THE IMPAIRED

PHYSICIAN

I Definition
1973 American Medical Association
Impaired physician is one who is unable to
practice medicine with reasonable skills
and safety to patients because of physical
or mental illness, including deterioration
through aging process or loss of motor
skill or excessive or abuse of drugs
including alcohol.

John C. Hagan, M.D.

Physician impairment means condition

temporary or permanent that makes
his/her unable to practice medicine or
surgery with reasonable skill and ability. It
runs from emotional and physical
exhaustion, career burnout, mental
problem, alcoholism, drug addiction,
depression and suicide.

II Causes
A. Substance/ drug dependency or abuse
(Addictive Disorder in Physician)
B. Alcoholism
C. Behavioral disorder
D. Personal problem
E. Severe marital problem
F. Incompetence

II Causes

G. Psychiatric disorder or mental illnesses

Anxiety
Depression
Anger management problem
H. Unethical conduct
Sexual contact with patients
Boundary conflicts
Economic self-interest

II Causes
I. Other non-addicting medical problems
Dementias
Other Neurological conditions
Hematology-Oncology Disorders
Bipolar, Unipolar Affective Disorders
Personality Disorders

III Factors Contributing to substance

abuse by physicians and medical
students

1. Access to pharmaceuticals (availability)

2. Family history of substance abuse
3. Personality factors
( e.g., grandiosity, guilt)
4. Stress at home and/or at work
5. Thrill-seeking

III Factors Contributing to substance

abuse by physicians and medical
students

6. Self-treatment of pain, sleep patterns,

emotional disorders
7. Chronic fatigue
8. Social/ economic status

IV Effects of a Physicians Impairment

on
1. The integrity of the Profession
2. The health and welfare of the
community
3. The safety of the patient
4. The impaired colleague

V Signs and symptoms of Addictive

Disorders in Physicians

Sequential, progressive deterioration in every

facet of life:
Family life
Community
Finances/ Legal matters
Spiritual and emotional health
Physical health
Professional performance

Signs and symptoms of ADP:

Family Life
1. The physician withdraws from family
activities; there are unexplained absences
2. The spouse becomes a caretaker
3. Fights increase in frequency; there is
dysfunctional anger; the spouse tries to
control the physicians substance abuse

Signs and symptoms of ADP:

Family Life
4. Substance abuse disorders become a
family illness
5. There is a child abuse (emotional
and/or physical)
6. The children assume responsibility for
maintaining normal family functioning

Signs and symptoms of ADP:

Family Life
7. The children develop abnormal,
antisocial behavior ( depression,
promiscuity, running away from home,
substance abuse)
8. Sexual problems emerge ( impotence,
extramarital affairs)
9. The spouse disengages, seeks
separation or divorce, abuses substances

Signs and symptoms of ADP:

Community
1. Becomes isolated and withdraws from
community activities, church, friends,
leisure, hobbies and peers
2. Exhibits embarrassing behavior at clubs
or parties
3. Experiences legal problems, and
exhibits role-discordant behaviors

Signs and symptoms of ADP:

Community
4. Behavior is unreliable and unpredictable
in community and social activities
5. The physician is unpredictable in
personal behavior, engaging in excessive
spending, risk taking behaviors

Signs and symptoms of ADP:

Physical Status
1. The physicians personal hygiene
deteriorates
2. His/her clothing and dress habits deteriorate
3. The physician has multiple physical signs
and complaints
4. There is evidence of a serious emotional
crisis

Signs and symptoms of ADP:

Physical Status
5. The physician writes numerous
prescriptions for personal use
6. The physician experiences frequent
hospitalizations, and/or has numerous
visits to physicians and dentists
7. The physician is involved in multiple
episodes of accidents and trauma

Signs and symptoms of ADP:

Office or Clinic
1. Schedule and patient appointments
become disorganized; starts progressively
later in the day
2. The physicians behavior toward staff
and patients is hostile, withdraw, or
unreasonable
3. The physician spends time behind
locked doors

Signs and symptoms of ADP:

Office or Clinic
4. The physician orders excessive office
supplies of drugs
5. Patients complain to staff about
physicians behavior
6. The physician is frequently absent from
the office or has unexplained or frequent
illnesses

Signs and symptoms of ADP:

Hospital
1. Makes rounds late or exhibits
inappropriate or abnormal behavior
2. Decrease in quality of performance in
staff presentations, writing in charts,
record keeping
3. Enters inappropriate orders for or overprescribes medications

Signs and symptoms of ADP:

Hospital
4. Nurse, other staff report a change in
behavior
5. Becomes involved in malpractice suits
and/or legal sanctions against him/herself
or the hospital
6. Unavailable for or responds
inappropriately to pages and/or telephone
calls

Signs and symptoms of ADP:

Hospital
7. Engages in heavy drinking at staff
functions
8. Is reluctant to undergo physical
examinations or drug screening

Other signs and symptoms of ADP

1. Has changed jobs often during past five
years
2. Frequent geographic locations without
clear reasons
3. Frequent hospitalizations
4. Complicate and elaborate medical
history

Other signs and symptoms of ADP

5. Unexplained time lapses between jobs
6. Indefinite or inappropriate professional
references and vague letters of references
7. Employment in one or more positions
not appropriate to his/her qualifications
8. Decline in professional productivity

Thank You!