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ACP issues guidance for physician impairment

A position paper recently published in the Annals of Internal Medicine discussed the American College of Physicians’, or ACP’s, position regarding physician impairment that included professional duties and principles to help guide physician, colleague and institutional responses to physician impairment.

“Physician impairment, the inability to carry out patient care responsibilities safely and effectively, is a problem of professional functioning that has implications for both patients and impaired physicians,” Robert M. McLean, MD, FACP, ACP President, said in a press release. “However, it is important to remember that just because a person has an illness or other condition, it does not necessarily mean he or she is impaired.”

Physician impairment can be caused by substance use disorders, medical or mental health conditions, fatigue and cognitive or motor skill decline due to age or disease, according to the press release.

The ACP Ethics, Professionalism and Human Rights Committee developed the positions outlined in the paper after conducting an environmental assessment and literature reviews on PubMed and Google Scholar.

One position taken by the ACP explained that professional duty requires physicians to recognize and address physician illness and impairment. To address this position, the ACP recommended that physicians help each other through reporting physician impairment and discussing potential impairment with the afflicted colleague. The paper highlighted the importance distinguishing between functional impairment and potentially impairing illness to guide identification and assistance for the impaired physicians.

The college suggested that physician health programs, or PHPs, should develop practices systematically based on evidence and further research. Additionally, PHPs should achieve physician rehabilitation and reintegration goals through established ethical standards that include safeguards for patients and physician rights.

The health care community must consider maintenance of physical wellness and personal well-being as a professional priority, according to the ACP. One method the ACP suggests addressing this is through institutional establishment of policies to educate staff and learners on the referral, rehabilitation and reintegration of impaired physicians.

“The guidelines recognize that developing well-trained physicians requires an enormous investment and that the community benets when, instead of being asked to heal themselves during periods of impairment, these talented professionals are supported and treated as needed,” Jeffrey H. Samet, MD, MA, MPH, of the schools of Medicine and Public Health at Boston University and the Boston Medical Center and Jane Liebschutz, MD, MPH, of the University of Pittsburgh School of Medicine and the UPMC Health System wrote in an editorial accompanying the guidance. – by Erin Michael

Disclosures: Candilis reports a consultation fee from the American College of Physicians during the conduct of the study; expert fees from the Michigan Board of Medicine and the Michigan physician health program, outside submitted work, and individual stock in pharmaceutical companies Merck and Pfizer. Samet and Liebschutz report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.