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INTRODUCTION

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Physician impairment is an important issue that needs to be identified and rectified early. If not treated, it poses significant problems for the patients, physician himself, colleagues, and hospital staff. Detrimental effects of an impaired physician may include loss of license, dissolution of marriage, family problems, health problems, and even death. Therefore, early identification and treatment is imperative. Fortunately, once identified and treated, physicians often do better after recovery than others, and typically can return to a productive career and a satisfying personal and family life. Unfortunately, disciplinary action and stigma are powerful disincentives to physicians referring their colleagues or themselves. However, physicians have an ethical responsibility to act proactively with regards to impaired colleagues not only to help them, but also to protect patients.

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Illness is sometimes equated with impairment. However, these entities are distinct, and it is important to draw a distinction between illness and impairment. For example, addiction is a potentially impairing illness. Individuals with an illness may or may not have evidence of impairment. Typically, addiction that is untreated progresses to impairment over time. Hence, in addressing physician impairment, it makes sense to identify illness early and offer remedial measures prior to the illness becoming impairment.

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WHO IS AN IMPAIRED PHYSICIAN?

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According to the American Medical Association, an impaired physician is one who is “unable to practice medicine with reasonable skill and safety to patients because of physical or mental illness, including deterioration through the aging process or loss of motor skill, or excessive use of alcohol or abuse of drugs including alcohol.” Virtually, any significant medical problem that affects the physician’s judgment and inability to fulfill professional or personal responsibilities can be classified as physician impairment. This chapter focuses on substance abuse and dependence leading to physician impairment.

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It is a fact that many physicians possess a strong drive for achievement, exceptional conscientiousness, and a tendency to deny personal problems. These attributes are advantageous for “success” in medicine, ironically, however, they may also predispose to impairment. Impaired physicians may face some obstacles in accepting that they have an illness and should seek help. Some of these obstacles may include denial, aversion to being a patient, practice coverage, stigma, fear of disciplinary action, to mention just a few. When early referrals are not made, physicians afflicted by illness often remain without treatment until overt impairment manifests in the workplace.

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COMMON CAUSES OF PHYSICIAN IMPAIRMENT

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Data from state physician programs have shown that alcohol or opiates are the drug of choice for physicians enrolled for substance abuse disorders. The exact number of impaired physicians in the United States is unknown and hard to estimate. Reasons for difficulty in getting an accurate estimate include the fact that most impaired physicians self-report, and many that sought help and entered treatment did so confidentially without being part of the statistics. A 2001 ...

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