A Growing Number of Impairments
Whereas some PHPs focus on physicians with substance use disorders, a growing number "take all comers," as Dr Adelman puts it.
The Massachusetts PHP is one of them. "Anything that is remotely health-related, including occupational performance, we consider a health problem," Dr Adelman says. "When doctors come to our program, we assess them thoroughly. We try to pigeonhole which of five categories of problem is active. One category is drugs and alcohol. Two is mental health. Three is workplace behavior that's not due to drugs and alcohol or psychiatric problems. Four is neurocognitive issues. And then there's occupational stress and burnout."
Workplace behavior issues are further subdivided into two categories. "One is pure performance issues," Dr Adelman says. "The doctor has a problem with punctuality, maintaining the pace, or completeness or timeliness of records. It's how they're performing on today's medical assembly line, which is moving very quickly. When that's an issue, sometimes the doctor has a learning disability. Sometimes the doctor has attention-deficit disorder. Sometimes we see doctors with obsessive-compulsive disorder, where they're compulsively thorough."
The other category is unprofessional or disruptive behavior. "Rough edges," Dr Adelman calls it. "Doctors behaving badly when it's not due to mental illness, addiction, a neurocognitive issue, or a medical problem."
Dr Adelman likens the problem to global warming. "It's getting hotter and hotter in the healthcare ecosystem," he says. "Everyone has his or her own boiling point. Some people's boiling points are lower than others. When the heat and the pressure in the ecosystem go up, as they have, more doctors are blowing a gasket."
"Among some doctors, there's also the idea that doctors can talk down to people," says Dr Adelman. "The rest of the world doesn't look at it that way anymore. So you have nurses, secretaries, and support staff saying, 'He can't say that to me. I'm reporting him.'"
Such reporting is often facilitated (and kept anonymous) by "incident reporting systems"—software programs that reside on desktop computers at a growing number of hospitals and group practices, Dr Adelman says.
The Tip of the Iceberg
"Doctors are human beings like everyone else, and lots of human beings have significant health problems in a given year," Dr Adelman points out. "We're seeing the pathological tip of the iceberg. This movement—which I really think needs to be a physician health promotion movement as well as a physician remediation movement—needs to change the physician mindset so that doctors are getting the help they need in time.'"
Dr Adelman recalls a phone call he recently received about a dentist—even though dentists aren't among the Massachusetts PHP's clients—who was falling asleep while working on patients.
"That person could lose his license just from that little snippet I heard," Dr Adelman reflects. "Maybe he had an alcohol problem. Maybe it was sleep apnea. Who knows? But that's impairment. We want to change the culture so doctors address health problems before they become impaired."
"In Massachusetts," he adds, "impaired performance is what gets you attention at the board. Taking care of yourself doesn't."
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Cite this: Neil Chesanow. Impairment Among Physicians is Growing: Why? - Medscape - Feb 24, 2015.