Physician Impairment

Identification of Physician Impairment FREEONLINE FIRST

Julius Cuong Pham, MD, PhD; Peter J. Pronovost, MD, PhD; Gregory E. Skipper, MD

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JAMA. 2013;():1-2. doi:10.1001/jama.2013.4635.

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Published online April 29, 2013

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When a critical event occurs in most high-risk industries (such as airlines, nuclear power, or railways), a detailed investigation examines a variety of system and individual factors (such as fatigue and substance abuse), that caused or contributed to the event. Directly involved individuals are commonly tested for alcohol and other drugs. Airplane pilots and truck drivers are tested following crashes and near misses.¹ Some law enforcement officers are tested following fatal shooting incidents.

Mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine. Yet alcohol, narcotic, and sedative addiction is as common among physicians as the general population,² and physicians are as susceptible to the effects of prescription and nonprescription drugs and alcohol as any other person. According to a 2006 article, “at least one-third of all physicians will experience, at some time in their career, a period during which they have a condition that impairs their ability to practice medicine safely.”³ Coupled with the estimate that one-third of all hospital admissions experience a medical error,⁴ physician impairment seems to be a possible contributor to patient harm./.../