The Troubled Physician Prevention and Intervention

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

2. EAP Physician Consults1998-99 • Critical Incident Stress Debriefings • 4 MD deaths • 2 MD terminations for misconduct • Request from Legal for Consult • 2 MD employment application irregularities

3. Reasons for the Vanderbilt Physician Wellness Program • Need for a comprehensive program for VUMC physicians(650 residents and 750 faculty - 400 students) • Emerging world-wide interest in physician burnout

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

5. JCAHO Intent Statement • “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)

6. JCAHO Process Components • Education • Referral • Diagnosis/Treatment • Confidentiality • Evaluation (Verification) • Monitoring • Reporting

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

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

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

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

11. UtilizationPhysician Wellness Program

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

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

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

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

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

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