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The Toll of Unmanaged Stress
- Addictive behaviors
- Relationship distress
- Emotional/behavioral problems
- Professional dissatisfaction
- Increased risk of unethical behaviors
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Addictive Behaviors: Increased use of tobacco, alcohol, prescription medications and/or illicit substances "to help cope with stress" places the individual at great risk for physical and psychological dependence.
Relationship Distress: Depersonalization, which refers to treating people like objects, may arise as a protective mechanism in human services professionals to minimize emotional involvement that could interfere with functioning in crisis situations. In moderation, "detached concern" toward patients by physicians may be appropriate and necessary, but when excessive, it may lead to callousness and cynicism with subsequent negative effects on the physician-patient relationship.
Emotional/Behavioral Consequences: Emotional exhaustion is caused by excessive psychological and emotional demands made on people helping people that leave individuals drained and depleted. Low morale, reduced effectiveness, burnout and health problems are often the result.
Professional Consequences: Feelings of diminished personal accomplishment are reflected in symptoms of stress, depression, and a sense of inefficiency and diminished competence. With such feelings, the individual believes that his or her actions no longer can or do make a difference. This adversely affects the physician-patient relationship, patient satisfaction, and perhaps, ultimately, healthy outcomes.
Definition of an Impaired Physician
A physician who is unable to practice medicine
with reasonable skill and safety to patients because
of physical or mental illness, including deterioration
through the aging process or loss of motor skill, or
excessive use or abuse of drugs including alcohol
[Schiedermayer, D.L. and Tesch, B.J., Wisconsin Medical Journal, 1982]
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Another definition of impairment is from a textbook, "The Physician as Patient," by Myers and Gabbard, American Psychiatric Publishing, 2008. In the text, the Federation of State Medical Boards define impairment as "the inability of a licensee to practice medicine with reasonable skill and safety by reason of: mental illness; physical illness or condition , including, but not limited to, those illnesses or conditions that would adversely affect cognition, motor or perceptual skills; or habitual or excessive use or abuse of drugs defined by law as controlled substances, or alcohol or of other substances that impair ability [Federation of State Medical Boards, 2000, p. 26].
Types of Impairment Addressed by the PHR Committee
- Substance Use Disorders
- Mood Disorders
- Sexual Boundary Violations
- Disruptive Physicians/Personality Disorders
- Cognitive Impairment
- Ethical Misconduct
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The majority of cases referred to Texas county medical society PHR committees have involved substance use disorders. However, as hospitals and medical societies are more aware of physician impairment, disruptive and dysfunctional behaviors of all types are being reported. Frequently, a psychiatric illness is at the root of the behavior, and these illnesses, although often difficult to identify, are treatable.
Stress management and boundary issues also are referred to the PHR committee. Mood disorders, sexual boundary violations, and cognitive disorders are addressed by the PHR committee.
Ethical misconduct does not only include sexual misconduct, but can include things such as sexual harassment in the workplace. There are many institutional guidelines laid down by hospitals, large medical groups, as well as the Federal government that spell out sexual harassment. Other forms of ethical misconduct can include such things as double billing and overcharging for services.
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Last Published: 6/8/2009 Print this page
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