Gen Hosp Psychiatry. 2013 Nov-Dec;35(6):659-63. doi: 10.1016/j.genhosppsych.2013.06.009. Epub 2013 Jul 30.
- Department
of Psychiatry, Vanderbilt Comprehensive Assessment Program, Vanderbilt
University, Nashville, TN 37212, USA. Electronic address:
reid.finlayson@vanderbilt.edu.
Abstract
OBJECTIVES:
We compare findings from 10 years of experience evaluating
physicians referred for fitness-to-practice assessment to determine whether those referred for
disruptive
behavior are more or less likely to be declared fit for duty than those
referred for mental health, substance abuse or sexual misconduct.
METHOD:
Deidentified data from 381
physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001-2012) were analyzed and compared to general
physician population data and also to previous reports of
physician psychiatric diagnosis found by MEDLINE search.
RESULTS:
Compared to the
physicians referred for
disruptive
behavior (37.5% of evaluations), each of the other groups was
statistically significantly less likely to be assessed as fit for
practice [substance use, %: odds ratio (OR)=0.22, 95% confidence
interval (CI)=0.10-0.47, P<.001; mental health, %: OR=0.14, 95%
CI=0.06-0.31, P<.001; sexual boundaries, %: OR=0.27, 95%
CI=0.13-0.58, P=.001].
CONCLUSIONS:
The number of referrals to evaluate
physicians presenting with behavior alleged to be
disruptive
to clinical care increased following the 2008 Joint Commission
guidelines that extended responsibility for professional conduct outside
the profession itself to the institutions wherein
physicians work. Better strategies to identify and manage
disruptive physician behavior may allow those
physicians to return to practice safely in the workplace.
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