In a position paper published in the Annals of Internal Medicine, the American College of Physicians (ACP) defines physician impairment as “the inability to carry out patient care responsibilities safely and effectively” and further calls it a “problem of functioning” that does not necessarily go hand in hand with a potentially impairing illness or condition. The paper lists 5 position statements that discuss professional competence and self-regulation, physician health programs (PHPs), distinguishing between functional impairments and illness with the potential to impair, and physician wellness and well-being. The paper then spells out a rationale for each and makes suggestions for implementation, with a focus on rehabilitating and reintegrating the physician back into practice whenever possible and to do so without compromising the safety of patients.
The positions delineated are as follows:
Position 1: Physicians are required to recognize and address illness and impairment as part of the professional duties of self-regulation and competence.
Position 2: Identifying and assisting the impaired physician should be guided by the distinction between functional impairment and illness with the potential to impair.
Position 3: PHP best practices should be systematically developed and informed by available evidence and further research.
Position 4: PHPs should rehabilitate and reintegrate physicians within the context of ethical standards while safeguarding both physician rights and patient safety.
Position 5: The professional priority of maintaining physician wellness and well-being should be promoted among learners and colleagues in the healthcare community.
The ACP concluded that impaired physicians must seek treatment when unable to provide safe care for patients, and both the self-regulation of physicians regarding their own condition and the assistance of colleagues who refer impaired individuals and help to care for their patients are aspects of “[the] privilege of medical practice [which] is predicated on the physician’s and the profession’s commitment to providing safe, competent, and ethical patient care.”
Candilis PJ, Kim DT, Sulmasy LS; ACP Ethics, Professionalism and Human Rights Committee. Physician impairment and rehabilitation: reintegration into medical practice while ensuring patient safety: a position paper from the American College of Physicians [published online June 3, 2019]. Ann Intern Med. doi: 10.7326/M18-3605