1. Workability assessment of the physicians Dr. Zdenka Čebašek-Travnik, MD Psychiatrist University Psychiatric Clinic Ljubljana

2. Conflict of interest disclosure I have no potential conflict of interest to report Dr. Zdenka Čebašek-Travnik

3. 3 Workability assessment of the physicians has its own specifics Should we use the same procedure as for all workers? Vote please … YES NO

4. 4 What do we have to assess in the case of physicians? Depends on specific workplace and specialty Depends on problems to be assessed Regular assessment Question of actual performance Physician-related errors It is not a test of medical knowledge It is not a task for medical board or court It is “just” assessment

5. 5 Content of assessment Physical ability to work Psychical ability to work neuropsychological test performance: Attention Sequential processing Logical analysis Eye-hand coordination Verbal and non-verbal learning Communication skills, professionalism

6. 6 Mental health in physicians - Factors that can contribute to medical practice errors - Cognitive impairment - Personality factors - Substance use disorders Physician impairment: a change for the worse that interferes with their functioning as physicians in ways that endanger patients. Bok S. (1993). Impaired physicians: What should patients know?

7. 7 What about substance use disorders (SUD)? Physician with a disease, that is stigmatized by itself and in by the treatment process. Referrals for the assessment??? Employer Medical board Colleagues

8. 8 How to achieve objective and proper regard of workability assessment of physicians: who deny /as most addicted persons/ their problems minimize the consequences of their SUD are stigmatized by their surroundings more for entering the treatment process than for addiction itself In some countries special committees or boards are occupied with workability of addicted physicians. There are different experiences, some even negative. The goal is not to damage someone’s reputation – but to get him or her to appropriate help. Mott JS. Dealing with the impaired supervisor. Physician Assistant, Sept 90, p. 93.

9. 9 Proposed solutions Assessment: Done by independent professionals and/or institutions Independent form medical board and employer  Physician advocacy or ombudsman Why independent? Read Physician Suicide Letters—Answered by Pamela Wible Here are private letters and last words from our doctors who could no longer bear the pain of an abusive medical system. Dr. Wible takes you behind the white coat and into the mind, heart, and soul of our doctors— and provides answers.

10. 10 Proposed solutions for physicians with mental health problems and SUD Successful help programs that include professional and independent assessment and versatility help to impaired physicians and their relatives

11. 11 What do We Physicians need Specific workability assessment – with regards of working place and special demands Assessment should be done by independent professionals/institutions Regular assistance of physician advocacy service or ombudsman should be considered

12. The goal should not be to damage doctor’s reputation, but to get him or her to appropriate help. Take home message