Radiologists can be affected by the same illnesses as anyone else, from substance abuse to chronic infectious diseases such as HIV, hepatitis, and tuberculosis. And just like anyone else, these illnesses can negatively affect their work, according to a paper published online in the Journal of the American College of Radiology.
"Physicians don't tend to talk about impairment and its personal, social, and emotional effects," lead author Dr. Claire Bender of the Mayo Clinic in Rochester, MN, told AuntMinnie.com. "We wrote this paper because we want radiologists to know that they can get help -- and that they're not alone."
Physicians are trained to identify and treat diseases, but when they become ill, they may deny their illness for fear of disciplinary action and associated stigma, according to Bender and colleagues. Yet physicians who remain untreated can be dangerous.
"Ultimately, patients and coworkers can be at risk if a radiologist's abilities are impaired by addiction or illness," she said.
Managing risk
Studies have estimated that 10% to 15% of all healthcare professionals will misuse alcohol or drugs at some time during their career, the authors wrote. It's important to note that having an illness does not necessarily mean a radiologist is impaired: Impairment means that an individual affected by disease is unable to perform specific activities, while illness can be present in an individual without impairment (JACR, January 7, 2015).
During a stint as chair of Mayo's personnel committee, Bender and her colleagues dealt with physicians who were challenged by either substance-abuse issues or infectious disease.
"It's the nature of the environment in which we work," she said.
The American Medical Association's Code of Medical Ethics includes sections that address substance abuse, physicians and infectious diseases, and HIV-infected physicians, and the legal implications for physicians impaired by these conditions are clear. So how can radiologists and their practices minimize legal risk and provide safe patient care? Bender's group referenced three risk-management guidelines from a paper written by Dr. John J. Smith and Dr. Leonard Berlin (American Journal of Roentgenology, March 2002, Vol. 178:3, pp. 567-571):
- Radiologists who are infected or have substance abuse problems and who are aware of their condition must take all reasonable steps to minimize the potential for patient injury.
- A radiology group or hospital that has knowledge of or suspects that a radiologist is impaired must take steps to ensure that no patient injury will result from that impairment.
- In clinical situations where a radiologist with a known substance-abuse impairment or potentially transmissible disease is involved in radiologic procedures that may result in disease transmission or other patient injury, consideration should be given to including information about this as part of the informed consent process.
But managing risk may be the "easier" part of dealing with impaired physicians. What can be really challenging is identifying them in the first place, Bender said. States' physician health programs are a good resource -- most belong to the Federation of State Physician Health Programs -- as well as the Federation of State Medical Boards and the American Society of Addiction Medicine.
"If you're concerned about a colleague, it can be difficult to pursue the issue," she said. "It's a delicate situation, and it's important to get expert help."
Radiologists should be familiar with the warning signs of impairment for themselves and their colleagues. The authors listed some possible signs and symptoms of impairment:
- Fatigue, deteriorating personal hygiene, or unusual eating behaviors
- Disturbed personal and professional relationships
- Social withdrawal from peers, inappropriate behavior in the professional setting, and unpredictable or aggressive behavior
- Unexplained absences, decreasing quality and interest in work, and inadequate professional performance
- For substance abuse, excessive agitation or edginess, dilated or pinpoint pupils, noticeable drug or alcohol odors, and self-prescribing prescriptions for controlled substances or requesting them from colleagues
"If an individual is at risk for impairment, consultation with their chair or employee health should be considered," the authors wrote. "Comorbid physical and psychiatric illnesses can exist with addiction illnesses."
Substance-abusing radiologists should be monitored until any treatment or rehabilitation has been completed. Those who suspect they have an infectious disease must contact their employee occupational health service immediately, as well as their state's department of health, and follow any control procedures necessary to avoid infecting others.
Physician impairment is a serious issue, Bender and colleagues concluded.
"All radiologists have the duty to verify their own state of health and seek help as soon as possible when they know it may be in danger," they wrote. "Radiologists owe this to themselves, their partners, their institutions, and their patients."
