1. 0 So Little Patients So Little Time Competence & Impairment in Clinical Practice

2. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Disclosure  The speaker has no financial interest in the subject matter of this presentation and is not representing the Ethics Committee of the American Academy of Ophthalmology with this presentation.  For questions about the material contained herein or about the Academy’s ethics program in general, please contact the ethics program manager, Mara Pearse Burke at ethics@aao.org.ethics@aao.org

3. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  Is not fully competent by reason of: Mental impairment Physical impairment Emotional impairments  Often fails to recognize the impairment  If recognized, a physician may deny the significance of the impairment lack insight re consequences

4. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Case 1 Physician Profile  Dr. Hightower is 47 years old  A busy anterior segment surgeon  Owns a suburban practice  Takes pride in being on the faculty of a major urban medical school

5. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Appears Remarkably Dedicated  Takes on as many new referrals as possible  Increases clinical productivity  Extends his workday to begin at 5:00 am  Finishes EMR charts after midnight

6. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Things Get Out of Control  Dr. Hightower appears driven by time considerations  He is increasingly late for meetings and appointments  His chart notes and orders are more often incomplete and illegible  Begins taking Ritalin to continue working longer days while sleeping less  Begins taking barbiturates to induce sleep

7. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impairment Affects Patients  Hospital staff express concern about a series of “ near miss ” avoidances of surgical complications.  Dr. Hightower performs a corneal transplant in the wrong eye.

8. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Applicable Principles and Rules of the Code  Principles of the Code: 1: Serving the best interests of the patient 6: Corrective action  Rules of The Code 1: Competence 5: The Impaired Ophthalmologist

9. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY What Do You Think?  Are Dr. Hightower’s actions concerning?  What actions are required by you and your colleagues?  What is the best way to proceed in assisting your impaired colleague?  If the response of Dr. Hightower is denial what are your responsibilities?

10. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Rule 5. The Impaired Ophthalmologist The Impaired Ophthalmologist. A physically, mentally or emotionally impaired ophthalmologist should withdraw from those aspects of practice affected by the impairment. If an impaired ophthalmologist does not cease inappropriate behavior, it is the duty of other ophthalmologists who know of the impairment to take action to attempt to assure correction of the situation. This may involve a wide range of remedial actions.

11. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Discussion  Importance for patients: Physician impairment  diminished safety  Importance for the profession: Loss of public trust  Remediation Colleagues are the most likely to be effective Community resources Removal from practice if necessary (temporary/permanent)

12. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Physician Impairment Resources  Alcoholics Anonymous www.alcoholics-anonymous.org  American Society of Addiction Medication, Inc. www.asam.org  American California Diversion Program for Impaired Physicians www.physicianassistant.ca.gov/diversion.htm  Talbott Recovery Center www.talbottcampus.com  American College of Surgeons www.facs.org