It was late, around midnight when the internist stumbled into the emergency department, the one I had spoken with less than an hour earlier concerning a patient who had to be admitted to the hospital. He sounded okay over the telephone, perhaps a little sleepy, something I felt was probably due to the late night call.
I was a third year family practice resident moonlighting in ED’s for extra income and for the experience. That night, for the first time in my practice career, I saw with crystal clarity the reality of impairment in the workplace involving a colleague.
He was stumbling, weaving and slurring his words. His eyes were glassy and bloodshot. He smelled of alcohol as he shuffled past me on his way to examine the patient I had called him to admit. More about him in a moment.
There was a second reality I discovered that evening, one of workplace complacency with such issues. I asked a nearby nurse if she had seen what I described. She chuckled and said, “Oh, he comes in like that all of the time.” Not only are there impaired individuals within any system, sometimes the systems are sick too.
Impairment in the workplace due to drugs or alcohol is not always as readily apparent, as it was with the internist. Signs will often be hidden, obscured or explained away until the latter stages of an addiction. Too often, people wait for overt signs of impairment or until there is a crisis which can no longer be ignored.
There are tale-tale signs which can indicate an impairment issue in the workplace, signs which should never be ignored or explained away without further scrutiny or inquiry. Familiarize yourself with these 23 common signs and symptoms of healthcare provider impairment.
- A decrease in performance.
- Mood swings, depression/euphoria/anxiety.
- Heavy drinking at social events.
- Excessive sweating or flushed face (plethora).
- Markedly dilated pupils.
- Frequent absences.
- Difficult to access or becomes inaccessible.
- A tendency toward social isolation.
- Sexual promiscuity.
- Frequent illnesses or injuries.
- Spending more time a work or working odd hours.
- Unusual prescribing habits.
- Diversion of prescribed drugs back to the provider.
- Multiple DWI’s.
- Domestic distress/marital discord/frequent affairs.
- Smell of alcohol or stale alcohol while in the workplace.
- Problems with law enforcement.
- Frequent legal issues.
- Patient complaints.
- Slurred speech.
- Stumbling/gait difficulty.
- Isolation behind closed doors in the office.
This is not an all inclusive list of signs and symptoms but these are the ones which are encountered most frequently. Sure, just because someone may be showing one or more of theses symptoms doesn’t automatically mean they are impaired, either.
If you do see these symptoms and your gut is telling you something isn’t right, it is better to ask or act than to sit idly by and watch someone self-destruct. Remember, for those of us who provide care, our first charge is to do no harm to patients. This also means not allowing any harm to come to patients if we suspect they may be at risk.
In fact, most state medical boards require by law that healthcare providers report a colleague if impairment in the workplace is suspected. Surprisingly, in one study a third of physicians surveyed said they would not report an impaired colleague and cited various inadequate excuses why they wouldn’t do so. Reassuringly, two-thirds said they would report.
Recognizing and reporting workplace impairment requires a certain vigilance. It is the nature of addiction to keep things hidden which only provides opportunities for mishap.
The question most people ask is, “What do I do if I suspect impairment in a healthcare provider or colleague? Most states now have a fully functioning Physician Health Program (PHP). PHP’s function to assist impaired providers with getting sober and achieving a state of wellness, not to punish them. They intervene to help salvage provider’s lives and careers.
Healthcare providers are people too. They deserve the same compassion, empathy and assistance we give to our patient’s. Sooner or later, we all become patients.
In most instances, if you suspect or become aware of impairment you can refer a colleague to a PHP anonymously. You can check with your state Medical Board or Medical Society.
Once in recovery, physicians and other healthcare providers can return to what they do best, what they love to do, what they were trained to do — taking care of patient’s.
All accredited hospitals now have Physician Health Committees which also assist with workplace impairment issues. This is yet another valid avenue for assessment or referrals.
Patients can refer a healthcare provider to a state PHP if they suspect impairment, also anonymously most of the time. Again, check with your own state’s PHP.
There may be other times when a frank discussion with an impaired provider is desirable. The reason being, if they can be encouraged to refer themselves to a PHP, in most cases they are allowed to maintain their anonymity, even if treatment is prescribed.
This has brought many impaired providers out of the shadows with their addiction, to get the help they need without involving their state medical board. The fear of the stigma associated with being publicly labeled an addict is circumvented but the addict gets the treatment they deserve while the public is protected in the process.
It is estimated between 12- 14% of physicians and other healthcare providers are addicted to alcohol or other substances. Exploding rates of Job Related Burnout are driving many physicians to act out with alcohol, drugs or other addictive and destructive behaviors.
It is imperative we all share in the responsibility of identifying early on any impaired healthcare provider who needs our help, to get them the treatment they deserve while honoring our first and foremost responsibility to do no harm to those we serve.
You may be wondering whatever happened to the impaired internist. I referred him anonymously to my state PHP. He was assessed, diagnosed as alcoholic and he willingly went off to treatment. He stayed sober and in recovery until his natural death more than ten years later.
He never knew who reported him. I heard through the grapevine how he wished he knew who it was that intervened on his behalf. He said he wanted to thank them for salvaging his life.
Have you ever encountered an impaired colleague or provider in the workplace? What did you do? What was the outcome? Do you have concerns for someone and don’t know what to do or where to turn? Have you become concerned about your own use of drugs or alcohol?
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