Physician’s Health Message
Duty to Report: A Loaded Question with No Easy Answer
By Michael Baron, MD, MPH, TMF Medical Director
February 5, 2020
A funny thing happened on the way to work one recent day. I received a call from an old friend, a clinical pharmacist who has worked at an inpatient psychiatric facility for many years. After the catching-up part of the conversation, she asked me about an admitting doctor’s reporting responsibility when discharging a healthcare professional from the inpatient unit. My initial response was, “That’s a loaded question with no easy answer.”
As it happens, I’m asked this question at least monthly. My usual answer is, it depends. There are many variables that determine the answer. I will attempt to explain, and provide some real-life examples to illustrate those variables.
Generally, management of a colleague’s healthcare is between the physician and the patient, just like with any other case. The treating physician should not disclose any aspect of the medical care without appropriate consent from their patient, with one exception – that being if the colleague is impaired by their physical, mental, or substance use disorder.
Impairment is very different from illness and it is important to understand those differences. Illness, per se, does not constitute impairment. The short definition of impairment is the inability of a physician to practice medicine with reasonable skill and safety as result of an illness.
The Federation of State Medical Boards’ Policy on Physician Impairment officially defines impairment as a functional classification which exists dynamically on a continuum of severity and can change over time rather than being a static phenomenon.* When functional impairment exists, it is often the result of an illness in need of treatment. With appropriate treatment, the issue of potential impairment may be resolved while the diagnosis of an illness may remain.
Note that not all impairment ends with treatment. The most glaring example is the physician who has developed dementia. Treatment generally does not reverse the cognitive decline that is causing the impairment.
The treating physician is well positioned to detect if their colleague patient is impaired by an illness. Although that statement is easily understood it is not easily done. The last thing a physician wants to do is tell a colleague they are impaired and should not practice medicine. No doctor wants to say it, and no doctor wants to hear it. Since most physicians are conflict-avoidant, physician patients are seldom told they must stay out of the office until the illness resolves.
The ability to detect impairment is much easier for a medical illness than for a behavioral disorder. But the rule for both is generally the same: physicians are permitted to be ill; they are not permitted to work while impaired.
When a physician gets the flu with symptoms like fever, myalgias, cough, etc., they are expected to stay home because they are infectious and impaired by the febrile illness. When the fever remits, their cognitive ability returns, they are no longer infectious, and the physician can go back to work. Influenza is a clear example.
Addiction and/or behavioral illness don’t have the same level of clarity.
Let’s look at a few real-life cases that involve alcohol use and a mood disorder. In each case the patient is a licensed physician. Changes were made in the stories to protect the confidentiality of the physicians involved. In each scenario, pertinent statutes or AMA ethics opinions will be identified.