So Little Patients So Little Time 0 Competence

So Little Patients So Little Time 0 Competence & Impairment in Clinical Practice

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. AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

The Impaired Physician § Is not fully competent by reason of: • Mental impairment • Physical impairment • Emotional impairments § Often fails to recognize the impairment § If recognized, a physician may • deny the significance of the impairment • lack insight re consequences AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

Case 1 Physician Profile § § Dr. Hightower is 47 years old A busy anterior segment surgeon Owns a suburban practice Takes pride in being on the faculty of a major urban medical school AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

Appears Remarkably Dedicated § Takes on as many new referrals as possible § Increases clinical productivity § Extends his workday to begin at 5: 00 am § Finishes EMR charts after midnight AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

Things Get Out of Control § Dr. Hightower appears driven by time considerations § He is increasingly late for meetings and appointments § His chart notes and orders are more often incomplete and illegible § Begins taking Ritalin to continue working longer days while sleeping less § Begins taking barbiturates to induce sleep AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

The Impairment Affects Patients § Hospital staff express concern about a series of “near miss” avoidances of surgical complications. § Dr. Hightower performs a corneal transplant in the wrong eye. AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

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 AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

What Do You Think? § Are Dr. Hightower’s actions concerning? § What actions are required by you and your colleagues? § What is the best way to proceed in assisting your impaired colleague? § If the response of Dr. Hightower is denial what are your responsibilities? AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

Rule 5. 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. AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

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) AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG

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 AMERICAN ACADEMY OF OPHTHALMOLOGY WWW. AAO. ORG