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The Troubled Physician Prevention and Intervention Anderson Spickard, Jr., M.D. Director Center for Professional Health at Vanderbilt December 20, 2002 EAP Physician Consults 1998-99 Critical Incident Stress Debriefings » 4 MD deaths » 2 MD terminations for misconduct Request from Legal for Consult » 2 MD employment application irregularities Reasons for the Vanderbilt Physician Wellness Program Need for a comprehensive program for VUMC physicians(650 residents and 750 faculty - 400 students) Emerging world-wide interest in physician burnout Physician Wellness Development Plan Approved by the Medical Center Medical Board July 15, 1999 Director, staff and space assigned Program directed at prevention, early identification, treatment and relapse prevention after reentry to work JCAHO Intent Statement “The medical staff implements a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function” - JCAHO, Medical Staff Standards (MS.2.6) JCAHO Process Components Education Referral Diagnosis/Treatment Confidentiality Evaluation (Verification) Monitoring Reporting ACGME Requirements for Resident Support Provide confidential counseling services Medical and psychological support Written policies about impairment including substance abuse Organization of the Physician Wellness Committee 17 members of the faculty representing many of the clinical departments Section of Physician Wellness created in the EAP Intense marketing of the program to house staff and faculty through grand rounds, brochures and e-mail Program for Physician Wellness All assessments free to faculty and residents Physicians self referred or sent by supervisor for assistance in the EAP Results of the Program Physicians with relationship problems, addiction issues, disruptive behavior now recognized early and sent to EAP for assessment Referrals have tripled in two years and are increasing A culture of wellness in the medical center is improving Utilization Physician Wellness Program Number of Physicians Before PWP (Orange) and Since PWP (Gold) 58 47 25 7 6 4 1 92-93 93-94 14 8 94-95 95-96 96-97 Fiscal Year 98-99 99-00 00-01 01-02 Institutional Barriers to Program Implementation Medical Center leaders not committed Recovering people not used to help Lack of funding for implementation Medical leaders don’t confront physicians with A/D issues, disruptive behavior,etc. Need code of conduct Resources for referral are limited Impairments In Physicians Alcohol and drug dependence Psychiatric disorders (bipolar, depression,schizophrenia, anxiety disorders) Personality disorders Sexual boundary violations and sexual harassment Disruptive behavior (uncontrolled anger) Resident Impairment Depression Alcohol and drugs (self medication) Marital problems Fatigue Psychiatric Illness other than depression including OCD, etc. Risk Factors of Those Who Abuse Alcohol and Drugs Stress Access to drugs; relax with alcohol Self medicate Family history of A/D addiction Lack of a support group Barriers to Diagnosis of Physician Impairment Denial Rationalization Myth of invulnerability Social acceptability of alcohol and drug use. Colleagues ignore behavioral problems Vanderbilt Resident Wellness Support Network Retreat for Anesthesia Department Marriage retreat for residents with Michael Myers Fallibility rounds Women physicians support group International physicians health assessment Balancing resident professional and private life seminars Personal Wellness Profiles (stress, weight, cholesterol)