The Impaired Medical Staff Member Michele Kilo, MD Kathryn Pieper, PhD Stephanie Andrews, LSCSW,...
-
date post
19-Dec-2015 -
Category
Documents
-
view
216 -
download
2
Transcript of The Impaired Medical Staff Member Michele Kilo, MD Kathryn Pieper, PhD Stephanie Andrews, LSCSW,...
The Impaired Medical Staff Member
Michele Kilo, MDKathryn Pieper, PhD
Stephanie Andrews, LSCSW, LCSWSection of Developmental & Behavioral Sciences
The Impaired Medical Staff Member
I. Forms of impairment
II. Response to impairment
III. Process of reporting impairment
Definition of Impaired Physician
The American Medical Association Council on Mental Health published a report defining physician impairment as “the inability to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence.”
Forms of Impairment
Classic – Substance Use & Abuse Mental Illness – Axis I & Axis II Disruptive Behavior Medical Illness
Classic Form of Impairment
Substance Use and Abuse:– Overall, the prevalence of substance use
disorders in healthcare professionals appears to be about equal to that in the general population (8-14%).
– Identification of substance abuse and dependence in healthcare professionals is often very difficult because of extremely strong denial and the “Conspiracy of Silence.”
Classic Form of Impairment
Substance Use and Abuse:– Healthcare providers tend to have better
treatment outcomes.– Patterns of substance use include recreational
use, performance-enhancement (seen more in ER physicians) and self-treatment of pain, anxiety and depression (seen more in residents and practicing physicians).
– What can this look like?
Classic Form of Impairment
Substance Use and Abuse by Medical Specialty – highest use:– Anesthesiology- due to access to drugs with high
potential for abuse and addiction– Emergency Medicine – higher prevalence in most
studies – higher prevalence of marijuana and cocaine use
– Psychiatry – higher prevalence in most studies – higher prevalence of benzodiazepine use.
Classic Form of Impairment
Substance Use and Abuse by Medical Specialty – lowest use:– OB/Gynecology– Pathology– Radiology– Pediatrics
Mental Illness
A multiaxial system involves an assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment and predict outcome. There are five axes included in the DSM-IV multi-axial classification:
Mental Illness
Axis I Clinical DisordersOther Conditions That May Be a
Focus of Clinical AttentionAxis II Personality Disorders
Mental RetardationAxis III General Medical ConditionsAxis IV Psychosocial and Environmental
ProblemsAxis V Global Assessment of Functioning
Mental Illness
Axis I disorders are commonly seen in impaired medical staff include Anxiety Disorder and Depression.
Axis I disorders typically respond to outpatient or inpatient treatments, including psychotherapy, medication or treatment programs.
Mental Illness
Axis II disorders include personality disorders (narcissistic, histrionic, borderline, paranoid, schizoid and antisocial).
Axis II disorders are VERY difficult to treat and are EXTREMELY disruptive to the individuals around the person with this type of disorder.
Mental Illness
Personality disorders develop over a period of many years and are characterized by persistent difficulty in interpersonal relationships.
Individuals with this type of disorder view the problems they encounter as SOMEONE ELSE’S fault.
Disruptive Behavior
May often be associated with a combination of above-mentioned forms of impairment.
Overt or subtle intimidating behavior including:– Verbal, physical, emotional, undermining, degrading,
demeaning, negative – Can include boundary violations such as sexual and
professional boundaries– Other staff refusing to work with this person– Can be extremely subtle
Medical Illness
Importance of attending to observed impairment in a timely manner
If impairment is a newly observed behavior, may be medically induced
Greater chance, for all impaired behavior, for a successful recovery the sooner intervention takes place.
Response to Impairment
By Impaired Medical Staff:– Fear of consequences– Loss of license = loss of identity/potential loss of
career– Feelings of “I can take care of myself”– Strong tendency to self-diagnose and treat– Disease understanding does not equal disease
acceptance– Shame & embarrassment
Response to Impairment
By Staff:– Fear of Intimidation by impaired medical staff
member– Fear of loss of job if known as whistle blower– Peer pressure to keep “conspiracy of Silence”– After reporting concerns, lack of follow through,
feeling of vulnerability
Process of Reporting Impairment
Ethical obligation to report a physician who may be endangering the lives of others through impairment – result of the 1972 AMA House of Delegates
State Impaired Physicians Programs, also known as Physicians Health Programs, are present in all 50 states, as a result of The Disables Doctors Act of 1974.
Process of Reporting Impairment
The Missouri State Medical Association established the Missouri Physician Health Program (MPHP) in 1985.
The MPHP is legally and financially independent of licensure and regulatory agencies, such as the Board of Healing Arts, BNDD and DEA. It has no reporting requirements to the National Practitioner Data Bank.
Process of Reporting Impairment
MPHP maintains a confidential hotline Physicians who volunteer to participate in the
program have the opportunity to arrest the progression of their disease and check their impairment before public exposure, disciplinary action of licensing boards or loss of family relationships, financial resources and clinical privileges occurs.
Process of Reporting Impairment
As of January 2001, the Joint Commission on Accreditation of Healthcare Organizations has required that all JCAHO accredited hospitals establish a “process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function.”
CMH Process of Reporting
Potential Route of Reporting:– Person themselves, to express your concerns– Section Chief– Department Chair– Any chosen confidant in a position of authority
Anyone and everyone can make an anonymous and confidential referral
*Please remember this is all confidential
Staff Advocacy Process
Recently Developing Chaired by Chief Nursing Officer, Cheri Hunt, RN Dr. Kilo a member If concerns about an Allied Health professional staff
and/or other employee that may or may not involve patient/parent interactions a referral can be made to the Staff Advocacy Committee
Appropriate referrals
Conclusion:
Physicians helping Physicians Not meant to be a punitive process Goal is for early identification and
intervention for greatest opportunity for recovery and return to practice.