The Troubled Physician Prevention and Intervention Anderson Spickard, Jr., M.D. Director Center for Professional Health at Vanderbilt December 20, 2002

EAP Physician Consults l Critical Incident Stress Debriefings »4 MD deaths »2 MD terminations for misconduct l Request from Legal for Consult »2 MD employment application irregularities

Reasons for the Vanderbilt Physician Wellness Program l Need for a comprehensive program for VUMC physicians(650 residents and 750 faculty students) l Emerging world-wide interest in physician burnout

Physician Wellness Development Plan l Approved by the Medical Center Medical Board July 15, 1999 l Director, staff and space assigned l Program directed at prevention, early identification, treatment and relapse prevention after reentry to work

JCAHO Intent Statement l “The medical staff implements a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function” - JCAHO, Medical Staff Standards (MS.2.6)

JCAHO Process Components l Education l Referral l Diagnosis/Treatment l Confidentiality l Evaluation (Verification) l Monitoring l Reporting

ACGME Requirements for Resident Support l Provide confidential counseling services l Medical and psychological support l Written policies about impairment including substance abuse

Organization of the Physician Wellness Committee l 17 members of the faculty representing many of the clinical departments l Section of Physician Wellness created in the EAP l Intense marketing of the program to house staff and faculty through grand rounds, brochures and

Program for Physician Wellness l All assessments free to faculty and residents l Physicians self referred or sent by supervisor for assistance in the EAP

Results of the Program l Physicians with relationship problems, addiction issues, disruptive behavior now recognized early and sent to EAP for assessment l Referrals have tripled in two years and are increasing l A culture of wellness in the medical center is improving

Utilization Physician Wellness Program

Institutional Barriers to Program Implementation l Medical Center leaders not committed l Recovering people not used to help l Lack of funding for implementation l Medical leaders don’t confront physicians with A/D issues, disruptive behavior,etc. Need code of conduct l Resources for referral are limited

Impairments In Physicians l Alcohol and drug dependence l Psychiatric disorders (bipolar, depression,schizophrenia, anxiety disorders) l Personality disorders l Sexual boundary violations and sexual harassment l Disruptive behavior (uncontrolled anger)

Resident Impairment l Depression l Alcohol and drugs (self medication) l Marital problems l Fatigue l Psychiatric Illness other than depression including OCD, etc.

Risk Factors of Those Who Abuse Alcohol and Drugs l Stress l Access to drugs; relax with alcohol l Self medicate l Family history of A/D addiction l Lack of a support group

Barriers to Diagnosis of Physician Impairment l Denial l Rationalization l Myth of invulnerability l Social acceptability of alcohol and drug use. l Colleagues ignore behavioral problems

Vanderbilt Resident Wellness Support Network l Retreat for Anesthesia Department l Marriage retreat for residents with Michael Myers l Fallibility rounds l Women physicians support group l International physicians health assessment l Balancing resident professional and private life seminars l Personal Wellness Profiles (stress, weight, cholesterol)