1. 0 Ethics Lecture The Impaired Physician

2. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Disclosure  The speaker has no financial interest in the subject matter of this presentation and is not representing the Ethics Committee of the American Academy of Ophthalmology with this presentation.  For questions about the material contained herein or about the Academy’s ethics program in general, please contact the ethics program manager, Mara Pearse Burke at ethics@aao.org.ethics@aao.org

3. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Why is this Topic Important?  Obligation to act n the best interests of patients.  Legal ramifications.  Integrity of the Profession

4. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  Is not fully competent by reason of: Mental impairment Physical impairment Emotional impairments  Interferes with ability to engage in safe professional medical activity  Often fails to recognize the impairment

5. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  Estimated 15% of physicians become impaired during career  Alcohol and opioids most commonly abused  Higher rate of prescription drug abuse  Impaired clinical performance is a late sign

6. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  If recognized, a physician may Deny the significance of the impairment Lack insight about professional consequences Attempt self-treatment Deny due to shame

7. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  Early symptoms Issues with primary relationships Isolation from friends and colleagues  Progressive signs Depression Irritability Mood swings Inappropriate degree of response

8. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  Most physician agree on reporting condition  Most physicians feel someone else will report  Helping professional colleague is initial concern  Protecting the public is paramount

9. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  Your responsibility Gathering facts about behavior Convince the physician of the importance of the situation  Intervention Not done alone. Engage an expert. Present facts to avoid denial by physician

10. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY The Impaired Physician  Level of reporting  Self-reporting  Hospital boards  Medical licensing board Can be most punitive  Treatment  Physician Health Program (PHP)

11. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Applicable Principles and Rules of the Code  Principles of the Code: 1: Serving the best interests of the patient 6: Corrective action  Rules of The Code 1: Competence 5: The Impaired Ophthalmologist

12. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Rule 1. Competence Competence. An ophthalmologist is a physician who is educated and trained to provide medical and surgical care of the eyes and related structures. An ophthalmologist should perform only those procedures in which the ophthalmologist is competent by virtue of specific training or experience or is assisted by one who is. An ophthalmologist must not misrepresent credentials, training, experience, ability or results.

13. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Rule 5. The Impaired Ophthalmologist The Impaired Ophthalmologist. A physically, mentally or emotionally impaired ophthalmologist should withdraw from those aspects of practice affected by the impairment. If an impaired ophthalmologist does not cease inappropriate behavior, it is the duty of other ophthalmologists who know of the impairment to take action to attempt to assure correction of the situation. This may involve a wide range of remedial actions.

14. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Discussion  Importance for patients Physician impairment  diminished safety  Importance for the profession Loss of public trust  Remediation Colleagues are the most likely to be effective Community resources Removal from practice if necessary (temporary/permanent)

15. WWW.AAO.ORGAMERICAN ACADEMY OF OPHTHALMOLOGY Physician Impairment Resources  Alcoholics Anonymous www.alcoholics-anonymous.org  American Society of Addiction Medication, Inc. www.asam.org  American California Diversion Program for Impaired Physicians www.physicianassistant.ca.gov/diversion.htm  Talbott Recovery Center www.talbottcampus.com  American College of Surgeons www.facs.org