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

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

3. 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%

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

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

6. WELL-BEING COMMITTEE: An Underutilized Resource

7. 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

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

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

10. Well-Being Committee
Bylaws
Minutes
Reporting to MEC

11. Footer Text

12. 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.

13. Disruptive Practitioners

14. Defining Disruptive Behavior
AMA H 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.”

15. 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

16. 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

17. 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

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

20. Disclosing Hospitalization to Another Hospital
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21. 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.
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22. Case Studies

23. 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?

24. 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?
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25. 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.
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26. What Could Possibly Go Wrong?

27. Questions And Discussion