The troubled orthopedic surgeon: A community’s responsibility
Douglas W. Jackson
We all share similar trials, tribulations and responsibilities as orthopedic surgeons. Most of us find these challenges stimulating and, if handled successfully, they can result in great personal satisfaction. As I have traveled around the country and met many colleagues, I have found the vast majority of orthopedic surgeons are productive, energetic and thriving individuals who find their careers worthwhile and satisfying and are committed to their patients and improving the care they deliver.
However, we all have seen or known surgeons who may have lost their productivity and professionalism to the tolls of life. In a 2001 article published in American Journal of Medical Science, Boisaubin and Levine wrote, “an impaired physician is one unable to fulfill professional or personal responsibilities because of psychiatric illness, alcoholism, or drug dependency. Current estimates are that approximately 15% of physicians will be impaired at some point in their careers.”
In a 2006 article in Annals Internal Medicine, Leape and Fromson noted that physician performance problems are usually thought of as symptoms of an underlying disorder. They estimated that at least 10% of physicians will demonstrate deficiencies in their knowledge and skills at some point in their careers. A physician’s personality, training and the demands of his or her lifestyle may enhance susceptibility, but all professions have chemical abuse and mental illness among their members.
Seeing the signs
There is no one or even a few signs that will reveal to us that a colleague is impaired. It is a pattern of behavior that should raise suspicion. This pattern, if allowed to persist, usually involves an accumulative series of bad decisions that can be devastating to the orthopedic surgeon and eventually his or her patients.
Those who fall from grace the hardest usually have the involvement of chemicals, bad financial decisions and/or compromises, and pathologic personal relationships. One of these problems is difficult to overcome and one often leads to another. These problems can start and manifest themselves in a long list of signs including: being hard to locate; neglect of duties; extensive absenteeism; failure to remain current on medical knowledge; failure to keep adequate medical records; anger management situations involving coworkers and patients; crossing professional boundaries with patients; a decline in cognitive and motor skills; and manifestations of obvious mental illness. We all may display some of these traits at times, but for the impaired physician it is a pattern that emerges and takes control.
Recognize and acknowledge
Denial is a major part of the impairment that must be overcome. The colleague, his associates and family will often be in denial. We all know a colleague or two that we would not want to treat our family and who may have standards below those desired in our community.
Even though it is a small percentage of physicians who are troubled and may present a threat to safe patient care at one time or another during their careers, we have obligations and responsibilities to recognize and acknowledge who they are. These individuals often become quite adept at hiding their deficiencies and operating below the radar screen.
It is our responsibility as professionals and members of the orthopedic community to get involved whenever we identify substandard practice patterns and bring to light any unprofessional behavior and/or patient care problems. This is unpleasant for any of us to do: we all are hesitant to throw stones. We all have had bad results and/or complications, but when they cluster and a repeated pattern emerges, we need to step up to our professional duty.
Fortunately, times have changed. I remember when I first entered practice I had a referral source who would not remember calling me the night before. He would miss seeing his patients in the hospital for consecutive days, his medical records were usually in disarray and his follow-up on medical problems was poor. I went to the chief of staff and said I thought this physician’s privileges should be reviewed and how was that best done. As I was very young and just starting, I clearly remember the older surgeon telling me that I was new in town and to keep a low profile before raising such issues. He subsequently told the surgeon of the concerns I had raised and the physician confronted me. He said I needed his referrals and he did not need me or my opinions. In the heat of our exchange, I said I did not need his referrals if it meant substandard care and he needed help. He did not send me another patient and, to my knowledge, did not get help, but eventually left his practice on medical disability.
Today, we have an accepted ethical and institutional responsibility to report “good faith” suspicions of an impaired physician. There are established methods in place to process these suspicions confidentially to the “extent allowed by the law.” If the individual chooses to fight, it threatens their livelihood and often results in legal action.
When I was chairman of an orthopedic staff, I learned firsthand it could take a minimum of 50 hours of committee meetings, hearings, appeals and paperwork to restrict a physician’s ability to practice at our institution if that surgeon refused to enter a voluntary program. The thing that frustrated me is when I went back into the troubled physician’s past, there would often be a trail from his or her medical school to residency and/or fellowships.
No one likes to get involved in the unpleasantness and legal aspects of restricting a physician’s career or privileges. Most often, we are dependent on the state boards to restrict physician privileges as the result of more flagrant problems and behavior — like repeated DUIs, drug and prescription abuse, sexual impropriety, physical abuse, and arrests for various reasons. Our communities and professional organizations will then be able to easily restrict the impaired physician’s privileges. We have been weak in the past in policing ourselves, but it has gotten better.
On the positive side, let me restate that I am always impressed by the quality of orthopedic surgeons whom I meet at courses and am inspired by them to be a better physician and work harder. Most of the colleagues I have known well during my years in orthopedic surgery are thriving in their personal lives, keeping up intellectually and really focused on caring for their patients. However, we must always be vigilant and remember part of our professionalism is helping troubled and impaired colleagues and at the same time protecting patient care.
The good news is the success rate for rehabilitating many trouble colleagues has been quite impressive and I applaud those physicians who truly help others in our field. Similarly, my hat goes off to our colleagues who overcome their impairments and return to be productive and respected individuals in our profession and are able to resume a meaningful life.
See related article.
- Boisaubin EV, Levine RE. Identifying and assisting the impaired physician. Am J Med Sci. 2001;322(1):31-36.
- Leape LL, Fromson JA. Problem Doctors: Is There a System-Level Solution? Ann Int Med. 2006;144(2):107-115.
- Douglas W. Jackson, MD, is Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; e-mail: OT@slackinc.com.