Physicians have the highest rate of suicide for any profession 400 physician suicides are reported EACH year This statistic does not include “suspicious circumstances”

Suicide is usually the result of untreated or inadequately treated depression, coupled with knowledge of and access to lethal means. Medscape, July 17, 2014

The Stats! 12 – 17% of physicians suffer from a substance abuse disorder in their lifetime The rate of depression for male physicians = 12% Rate of depression for female physicians = 18%

Physician Impairment Substance Use Disorders Medical and Mental Disorders affecting ability to practice medicine safely Declining cognitive functioning Disruptive Behavior

Substance Use Disorders (in order of prevalence) Alcohol Opiates Benzos Marijuana

WELL-BEING COMMITTEE: An Underutilized Resource

By Joint Commission mandate, two separate committees WBC vs. Peer Review By Joint Commission mandate, two separate committees Peer Review = Clinical Competence Well Being Committee = Practitioner Health

WELL-BEING COMMITTEE Confidentiality Self-referral Referral by others Intervention Not punitive Advisory to MEC

Well-Being Committee Protocols Testing Referral and Monitoring – Outside Providers Written Agreement Re-entry Reporting requirements Lapse

Well-Being Committee Bylaws Minutes Reporting to MEC

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Managing the Reluctant Physician Enforcing a requirement to report to the Wellbeing Committee. Mandatory physical and psychiatric examinations. Qualifications of the examining physicians [the need to make tentative diagnoses]. Extent of the examination. Distribution of the results of the examination. Prescribed consequences of a failure to submit. “Behavior Agreements.” Formal investigations as a last resort.

Disruptive Practitioners

Defining Disruptive Behavior AMA H-140.918 Disruptive Physician Policy: “A style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care” or appropriate hospital operations.”

Disruptive Behavior Crosses the Line When It: Interferes with patient care Interferes with the orderly function of the workplace Creates a hostile environment Is directed at one or more people in a manner that causes distress Has no legitimate purpose

Why Are Some Physicians Disruptive? Personality or affective disorder Narcissistic, depressed, bipolar Stress, burnout Poor social skills (asshole) Lack of insight The behavior “works” – the physician gets his way Aging Medical problem Incompetence Drugs, alcohol

A Common Problem No one wants to act in such cases Understandable discomfort – we are embarrassed for these people Reluctance leads to poor response Failure to document Failure to warn fairly Thus, when the “last straw” is added, there are not enough to act on! Disruptive practitioners tend to fight

Proper responses to disruptive behavior and tools for implementing them Codes of Conduct Early Intervention (productive interaction) Behavior Agreements Well-Being Committee

Disclosing Hospitalization to Another Hospital Footer Text

Permissible to Report Member's Hospitalization to Another Hospital Peer review sharing encouraged for public welfare. Medical staff can share peer review information if member has signed a written release. Acceptable under HIPAA if: (a) the member is (or was) also a member of the medical staff at the other hospital; (b) the disclosure pertains to the member's medical staff membership at the other hospital; and (c) the disclosure is for the purposes of peer review. HIPAA authorization is not legally necessary. Footer Text

Case Studies

Is it a Willful Omission or just an Innocent Mistake? Dr. Donogood is a courtesy member of the medical staff and does very little at your hospital. He applies for reappointment but fails to mention that he had been summarily suspended at another hospital for a health reason. When you bring it to his attention he apologizes that it is an oversight but inspite of multiple requests he never gives you a release for the other hospital’s information and fails to keep his appointment for a health exam. How should this be handled?

Hypothetical A patient presents to the emergency department (ED) showing signs of severe intoxication requiring emergency intervention. After stabilization in the ED, the patient is transferred to the intensive care unit. The treating physician realizes that the patient is his colleague and a fellow member of the hospital's medical staff. Based on her condition, the treating physician has serious concerns about the member's ability to safely practice medicine. How should this be handled? Footer Text

Treating Physician Should Disclose the Hospitalization to the Medical Staff Without patient authorization the hospital is permitted to use and disclose the minimum amount of PHI necessary for its own healthcare operations, including peer review. Physicians have an ethical duty to report possibly incompetent or impaired colleagues. Most medical staff bylaws require/encourage internal reporting of colleagues exhibiting conduct reasonably likely to be detrimental to patient safety. Footer Text

What Could Possibly Go Wrong?

Questions And Discussion