The following conversation takes place in the staff room of a family practice clinic.
Depression in a colleague
Commentary on: Depression in a colleague
In this scenario a physician is clinically depressed and unable to function.
- What is the responsibility of the impaired physician?
- To himself?
- To his patients?
- What is the responsibility of his concerned colleague?
- To his colleague?
- To his colleague’s patients?
- Does his behaviour constitute professional misconduct?
- To whom should his colleague speak about the situation?
- How might the situation differ if he was practicing solo?
- What support services are available for impaired physicians?
Dealing with an impaired or incompetent colleague is extremely difficult. There is a general impression that physicians consider themselves invulnerable to the ills of other human beings. Thus, they may fail to recognize deficiencies in their professional conduct due to ill health, age or substance abuse. Even if the problem is recognized, pride may prevent the physician from seeking help, as in this case.
As a self-regulating professional, the physician has the duty to his patients to provide the highest quality care. If he cannot do this due to ill health, he has an ethical duty to see that his patients are properly cared for by others, until he is capable again.
It is also generally believed that physicians tend not to report colleagues who are possibly incapacitated or incompetent: “After all, it could be me next. That really wasn’t incompetence; he just made a mistake.”
However, as a self-regulating professional with a duty to society, the concerned colleague, Tom, behaves appropriately in discussing the situation with Dennis. Tom indicates that he feels that Dennis is unable to practice until treated for his depression. Does the concerned colleague have any responsibility to his colleague’s patients? Yes, but only in the sense of general accountability to society as a member of the profession. He has no fiduciary relationship to his colleague’s patients.
What should he do if his depressed friend refuses to stop practicing and seek help? (Reporting requirements vary among provinces and territories. Consult your medical regulatory authority guidelines for more information.) Clearly, in this instance, Dennis’ colleagues have been aware of the situation and have been covering for the incapacitated physician. This code of silence cannot be maintained indefinitely. Are there more senior heads of programs or institutional administrators who should be aware of the situation and who might be able to intervene?
Most provinces and territories have a physician health program in place where support services for impaired physicians are available.