An emergency physician recently began working at a local community hospital. The emergency department is very busy and is part of a larger training program for emergency medicine residents. At times the physician works with residents but is not their direct supervisor. During the third week on the job, the physician meets the emergency medicine chief resident, who comes in infrequently to cover for other residents but is busy primarily with a nonclinical research project. He has an excellent reputation in the program and is near the end of his final year. At the end of the shift the physician sees the chief resident in the locker room; although the physician cannot be sure, it appears that the chief resident is snorting a substance behind his locker door. The following week the physician sees him snorting a white powder in the bathroom. The physician confronts the chief resident and asks if he is using drugs. He initially denies drug use but then says, "Please don't tell anyone about this. They'll kick me out, and I've worked so hard to get here. I'll do anything you say - stop, get help, sign up for treatment." The physician is ethically obligated to do which of the following?

Question

An emergency physician recently began working at a local community hospital.  The emergency department is very busy and is part of a larger training program for emergency medicine residents.  At times the physician works with residents but is not their direct supervisor.  During the third week on the job, the physician meets the emergency medicine chief resident, who comes in infrequently to cover for other residents but is busy primarily with a nonclinical research project.  He has an excellent reputation in the program and is near the end of his final year.  At the end of the shift the physician sees the chief resident in the locker room; although the physician cannot be sure, it appears that the chief resident is snorting a substance behind his locker door.  The following week the physician sees him snorting a white powder in the bathroom.  The physician confronts the chief resident and asks if he is using drugs.  He initially denies drug use but then says, "Please don't tell anyone about this.  They'll kick me out, and I've worked so hard to get here.  I'll do anything you say - stop, get help, sign up for treatment."  The physician is ethically obligated to do which of the following?

Quizplus · Accepted Answer

Explanation: Physicians have an ethical obligation to patients, their colleagues, and the medical profession to take action when another physician appears to be impaired due to a substance use disorder. Their first responsibility is to protect an impaired physician's patients from harm. According to the American Medical Association, "Physicians have an ethical obligation to intervene in a timely manner to ensure that impaired colleagues cease practicing and receive appropriate assistance from a physical health program, and to report impaired colleagues in keeping with ethics guidance and applicable law." Reporting is mandatory and is generally made to the state's physician health program (PHP) (which oversees the management of impaired physicians) or the state licensing board. Physicians should inform supervisors and directors of training programs. Reporting to the PHP or board will likely still be required. Physicians are also ethically obligated to intervene to stop a physician who is treating patients while impaired. Physicians are often reluctant to report impaired colleagues, fearing that they will destroy their colleagues' careers and reputations. However, not reporting continues to put patients at risk and increases the long-term adverse sequelae of substance use for the impaired physician and his or her family. It is important to note that the vast majority of physicians referred to PHPs (including those attending involuntarily) have positive outcomes. (Choice A) The significant risk of harm to the resident's patients overrides his right to privacy. (Choices B and E) It is not the role of the physician to ensure that the resident receives treatment. Coercive treatment (eg, ensuring treatment adherence under the threat of loss of medical license) and other interventions may be necessary, but these actions should be taken by the PHP or licensing board. (Choice C) This resident's ongoing substance use places patients at risk. The physician should not wait to report the issue. Educational objective: Physicians are ethically and legally obligated to report impaired colleagues to physician health programs or state licensing boards in keeping with applicable state laws. The primary ethical obligation is maintaining patient safety. References: Physician health and wellness. (http://www.ncbi.nlm.nih.gov/pubmed/16490794) Mandatory reporting of impaired medical practitioners: protecting patients, supporting practitioners. (http://www.ncbi.nlm.nih.gov/pubmed/25442757)

An Emergency Physician Recently Began Working at a Local Community