How Should Physicians Address the Issue of an Impaired Colleague?

The Challenge: The title of physician has become synonymous with a high degree of responsibility. While this dynamic garners respect and gratitude for the work physicians do, it can adversely affect the physicians themselves. It’s easy to conceptualize physicians as leaders, but a key component of their identity that often goes unnoticed is their inherent humanity.

When the humanity of an individual is overshadowed by the weight of their responsibilities, that individual can be susceptible to burnout, emotional reactivity, and unhealthy coping mechanisms such as substance abuse. If a physician encounters a potentially impaired colleague, they must use a nuanced approach that carefully considers the context of the situation, the mental state of the colleague, and the psychological factors that generally impact physicians.

Key Takeaways

Impairment in the context of physicians can emerge from a multitude of sources, including mental health disorders, substance abuse, and familial or relational tensions. Anesthesiologist and behavior management expert Matthew J. Mazurek, MD, MHA, CPE, FACHE, FASA, says that one primary challenge often encountered when addressing impaired physicians is the general reluctance of physicians to ask for or seek help.

Mazurek offers the following reasons physicians may not seek treatment:

1. Personality and character traits of the physician, including doubt, guilt, and an exaggerated sense of responsibility.

2. Being conditioned to cope alone. Physicians are increasingly isolated in larger health systems and groups with production pressures. Physicians now spend more time documenting notes in the EMR, resulting in burnout and screen fatigue.

3. Survivor mentality. Physicians endure both physical and emotional exhaustion in medical school and residency, leading approximately 37% of physicians to perceive retirement as their most viable strategy for wellbeing.

4. Self-doubt and imposter syndrome. Physicians do not want to appear weak and insecure.

How can physicians address the issue of an impaired colleague? Mazurek suggests that when a colleague is suspected of impairment such as substance or alcohol use disorder, physicians have a prima facie duty to respect the autonomy of other physicians, but this duty should always be eclipsed by the need to protect patients, staff, and others when a physician is impaired in ways that can jeopardize care. Intervening requires a preponderance of evidence, and all evidence must be examined and contextualized based on the specifics of the situation.

The Bottom Line: Any signs of impairment should be considered and examined in the context of the case at hand. While decisive action must be taken when there is sufficient evidence of impairment, it’s also important to maintain empathy and compassion toward colleagues who are struggling. Mutual respect and commitment to one another’s wellbeing is the best way to have a positive impact.

To learn more about strategies to resolve disruptive behavior in the healthcare setting, please see our upcoming course by Mazurek, “Advanced Behavioral Management Strategies” which will be available in February 2023. This course will provide comprehensive insights about leadership principles and navigating conflict and will strengthen your ability to identify, analyze, and manage disruptive behaviors.

Find more information about our educational offerings at physicianleaders.org/education.