Once it is clear and certain that a colleague is legitimately impaired, several ethical questions must be considered. You must be sure you are being objective and have no ulterior motive in making the decision to report:
- Is this a person with whom you’ve had previous negative personal interactions?
- Would you stand to gain something if this colleague were found to be impaired, such as a desired panel of patients or an improvement in status or salary by a promotion into their former position?
- Would your own workload increase if this person were forced to take a leave of absence?
- Would there be a taint on the reputation of the hospital or practice if they were found to be impaired?
- What is the chance of retaliation from the impaired colleague or ostracization from other physicians who also know or work with the one who is impaired?
Tiered Response
Some experts have suggested a tiered system of responses. Of course, discretion must be used depending on the severity of the impairment and the possibility of risk to patient safety. A level 1 response is a collegial expression of concern, just between yourself and the colleague in question. It’s important to keep this conversation supportive and directed toward concrete plans of action, rather than turning it into a confrontation or any kind of attack on their character. It may be wise to have a neutral party, such as a practice’s lawyer, accountant or a mutual friend, present in some circumstances.
If there is no change in behavior or the other physician doesn’t seek help after that interaction, a level 2 response would involve confidentially approaching the individual’s manager or supervising clinician and asking them to approach the individual with you.
The last and final intervention, which is usually not necessary, would involve reporting the impaired colleague to a physician’s health program, hospital board of directors or applicable state medical board.4,5
Take Action
In the case above, a reasonable course of action would include seeking out the impaired colleague as soon as possible after the incident and approaching him with your concerns. Because he is putting patients in danger, his supervisor needs to be involved. A kind and compassionate option would be to offer to go with him to present the incident to his supervisor; if he resists your offer, it would be necessary to approach his supervisor alone.
The legal obligation to report an impaired physician varies by state, but as physicians, we have an ethical obligation to report. This helps protect the public from careless and negligent behavior, and protects the physician from further consequences of their behavior. Doing so may save a life—your colleague’s or one of their patients.