While 10% of physicians are expected to have some kind of psychiatric or substance abuse problem in their lifetime, only about 1% of physicians have problems of such severity that could potentially endanger patient care. Unfortunately, it has been well documented that anesthesiologists may be disproportionately represented in this number so the absence of the Medical Board’s Diversion Program is of concern to members of our specialty in California. Drs. Lee Snook and Tom Specht, in the Spring/Summer 2011 CSA Bulletin, have described what has happened in California since the Diversion Program closed in 2007 and the work by the California Medical Association (CMA) in forming the California Public Protection and Physician Health Inc. (CPPPH), which is still in its early stages and requires legislation. Meanwhile, our colleagues have no resource.
UC Davis Medical Center Wellbeing Committee has, for a few years now, managed a number of impaired physicians’ re-entry into the workplace. The committee has based its work on the Wellbeing Committee of UC San Diego, which had its program in place earlier. Anesthesiologists can and should take a lead on these committees, if only because we are disproportionately affected by the disease of addiction.
How can you help set such a system up at your hospital? First, get involved with the medical staff wellbeing committee. Every hospital is mandated to have one. Next, work with the chief medical officer (CMO)/chief of staff and the medical staff office to get their support for an expansion of the wellbeing committee mandate. A compelling argument is not just for benefitting the medical staff, but also for potentially improving patient safety and reducing hospital and medical staff liability. The psychiatrists and psychologists, if there are any on the medical staff, will be key to implementing such a system. Support for the committee will need to come from the medical staff office and the hospital administration. If funding is needed for either the medical staff or support staff, then with the same approach may be taken with the hospital administration as the CMO; improving the health and wellbeing of the medical staff, resulting in improved patient safety and reduced liability for the hospital.
At UC Davis, The Wellbeing Committee is made up of a broad range of members of the medical staff, including the chair who is a psychiatrist and the vice chair who is a psychologist—a skill set that is extremely important to the functioning of the committee. The committee has set itself two main goals: one is to maintain the health of the medical staff, thereby ensuring quality patient care, and the other is to monitor the health of medical staff members who have had a psychiatric or substance related problem of sufficient severity that patient care has been or could be potentially at risk.
Individual referrals come from chairs, training directors for residents, the chief medical officer (CMO) or the chief of staff. Frequently, referrals are a result of an acute behavioral incident. The initial consultation is kept confidential. However—and this is indicated up front—confidentiality may be breached either for the person’s safety or the safety of patients. Most people referred are judged not to be impaired and impose no safety risk; however, if the chair thinks the person needs hospitalization, s/he makes a referral, but participation is voluntary. If the person refuses, and there is judged to be a patient safety issue, the CMO is informed. For a psychiatric problem, if outpatient therapy is possible appropriate referrals are made for this also. Meanwhile, the individual involved is taken off clinical service.
Generally for chemical dependency, the individual will require monitoring after discharge from inpatient care. The monitoring and agreement is strict and follows that recommended by the Federation of State Medical Boards of the United States Inc. This policy has now been superseded by the April 2011 policy. Monitored physicians are known to the wellbeing committee chair and vice chair, departmental chair, departmental monitor and chief medical officer.
A full review for people with substance abuse occurs at 3 years, but it would be an exceptional person who was not monitored for 5 years at least. People with mental health issues are monitored until their psychiatrist feels they are ready to return to work full time without restrictions. When this recommendation comes, the committee chair reviews the case and makes a report to the wellbeing committee, which then decides if monitoring can be stopped.
To improve self-referrals, the committee has developed a Wellbeing website has an education outreach, and meets with faculty and residents at grand rounds, faculty meetings and other venues. The website has links to examples of self-assessments for mental illness, substance abuse and burn out.
This is but a brief outline of how the Wellbeing Committee at UC Davis functions. There will be a more detailed description in an upcoming article in the CSA Bulletin. In the interim, more extensive details may be obtained by contacting the authors:
Department of Anesthesiology and Pain Medicine
UC Davis Medical Center
PSSB Suite 1200, 42590 V Street
Sacramento, CA 95817
Our motto as physicians is “Primum Non Nocere”—first do no harm. As we strive to live that ethic for our patients, we should also help each other to achieve it by being accountable to one another. Physician wellbeing isn’t just an option, it’s a mandate!
Leinani Aiono-LeTagaloa, M.D. is a co-author of this article.