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Philip Candilis, MD, Authors Position Paper on Physician Impairment and Rehabilitation

A new position paper from the American College of Physicians (ACP), by lead author Philip J. Candilis, MD, professor of psychiatry and behavioral sciences at the George Washington University School of Medicine and Health Sciences, examines principles that should guide the health care profession’s response to physician impairment.

Candilis and ACP colleagues Daniel Kim, MPH, and Lois Snyder Sulmasy, JD, write that physicians have a duty to seek help when they are unable to provide care, but also “should be rehabilitated and reintegrated into medical practice whenever possible without compromising patient safety.”

The paper, titled “Physician Impairment and Rehabilitation: Reintegration into Medical Practice While Ensuring Patient Safety: A Position Paper from the American College of Physicians,” was developed on behalf of the ACP Ethics, Professionalism, and Human Rights Committee. Physician impairment refers to anything interfering with a physician’s ability to carry out patient care responsibilities safely and effectively, according to the paper. Causes can be varied, and may include substance use disorders, mental illness, profound fatigue, or a decline in cognitive or motor skills due to age or disease.

To identify colleagues who might be impaired, the authors note, “physicians should act on collegial concern as well as ethical and legal guidelines that require reporting of behavior that puts patients at risk.”

The authors take up five positions on the topic of physician impairment and rehabilitation. They include:

  • The professional duties of competence and self-regulation require physicians to recognize and address physician illness and impairment.
  • The distinction between functional impairment and potentially impairing illness should guide identification of and assistance for the impaired physician.
  • Best practices for physician health programs should be developed systematically, informed by available evidence and further research.
  • Physician health programs should meet the goals of physician rehabilitation and reintegration in the context of established standards of ethics and with safeguards for both patient safety and physician rights.
  • Maintenance of physician wellness with the goal of well-being must be a professional priority of the health care community promoted among colleagues and learners.

The authors conclude that physicians who are impaired should seek treatment, should be helped by their colleagues, and that health care organizations should “promote practice environments in which patient safety is prioritized and physician wellness and well-being are addressed.”

The position paper, “Physician Impairment and Rehabilitation: Reintegration into Medical Practice While Ensuring Patient Safety: A Position Paper from the American College of Physicians,” is available at https://annals.org/aim/fullarticle/2735179/physician-impairment-rehabilitation-reintegration-medical-practice-while-ensuring-patient-safety.