The evaluation of the impaired physician

Recent focus on impaired physicians has made it likely that psychiatrists and other mental health professionals will increasingly be involved in evaluating these individuals. In order to perform the job effectively, evaluators must familiarize themselves with a number of clinical and legal issues inherent in the evaluations. Preevaluation issues include receipt of sufficient information from the referral source, limits of confidentiality, and any potential conflict of interests between the evaluator and the physician to be evaluated. The clinical evaluation requires knowledge of the characteristics of physician substance abuse, of emotional disturbances including suicidality, of the emotional impact of litigation, and of the underlying causes of such unethical conduct as inappropriate prescribing of controlled substances and sexual contact with patients. Recommendations should be based on knowledge of available support systems, monitoring capacity, and options to restrict the physician's practice. Follow-up is essential for rehabilitation to be effective. Our obligations to our patients require our informed involvement with the problem of impaired physicians and with its solution.