Physician health and wellness: An ethical imperative

A recent report by the Council on Ethical and Judicial Affairs focuses attention on steps individual physicians and the profession can take to maintain doctors' well-being.

Posted Jan. 26, 2004.

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By the end of January, the promises we make to do better in the new year often begin to fall by the wayside. But some things are so important they have staying power -- they become priorities that endure.

Such should be the case with new AMA Council on Ethical and Judicial Affairs' recommendations on physician health and wellness. The council says ethics guidance in this area is essential because of its impact on doctors' professional performance.

Its message, outlined in a report endorsed by the AMA House of Delegates at its December 2003 Interim Meeting (link), emphasizes the importance of physicians attending to their own health and wellness, as well as that of their colleagues, by providing direction for both individuals and the profession as a whole.

This concept is consistent with ongoing efforts by the AMA, which has increasingly accented supportive approaches through its own physician health program. One of its most visible initiatives is the regularly held International Conference on Physician Health, which explores new research on this subject.

The report also highlights medicine's collective obligation to identify colleagues at risk -- whether from depression, alcoholism or a chronic condition -- and provide constructive and remedial steps to help them.

It's not an easy area to navigate. Evidence indicates that a physician's failing health or wellness sometimes might put patients at risk. Thus, concerns are often expressed in terms of "impairment" and "discipline" -- which may help protect patients but may not help the physician gain treatment.

AMA policy necessarily defines impairment as "any physical, mental or behavioral disorder that interferes with the ability to engage safely in professional activities." This definition encompasses a range of conditions -- sometimes chronic or degenerative, and sometimes the result of substance abuse, alcoholism or mental illness.

When a physician is impaired, that physician and his or her colleagues have an ethical responsibility to take action to avoid doing harm. In extreme cases, this action involves reporting the impaired doctor to licensing authorities.

But this report breaks new ground by offering concrete and proactive ways to help physicians avoid such pitfalls. It also seeks to provide mechanisms to ease colleagues' efforts to intervene if a problem is noticed. Ultimately, it treats reporting as a last resort -- a step taken when preventive and remedial interventions are no longer an option.

The overarching theme of the CEJA report is that it is an ethical responsibility for all physicians to maintain their own health and wellness and to look out for each other's health on a continuing basis. Physicians must internalize good health habits, meaning the prevention and treatment of acute or chronic diseases, including mental illness and disabilities. They also can play an important role in reducing occupational stressors. To achieve this goal, every physician should have a personal, objective doctor. This may seem simple, but it is not. Studies indicate that as many as 35% of doctors do not have their own "medical home And, in situations where health and wellness are compromised, it is this informed physician's responsibility to provide an honest self-assessment of his or her ability to practice.

Meanwhile, it is the medical profession's obligation to promote the well-being of its members on a broad scale. For instance, the culture of medicine should help physicians be more comfortable identifying colleagues who are in need of help at the early stages of physical or mental illness. Physicians often are reluctant to confront their peers and refer them to appropriate resources. Sometimes they fear such action will cause a domino effect of licensure actions, shame or stigmatization. Lack of familiarity with available resources also can be a barrier.

Therefore, medicine's backing of physician health programs is imperative. Such programs become integral to promoting physicians' overall well-being while also serving as central referral points for prompt intervention. Ultimately, though, the profession also must establish and maintain mechanisms to assure that impaired physicians promptly cease practice. But it also must make a priority of assisting recovered colleagues when they resume patient care.

After all, maximizing health and wellness is the goal most physicians set for their patients. It's a no less worthy one to set for themselves and their colleagues. And, as the council suggests, it is also an ethical imperative that deserves laserlike attention far into the future.

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External links

AMA Council on Ethical and Judicial Affairs' report on physician health and wellness, in pdf (link)

Information from the Federation of State Physician Health Programs, including upcoming meeting plans, state specific contacts and other resources (link)

Information on the 2004 International Conference on Physician Health (no longer available)

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