A physician returns to the office after attending a celebratory lunch for a colleague who is retiring at the end of the month. She notices a physician colleague in her medical practice trip on a doorway exiting a patient room. When she inquires if her colleague is okay, he responds that he is fine, but she notices that he appears tired and smells of alcohol. She has never noticed this behavior before in her colleague, who is normally considered one of the more competent physicians in the practice and who recently received an award for receiving the highest patient satisfaction scores out of the 75 physicians in the practice. The colleague in question has 3 more patients on his schedule, and the clinic will be open for another 3 hours. The nurse practitioner with whom the colleague works is also at the practice, and he has 7 more patients remaining to be seen.
Which of the following is the most appropriate action for the physician to take regarding her colleague?
D) Report the physician to the clinic administrator and reschedule the patients with another provider.
In the case of an impaired physician, the first rule is to remove the physician from patient care to protect the patients and the physician from any situation that could cause harm to the patients, as well as the potential for malpractice on the part of the physician. It is a physician’s obligation to report physicians who are impaired to the state medical board, but the first duty is to keep patients from being harmed.
Answer choice A: Allow the physician to see the remainder of his patients and bring it up at the next physician staff meeting, is incorrect. In this case, the physician cannot be allowed to continue seeing patients, as it could cause harm to the patients. After the physician is removed from patient care for the day, the physician should follow the medical group’s policies and procedures for reporting this issue within the group.
Answer choice B: Ask the practice administrator to reschedule the physician’s patients for another day, is incorrect. While this keeps the impaired physician from seeing and potentially harming patients, the patients should be seen by another provider whenever possible.
Answer choice C: Confront the physician and ask him to leave the clinic for the remainder of the day, is incorrect. While this may solve the problem of the physician being able to see patients, the physician who witnessed the other physician’s behavior may not be the best person to confront. It often is a person with more authority or in a supervisory position who has been trained specifically in these kinds of situations such as the hospital chief of staff, the medical director of the practice, a physician health committee, or other person or group with the authority to remove a physician from seeing patients. While it is important to be able to speak to our colleagues about such incidents, patient safety is a priority.
Answer choice E: Report the colleague to the state medical board, is incorrect. While impaired physicians should be reported to the appropriate state medical board, the priority is to remove the impaired physician from patient care first. The medical group’s policies and procedures often specify who will do the reporting to the state medical board.
Key Learning Point
An Impaired physicians should be removed from patient care in order to protect the patients as well as the physician. An impaired physician should also be reported to the state medical board.
