Physician Health Matters

How to Handle Fitness-for-Practice Evaluations

Portions of this article were taken from the American Psychiatric Association’s Guidelines for Psychiatric “Fitness for Duty” Evaluations of Physicians, supplied by Michael H. Gendel, M.D., medical director of the Colorado Physician Health Program.

A fitness-for-practice evaluation is the determination of a physician’s ability or inability to practice medicine with reasonable skill and safety following the onset of an illness or injury. Any such determination needs to be carefully considered, recognizing that at times physicians require a break from practice for their own well-being and the safety of their patients.

Physicians often need encouragement to consider factors that might impair their ability to work or to refrain from work when they’re facing a health or personal challenge. The demands of modern practice can result in a potentially harmful expectation to work when, in reality, the physician might be medically compromised. Physicians often make decisions about whether or not to work without seeking anyone else’s advice or opinion.

Comprehensive Exams
If signs or symptoms of a mental health disorder, substance use disorder, physical disease, or disability exist, a trained evaluator or psychiatrist should initiate an evaluation. An evaluator will determine the presence of any illness and its relationship to the physician’s fitness to practice medicine. The evaluation may also include treatment and/or monitoring options.

At the outset of the examination, the evaluator should make clear to the physician examinee that information from the assessment, including the ultimate opinion regarding whether the physician is fit to practice, will be provided to the individual who requested the evaluation. The evaluator should also explain that the primary purpose of the exam is to arrive at an opinion of fitness and not to directly treat the examinee as a patient. The evaluator should also discuss any potential conflicts of interest and clarify who is responsible for payment.

Collateral Documentation
After carefully reviewing the history of the presenting problem(s), a fitness-for-practice evaluator needs to obtain and review as much collateral documentation as possible. This may include discussions with the referring source, spouse or significant other, additional family members, and colleagues in the workplace.

The evaluation should also include a full psychiatric evaluation and examination of mental state, along with inquiries into the physician’s peer-review issues, hospital actions that resulted in any privilege changes, professional liability history, and complaints made to or actions by the state medical licensing board. If necessary, the evaluator should arrange for additional testing such as a neuropsychological exam (see related Vital Signs article, June/July 2006).

Final Report
After careful review of all information and documentation, the evaluator should write a report that addresses the following:

• The presence of an illness or disorder
• The relation of the illness and any consequent impairments to the ability to practice safely
• The treatability of the illness and recommendations for treatment and/or monitoring
• A summary of workplace concerns ­focusing on fitness to practice

The amount of detailed information the evaluation includes in the final report will likely depend on who will receive the report. Information should be shared only on a need-to-know basis, with third parties receiving only the information necessary to make responsible decisions regarding the physician’s fitness. For example, a report should always contain detailed recommendations, but it is not always necessary for a hos­pital, employer, or credentialing body to receive details about a physician’s family history or health issues from the distant past. Regardless of who receives the report, sensitive personal information can often be omitted or summarized so that only those facts relating to the current fitness-for-practice question are addressed.

For additional information, contact Physician Health Services at (781) 434-7404 or visit www.physicianhealth.org.

– Luis T. Sanchez, M.D.
– Jessica Vautour