Massachusetts Medical Society: How to Support a Colleague Who’s Impaired or Incompetent at Work

How to Support a Colleague Who’s Impaired or Incompetent at Work

Physician Health Matters

By Debra A. Grossbaum, JD, General Counsel, Physician Health Services

We all aim to be supportive to our colleagues, especially when we know that they may be struggling with personal or health-related problems. But what is our obligation when a personal issue seems to undermine a physician’s ability to provide medical care with optimal skill and safety?

Physicians, like everyone else, are susceptible to stressors and challenges that can derail their focus and attention. Unlike most other professionals, though, physicians do not have the leeway to perform at anything less than full competence. Patients enter the medical environment trusting that their physicians will be not only sufficiently trained, but also fully alert and well enough to apply their medical training to patients’ specific needs. As a theoretical matter, few would disagree.

Most Physicians Act on Concerns

Most physicians are ready to act on this obligation. In a survey involving 3,000 physicians, two out of three (64 percent) agreed with the professional commitment to report physician colleagues who are impaired or incompetent to practice (JAMA, 2010). Seventeen percent of respondents said they had personal knowledge of such a physician, and two in three of them (67 percent) had reported that colleague.

The most frequently cited reason for not reporting an incompetent colleague was a belief that someone else would address the problem, a belief that nothing would happen as a result, and fear of retribution. It may be helpful to recognize that allowing a potentially impaired physician to continue to work is detrimental for the physician as well as patients, and to learn the options for positive intervention.

Legal and Ethical Obligations

Under the “mandated reporting law,” physicians and other health care professionals are required to report to the Massachusetts Board of Registration in Medicine whenever they have a reasonable basis to believe that a physician could be impaired in his or her ability to practice medicine (Massachusetts General Laws, Chapter 112, section 5F). Beyond these legal obligations, there are ethical reasons to act. Physicians are sworn to “do no harm,” and have a clear obligation to ensure that they and those with whom they practice are fit to provide care.

Encourage Time Off

Several options may help mitigate concerns about addressing a colleague’s work performance. The sooner these steps are taken, the less likely it is that a physician’s ailment will become an impairment. First, ailing physicians must take time off work whenever their optimal performance is at stake. This can be encouraged by effectuating policies that not only allow, but actually encourage, time off to address illness. There is no fault or shame in being ill, and the medical workplace, of all professional environments, should create opportunities for wellness. In addition to taking days off as needed, physicians should be afforded nonpunitive leaves of absence to address health matters that require more significant intervention or long-term attention.

Refer to Physician Health Services

How to Refer a Colleague to Physician Health Services

Anyone can call PHS to make a referral — a supervisor, colleague, spouse, or the physician in need of services. For the referral to proceed, the physician must agree. PHS is a peer-review organization. Our records are protected and confidential, and we are a fully independent subsidiary of the MMS, with the goal of identifying, supporting, and monitoring physicians and medical students who are experiencing or are at risk for health-related concerns. For all PHS services, please call (781) 434-7404.

For colleagues who do not or cannot acknowledge their own health vulnerabilities, physician health programs (PHPs) can facilitate objective, independent, and confidential assessments, and make recommendations when remediation is indicated. In Massachusetts, the PHP is Physician Health Services, Inc. (PHS), which serves as an important resource when colleagues are unsure what may be ailing a physician and are reluctant to probe or compromise confidentiality. In such cases, the workplace can remain at arm’s length from a colleague’s personal matters while the PHP determines whether there is a health issue that requires some type of accommodation or remediation. Referrals to PHS are easily made, and only proceed with the agreement and cooperation of the referred physician.

While it can be a challenging burden to be each other’s keepers, the duty to keep a watchful eye does befall all health care providers, both legally and ethically. We need to work together so that this mutual duty is executed is a caring and supportive manner, in order to best benefit physicians and patients alike.

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