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Impaired Psychiatrists

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Malpractice and Liability in Psychiatry

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Abstract

Impairment, or the inability to practice medicine with reasonable skill and safety due to illness or injury, affects approximately 15% of physicians during their careers. A review of the literature reveals that individual factors, such as personality traits, as well as systemic issues, including excessive work demands, may predispose physicians to illness, particularly mental illness, which if left untreated may lead to impairment and ultimately patient harm. Ill physicians may be reluctant to seek help for a variety of reasons, including concerns about a lack of confidentiality and potential negative consequences related to credentialing and medical board involvement. Physician health programs that provide a confidential avenue for treatment improve early identification of illness, which protects the public at large and provides an opportunity for physicians to receive needed treatment to return to the practice of medicine safely.

Simply weeding out detected offenders did not materially advance the safety of patients, was needlessly wasteful of valuable medical skills and, not least, was inhumane. (Dilts & Sargent, 2003)

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References

  • AMA Council on Mental Health. (1973). The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA, 223(6), 684–687.

    Article  Google Scholar 

  • American Board of Medical Specialties. (2021). Board certification requirements. https://www.abms.org/board-certification/board-certification-requirements/. Accessed June 13, 2021.

  • American Medical Association. (2017). Code of medical ethics of the American Medical Association. American Medical Association. Also available at https://www.ama-assn.org/about/publications-newsletters/ama-principles-medical-ethics

  • American Psychiatric Association. (2004). Resource document guidelines for psychiatric “fitness for duty” evaluations of physicians. Available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents. Accessed June 6, 2021.

  • Anfang, S. A., Faulkner, L. R., Fromson, J. A., & Gendel, M. H. (2005). The American Psychiatric Association’s resource document on guidelines for psychiatric fitness-for-duty evaluations of physicians. Journal of the American Academy of Psychiatry and the Law, 33, 85–88.

    Google Scholar 

  • Baldwin, P. J., Dodd, M., & Wrate, R. W. (1997). Young doctors’ health—I. How do working conditions affect attitudes, health and performance? Social Science & Medicine, 45(1), 35–40.

    Article  CAS  Google Scholar 

  • Boisaubin, E. V., & Levine, R. E. (2001). Identifying and assisting the impaired physician. American Journal of the Medical Sciences, 322, 31–36.

    Article  CAS  Google Scholar 

  • Braquehais, M. D., Bel, M. J., Lusilla, P., Valero, S., Mozo, X., Casas, M., et al. (2015). Psychiatrists admitted to a physicians’ health programme. Occupational Medicine, 65(6), 499–501.

    Article  CAS  PubMed  Google Scholar 

  • Brooks, E., Gendel, M. H., Early, S. R., Gundersen, D. C., & Shore, J. H. (2012). Physician boundary violations in a physician’s health program: A 19-year review. Journal of the American Academy of Psychiatry and the Law, 40(1), 59–66.

    Google Scholar 

  • Brooks, E., Gendel, M. H., Gundersen, D. C., Early, S. R., Schirrmacher, R., & Shore, J. H. (2013). Physician health programmes and malpractice claims: Reducing risk through monitoring. Occupational Medicine, 63(4), 274–280.

    Article  CAS  PubMed  Google Scholar 

  • Candilis, P. J., Kim, D. T., Sulmasy, L. S., & for the ACP Ethics Professionalism and Human Rights Committee. (2019). Physician impairment and rehabilitation: Reintegration into medical practice while ensuring patient safety: A position paper from the American College of Physicians. Annals of Internal Medicine, 170(12), 871–879. https://doi.org/10.7326/M18-3605

    Article  PubMed  Google Scholar 

  • Carpenter, L. M., et al. (2003). Mortality of doctors in different specialties: Findings from a cohort of 20,000 NHS consultants. Occupational and Environmental Medicine, 54, 388–395.

    Article  Google Scholar 

  • Carr, G. (2003). Professional sexual misconduct--an overview. Journal of the Mississippi State Medical Association, 44(9), 283–300.

    PubMed  Google Scholar 

  • Carr, G. D., Hall, P. B., Finlayson, A. J., & DuPont, R. L. (2017). Physician health programs: the US model. In K. J. Brower & M. B. Riba (Eds.), Physician mental health and well-being, integrating psychiatry and primary care (pp. 265–294). Springer.

    Google Scholar 

  • Crowley, T. J. (1984). Contingency contracting treatment of drug-abusing physicians, nurses, and dentists (NIDA Research Monograph 46) (pp. 68–83). U. S. Government Printing Office.

    Google Scholar 

  • DesRoches, C., Rao, S., Fromson, J., Birnbaum, R., Lessoni, L., Vogeli, C., & Campbell, E. (2010). Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA, 304(2), 187–193.

    Article  CAS  PubMed  Google Scholar 

  • Dilts, S. L., & Sargent, D. A. (2003). The law and physician illness. In R. Rosner (Ed.), Principles and practice of forensic psychiatry (2nd ed., pp. 171–179). Arnold.

    Google Scholar 

  • DuPont, R. L., & Humphreys, K. (2011). A new paradigm for long-term recovery. Substance Abuse, 32(1), 1–6.

    Article  PubMed  Google Scholar 

  • Federation of State Physician Health Programs. (2018). https://www.fsphp.org. Accessed June 3, 2021.

  • Firth-Cozens, J. (1999). The psychological problems of doctors. In Firth-Cozens, J. & Payne, R.L. (eds). Stress in health professionals: Psychological and organizational causes and interventions. : Wiley.

    Google Scholar 

  • Firth-Cozens, J. (2000). The person or the job? Longitudinal studies of UK doctors. In Healthcare workers: Their health risks and how to minimise them (Berzelius Symposium 52). Royal Society of Medicine.

    Google Scholar 

  • Firth-Cozens, J. (2018). Improving the health of psychiatrists. Published online by Cambridge University Press. https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/improving-the-health-of-psychiatrists. Accessed June 13, 2021.

  • Frank, E., Boswell, L., Dickstein, L. J., & Chapman, D. P. (2001). Characteristics of female psychiatrists. American Journal of Psychiatry, 158(2), 205–212.

    Article  CAS  Google Scholar 

  • Frank, E., & Segura, C. (2009). Health practices of Canadian physicians. Canadian Family Physician, 55(8), 810–811.

    PubMed  PubMed Central  Google Scholar 

  • FSMB. (2016). Position statement on duty to report. https://www.fsmb.org/siteassets/advocacy/policies/position-statement-on-duty-to-report.pdf. Accessed June 2, 2021.

  • Gendel, M. H., & Cooper, P. D. (2017). The law and the physician – Ill physicians. In R. Rosner & C. L. Scott (Eds.), Principles and practice of forensic psychiatry (3rd ed., pp. 203–211). CRC Press.

    Google Scholar 

  • Giæver, F., Lohmann-Lafrenz, S., & Løvseth, L. T. (2016). Why hospital physicians attend work while ill? The spiraling effect of positive and negative factors. BMC Health Services Research, 16, 548. https://doi.org/10.1186/s12913-016-1802-y

    Article  PubMed  PubMed Central  Google Scholar 

  • Gundersen, D. (2015, March 20). President’s message. FSPHP Newsletter.

    Google Scholar 

  • Hawton, K., Clements, A., Sakarovitch, C., Simkin, S., & Deeks, J. J. (2001). Suicide in doctors: A study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995. Journal of Epidemiology and Community Health, 55(5), 296–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hughes, P. H., Storr, C. L., Brandenburg, N. A., Baldwin, D. C., Anthony, J. C., & Sheehan, D. V. (1999). Physician substance use by medical specialty. Journal of Addictive Diseases, 18(2), 23–37. https://doi.org/10.1300/J069v18n02_03.

  • Kane, L. (2019). Medscape national physician burnout, depression & suicide report. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056. Accessed June 13, 2021.

  • Kane, L. (2020). Medscape national physician burnout & suicide report 2020: the generational divide. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460#2. Accessed June 13, 2021.

  • Kerebih, H., Salelew, E., & Hailesilassie, H. (2019). Factors associated with medical students’ choice of psychiatry as future specialty: A cross-sectional study. Advances in Medical Education and Practice, 10, 751–758.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kumar, S. (2007). Burnout in psychiatrists. World Psychiatry, 6(3), 186–189.

    PubMed  PubMed Central  Google Scholar 

  • Kumar, S., Hatcher, S., & Huggard, P. (2005). Burnout in psychiatrists: An etiological model. International Journal of Psychiatry in Medicine, 35(4), 405–416.

    Article  PubMed  Google Scholar 

  • Kunyk, D., Inness, M., Reisdorfer, E., Morris, H., & Chambers, T. (2016). Help seeking by health professionals for addiction: A mixed studies review. International Journal of Nursing Studies, 60, 200–215.

    Article  PubMed  Google Scholar 

  • Morrison, J., & Morrison, T. (2001). Psychiatrists disciplined by a state medical board. American Journal of Psychiatry, 158, 474–478.

    Article  CAS  Google Scholar 

  • Mossman, D., & Farrell, H. (2011). Physician impairment: When should you report? Current Psychiatry, 10(9), 67–71.

    Google Scholar 

  • Myers, M. F. (2019). The mentally ill physician: Issues in assessment, treatment and advocacy. Canadian Journal of Psychiatry, 64(12), 823–837.

    Article  PubMed  PubMed Central  Google Scholar 

  • Myers, T., & Weiss, E. (1987). Substance use by interns and residents: An analysis of personal, social and professional differences. British Journal of Addiction, 82, 1091–1099.

    Article  CAS  PubMed  Google Scholar 

  • Pullen, D., Cam, D. E., Doughty, M. V., Lonie, C. E., & Lyle, D. (1995). The medical care of doctors. Medical Journal of Australia, 162(9), 481–484.

    Article  CAS  Google Scholar 

  • Reidar, T. (2019). “Work and mental health in doctors”: A short review of Norwegian studies. Porto Biomedical Journal, 4(5), 50.

    Article  Google Scholar 

  • Saravia, A. (2017). Determining whether a physician is competent to practice medicine is complex. https://www.hcplive.com/view/determining-whether-a-physician-is-competent-to-practice-medicine-is-complex-. Accessed June 2, 2021.

  • Shore, J. (1982). The impaired physician four years after probation. JAMA, 248, 3127–3130.

    Article  CAS  PubMed  Google Scholar 

  • Swearingen, C. (1990). The impaired psychiatrist. Psychiatric Clinics of North America, 13(1), 1–11.

    Article  CAS  Google Scholar 

  • Turnbull, J., Carbotte, R., Hanna, E., Norman, G., Cunnington, J., & Kaigas, T. (2000). Cognitive difficulty in physicians. Academic Medicine, 75(2), 177–181.

    Article  CAS  PubMed  Google Scholar 

  • Ziegler, P. Z. (2016). What you need to know when treating physicians: Issues, sensitivities and considerations. Psychiatric Times, 33(6), https://www.psychiatrictimes.com/view/what-you-need-know-when-treating-physicians-issues-sensitivities-and-considerations

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Authors and Affiliations

  1. Department of Psychiatry, University of Colorado, Denver, CO, USA

    Doris C. Gundersen

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  1. Doris C. Gundersen
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Correspondence to Doris C. Gundersen .

Editor information

Editors and Affiliations

  1. Psychiatry and Law Service, Emory University, Atlanta, GA, USA

    Peter Ash

  2. Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA

    Richard L. Frierson

  3. Forensic Psychiatry, Case Western Reserve University, Cleveland, OH, USA

    Susan Hatters Friedman

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Gundersen, D.C. (2022). Impaired Psychiatrists. In: Ash, P., Frierson, R.L., Friedman, S.H. (eds) Malpractice and Liability in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-91975-7_36

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  • DOI: https://doi.org/10.1007/978-3-030-91975-7_36

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