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The Troubled Physician Prevention and Intervention

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  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)

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

  15. 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

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

  17. 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)