor expected. This means only 31% of practices are not prepared to face one of the toughest problems any medical practice must deal with. This does not excuse those who are not. However, if asked to guess, my number would  have been a 50% at best. This is the professional version of breaking up a family over the failure of one member to face his or her problems.)

• 64% said that they would be prepared to deal with other impaired colleagues.

• 17% of the study group (309 doctors), however, said that they had “direct personal knowledge” of a colleague who was incompetent. Of that group, 204 reported the incompetent doctor to the authority responsible for dealing with this issue.

• Physicians working in hospitals and medical schools were most likely to report. Least like to report were members of underrepresented minorities or graduates of medical schools outside the U.S.

• The study says that those who did not report did not do so for three reasons. (1) They believed someone else was taking care of the problem. (2) They did not believe anything would happen if they reported. (3) They feared the consequences.

What Can You Do?

• Get another doctor right away if you think a doctor you are seeing is no longer the same skilled physician you have been used to.  Tell your new doctor why you moved. Ask if you need to move your records at the time you see your new doctor for the first visit. Your new doctor needs to know what happened because it will have affected your confidence in physicians. You and your new doctor will need to work on this together.

• If you went only once to a doctor but the physician’s behavior was extreme, that, too, should be reported. Examples of extreme behavior includes inappropriate examinations or patient intimidation.  In addition to those behaviors, some doctors get in trouble with drugs. Those who are able to “divert” drugs from patients for their own use can cross another kind of line and end up in jail.

• If you are unsure about what actions merit reporting, follow your instincts. If your instincts tell you something is seriously wrong, be discreet but report. You could help the doctor and the doctor’s other patients.  On the other hand, be careful not to talk about this to too many people. The doctor could sue you for defamation. An impaired doctor is a cornered one. Cornered people lash out. Act with that fact in mind.

• Patients can report doctors directly to state medical licensing boards. Be aware that there is a wide variation among states. There is not a national standard for staffing or the process to be followed. A patient’s name is to be kept confidential.

• Patients can report doctors to the medical staff office at the hospital where the doctor has privileges. Ask first if patient reports are kept confidential. Ask how confidentiality is protected. If the answer sounds too vague, think through what you want to do. An answer such as, “This never has happened here before,” is a clear sign nothing will happen. If the hospital has a good reputation, there should be an independent investigation. In practical terms, an investigation will look into allegations which may make it possible for the doctor to make a good guess as to which patient complained even though, in the legal sense, the patient’s privacy was protected.

Journal of the American Medical Association

“Results: Sixty-four percent (n = 1120) of surveyed physicians agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice. Nonetheless, only 69% (n = 1208) of physicians reported being prepared to effectively deal with impaired colleagues in their medical practice, and 64% (n = 1126) reported being so prepared to deal with incompetent colleagues. Seventeen percent (n = 309) of physicians had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice. Of those with this knowledge, 67% (n = 204) reported this colleague to the relevant authority. Underrepresented minorities and graduates of non-US medical schools were less likely than their counterparts to report, and physicians working in hospitals or medical schools were most likely to report. The most frequently cited reason for taking no action was the belief that someone else was taking care of the problem (19% [n = 58]), followed by the belief that nothing would happen as a result of the report (15% [n = 46]) and fear of retribution (12% [n = 36]).

“Conclusion Overall, physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority; however, when faced with these situations, many do not report.”

“Citation:“JAMA. 2010;304(2):187-193. doi:10.1001/jama.2010.921