Taking Aim at Physician Impairment

Taking Aim at Physician Impairment

When a critical event occurs in professions other than medicine, detailed investigations are conducted to examine systematic and individual factors that caused or contributed to the event. While these policies are the norm in many high-risk industries, they are not in place for medicine. Mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine, but research shows that alcohol, narcotic, and sedative addiction is as common among physicians as the general population. Furthermore, about one-third of all hospital admissions experience a medical error, meaning it’s possible that physician impairment can contribute to patient harm. Learning From Other High-Risk Industries To improve patient safety, medical institutions should take a cue from other high-risk industries and put policies in place that mandate employee testing for drug or alcohol impairment immediately after an unexpected or significant event occurs. Hospitals can take steps to address this overlooked patient safety issue. One such step is to have physicians participate in mandatory physical exams, drug testing, or both before medical staff appointments to a hospital can be made. This already occurs in some hospitals and has been successful in other industries. Hospitals should also consider random alcohol-drug testing and a policy of routine drug-alcohol testing for all physicians involved with a sentinel event leading to patient death.   An important component to addressing physician impairment is the establishment of testing standards by a national hospital regulatory or accrediting body. Medicine is under-regulated when compared with other industries. Hospitals can take the lead by capitalizing on their infrastructure to conduct adverse event analyses and drug testing and by governing...

Examining Standards of Care in Disasters

Following the terrorist attacks of September 11, 2001 in the United States, experts began to re-examine current approaches to providing care during disasters. A definitive standard of care for disaster victims has yet to emerge. One popular approach that has been proposed is to create “crisis” or “altered” care standards. These are meant to reduce the legal standard or duties of care for medical responders. In the  Annals of Emergency Medicine, George J. Annas, JD, MPH, and I published an article that attempted to explain why altering the standard of care for disaster situations is both unnecessary and dangerous. Reason & Prudence During Disaster Considering that resources are limited during disasters, patients must be managed as a population rather than as individuals to maximize outcomes for that particular group of people. To determine the best approach, it’s critical that specific metrics or standards of care are used to assess the actions of physicians. Efforts must be made to ensure that these standards of care remain the same in disasters as they would for normal situations. While the circumstances may change based on the event, the metric or standard should remain the same: to perform the same actions that reasonable and prudent physicians would do in similar situations. During disasters, physicians could and should ration care and allocate resources to patients who stand to benefit most. The ultimate goal is to maximize survival. By using the reasonable and prudent metric, disaster victims will receive the same standard of care as any other person. Squelching Fears of Liability The fear of liability is a real concern in establishing a standard of...