House officer responses to impaired physicians

Area of Science:

• Medical Education
• Physician Well-being
• Professional Ethics

Background:

• Physician impairment poses significant risks to patient safety and the medical profession.
• A common perception is that physicians often avoid addressing the impairment of their colleagues.

Purpose of the Study:

• To investigate how internal medicine house officers respond to scenarios involving impaired or incompetent physicians.
• To compare responses based on the role (house officer vs. attending physician) and type of impairment (alcohol, incompetence, depression).

Main Methods:

• Five case scenarios were administered to 76 internal medicine house officers at a large, urban teaching hospital.
• Data collected on house officers' initial responses to different physician impairment situations.

Main Results:

• House officers were more likely to directly confront an alcohol-impaired house officer (96%) than an alcohol-impaired attending physician (72% reported telling the chief resident).
• Incompetence led to reporting to the chief resident for both attending physicians (67%) and house officers (49%), with less direct confrontation of incompetent house officers (25%).
• A majority (71%) would directly confront a depressed house officer.

Conclusions:

• House officers' responses to physician impairment vary significantly based on the colleague's role and the nature of the impairment.
• Direct confrontation is more common for house officers with alcohol-impaired or depressed colleagues, while reporting to a superior is preferred for incompetence and attending physician impairment.