ACP issues ethical guidance on responding to physician impairment

Physicians who are impaired, or unable to carry out patient care responsibilities safely and effectively, should be rehabilitated and reintegrated into medical practice whenever possible without compromising patient safety, according to a new ACP position paper.

The paper, developed by ACP's Ethics, Professionalism and Human Rights Committee and published on June 4 by Annals of Internal Medicine, examines the professional duties and principles that should guide the response of colleagues and the profession to physician impairment. Impairment can have many causes, such as substance use disorders, mental illness, profound fatigue, or a decline in cognitive or motor skills due to age or disease, according to the paper.

The following statements summarize ACP's positions on the issue:

1. 1. The professional duties of competence and self-regulation require physicians to recognize and address physician illness and impairment.
2. 2. The distinction between functional impairment and potentially impairing illness should guide identification of and assistance for the impaired physician.
3. 3. Best practices for physician health programs should be developed systematically, informed by available evidence and further research.
4. 4. Physician health programs should meet the goals of physician rehabilitation and reintegration in the context of established standards of ethics and with safeguards for both patient safety and physician rights.
5. 5. Maintenance of physician wellness with the goal of well-being must be a professional priority of the health care community promoted among colleagues and learners.

ACP's principles may help guide all parties involved in addressing physician impairment, but challenges remain, such as stigma (both internal and external) and potential consequences to colleagues or supervisors who identify impairment, an accompanying editorial said. Still, impaired physicians cannot be expected to heal themselves alone, the editorialists said.

“The guidelines recognize that developing well-trained physicians requires an enormous investment and that the community benefits when, instead of being asked to heal themselves during periods of impairment, these talented professionals are supported and treated as needed,” they wrote.