The challenges in dealing effectively with this issue are compounded by multiple factors. These include an overall national shortage of physicians, particularly in rural communities, as well as being more prevalent in some specialties than others.
In addition, if an impaired physician has been a long-standing member and past leader of the medical staff, is responsible for a significant number of hospital admissions, has consistently participated in the institution’s annual fundraising campaigns, and is a friend of several trustees, the situation is predictably even more daunting. If such a physician is highly respected by his or her patients and close to retirement, it would not be surprising that people in authority were to rationalize their procrastination.
Nonetheless, inaction is indefensible. Citizens in the hospital’s service area properly and reasonably rely on the hospital to ensure that only highly qualified and competent physicians are on its medical staff. Furthermore, fear of potential litigation against the organization must not be the principal incentive to protect patients from an impaired provider.
Admittedly, dementia and other forms of cognitive impairment are rarely immediately apparent, primarily because their onset is gradual. Consequently, the difficulty of dealing properly and effectively with this concern cannot be overemphasized.
Hospitalist Lizbeth Hingst authored a poignant February 25, 2021 blog titled “Let us not forget the caregivers” for KevinMD.com. She quotes G.W. Carter who once wrote, “How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving and tolerant of the weak and strong. Because someday in your life, you will have been all of these.” Keeping these sentiments in mind should help us determine how to deal sensitively with impaired physicians.
Recommendations
The first step should be the appointment of a physician task force to advise on steps essential for best contending with this complex and multifaceted issue. Membership may not be accepted with enthusiasm, so the importance of having the right composition will be crucial to accomplishing its mission.
Consider a process to solicit from nurses the names of those physicians about whom they are concerned. Given such an inquiry must be conducted with exceptional tact, nursing leadership should be consulted to determine how this evaluation could be most appropriately pursued.
It is essential that the hospital’s governing body be informed of the initiative. Members may have ideas regarding how the program might be improved. The medical staff leadership, senior hospital management, and hospital board should receive periodic reports on the project’s progress and recommendations. Plans should be prepared for the most diplomatic way to inform physicians that the organization has determined they should not reapply for reappointment to the medical staff.
Concluding observations
As noted earlier, there will be no enthusiasm to embark on this effort if it hasn’t been done previously. Because the identified physicians are usually long-term medical staff members who have made significant contributions in a variety of ways to the hospital and patient care, they deserve to be properly honored. It is quite possible the hospital has no impaired physicians, but having even one requires timely action and is still essential.
Paul B. Hofmann is a health care consultant.
