Physicians experience all the usual illnesses and disabilities. Some have problems with substance use, others with cognition or depression. But not every illness leads to impairment, and even some physicians who are impaired can be accommodated and continue to practice safely, according to an AMA Council on Ethical and Judicial Affairs report adopted at the June 2021 AMA Special Meeting.
“Providing safe, high-quality care is fundamental to physicians’ fiduciary obligation to promote patient welfare,” the report says. “Yet a variety of physical and mental health conditions—including physical disability, medical illness and substance use—can undermine physicians’ ability to fulfill that obligation. These conditions, in turn, can put patients at risk, compromise physicians’ relationships with patients” as well as colleagues, and can “undermine public trust in the profession.”
While some conditions might make it impossible for a physician to provide care safely, appropriate accommodations or treatments can enable many physicians to continue practicing responsibly once their needs have been met.
“In carrying out their responsibilities to colleagues, patients and the public, physicians should strive to employ a process that distinguishes conditions that are permanently incompatible with the safe practice of medicine from those that are not and respond accordingly,” the council’s report says.
The AMA House of Delegates adopted the report’s recommendations, which update advice previously published in the AMA Code of Medical Ethics as opinion 9.3.2, “Physician Responsibilities to Impaired Colleagues.”
According to the updated ethical opinion, physicians should:
- Maintain their own physical and mental health, strive for self-awareness, and promote recognition of—and resources to address—conditions that may cause impairment.
- Seek assistance as needed when continuing to practice is unsafe for patients, in keeping with ethics guidance on physician health and competence.
- Intervene with respect and compassion when a colleague is not able to practice safely. Such intervention should strive to ensure that the colleague is no longer endangering patients and that the individual receive appropriate evaluation and care to treat any impairing conditions.
- Protect the interests of patients by promoting appropriate interventions when a colleague continues to provide unsafe care despite efforts to dissuade them from practice.
- Seek assistance when intervening, in keeping with institutional policies, regulatory requirements or applicable law.
Also, as a group, physicians should nurture a respectful, supportive professional culture by:
- Encouraging the development of practice environments that promote collegial mutual support in the interest of patient safety.
- Encouraging development of inclusive training standards that enable individuals with disabilities to enter the profession and have safe, successful careers.
- Eliminating stigma within the profession regarding illness and disability.
- Advocating supportive services and accommodations to enable physicians who require assistance to provide safe, effective care.
- Advocating respectful and supportive, evidence-based peer-review policies and practices that will ensure patient safety and practice competency.