Monitoring system needed to prevent safety hazard of problem physicians

January 17, 2006

Asserting that "physician performance failures are not rare and pose substantial threats to patient welfare and safety," experts in medical error are calling on state medical boards and healthcare organizations to institute a formal monitoring and prevention system for catching "problem doctors" before they do further harm.

Research has shown that "the vast majority of mistakes and injuries can be attributed to faulty systems that cause injuries or lead even competent, careful people to make errors," the authors write. And hospitals have begun to embrace principles of "human factors engineering" to correct these system-induced errors. But individual problem doctors still pose a considerable threat to patient safety.

"Performance problems are more widespread than people recognize; it's not just the small number of doctors disciplined annually by state medical boards, which is something like a half a percent of the nation's practicing physicians," said Dr. Lucian Leape, co-author of the article and recognized as the founder of the "medical error movement" with his authorship of the landmark 1994 JAMA paper, "Error in Medicine'. "Up to one-third of doctors may have a condition that impairs their performance at some time during their career, and most of them get little help for it." Leape is an adjunct professor of health policy at Harvard School of Public Health.

The article "Problem Doctors: Is There a System Solution?" appears in the January 17, 2006 issue of The Annals of Internal Medicine. The article is co-authored by Dr. John A. Fromson, an assistant clinical professor of psychiatry at Harvard Medical School and chairman of the department of psychiatry at MetroWest Medical Center. Dr. Fromson was responsible for setting up the Massachusetts Medical Society's program for dealing with impaired physicians.

The authors describe a menu of underlying causes for physician performance deficiency including mental and behavioral problems such as depression, anxiety, substance abuse and personality disorders, physical illness, including age-related and disease-related cognitive impairment, and failure to maintain or acquire knowledge and skills. Contributing to these problems for physicians in particular are environmentally-induced problems such as fatigue, stress, isolation, and easy access to drugs. While the rate of physical illness and alcohol dependence for physicians may be similar to the general population, there may be higher rates of mental illness. For example, the rate of suicide is 40 percent higher in male physicians and more than two-fold higher in female physicians than in the general population.

"The problem now is that typically little or nothing is done about recognized performance problems until someone is hurt or there is a malpractice suit. The doctor may then be warned by the chairman of the department, but it's often informal and without specific remediation assistance," said Leape. "If problems continue, then the physician is disciplined or reported to the state board. The exception is alcohol abuse. Most states have good programs for helping alcoholic doctors. But for all of the other problems, we need a system to enable us to intervene much earlier, before a patient is injured. Doctors have not done it because they have not wanted to be critical of colleagues, and there was no mechanism short of curtailing practice or taking a doctor's license away. But everyone knows at least one doctor with a problem: it's the elephant in the room. What we need to do is set up a regular system to identify these problems early and offer physicians help."

According to the authors' estimate, when all conditions are considered, "at least one third of all physicians will experience, at some time in their career, a period during which they have a condition that impairs their ability to practice medicine safely."

The authors propose that "the current ad hoc, informal, reactive approach to physician performance problems be replaced with a routine, formal, proactive system of monitoring that uses validated measures to focus strictly on clinical and behavioral performance."

To create a model system an institution would:The authors note that while the monitoring programs must take place at the local level, hospitals do not have the resources to develop the measures and the methods needed for implementing these systems. The authors therefore call for a national effort by the Federation of State Medical Boards, the American Board of Medical Specialties and the Joint Commission on Accreditation of Healthcare Organizations to ensure safe, competent medical care for patients by developing standards, measures, and methods for a physician performance monitoring system.

Harvard T.H. Chan School of Public Health

Related Substance Abuse Articles from Brightsurf:

College students with disabilities at greater risk for substance abuse
College students with physical and cognitive disabilities use illicit drugs more, and have a higher prevalence of drug use disorder, than their non-disabled peers, according to a Rutgers study.

An AI algorithm to help identify homeless youth at risk of substance abuse
While many programs and initiatives have been implemented to address the prevalence of substance abuse among homeless youth in the United States, they don't always include data-driven insights about environmental and psychological factors that could contribute to an individual's likelihood of developing a substance use disorder.

How Tweets may influence substance abuse in youth
In a new study from the University of Pennsylvania School of Nursing (Penn Nursing), researchers characterized the content of 23 million drug-related tweets by youths to identify their beliefs and behaviors related to drug use and better understand the potential mechanisms driving substance use behavior.

Time in host country -- a risk factor for substance abuse in migrants
Refugees and other migrants who move to Sweden are initially less likely to be diagnosed with alcohol or drug addiction than the native population but over time their rates of substance abuse begin to mirror that of the Swedish born population.

Children of incarcerated parents have more substance abuse, anxiety
Children of incarcerated parents are six times more likely to develop a substance use disorder in adulthood and nearly twice as likely to have diagnosable anxiety compared to children whose parents were not incarcerated, according to new research from the Center for Child and Family Policy at Duke University.

Reducing care needs of teens with substance-abuse disorders
Screenings, interventions, and referrals can help adolescent teens overcome substance abuse in the short-term.

Pain and substance abuse interact in a vicious cycle
Pain and substance use interact in a vicious cycle that can ultimately worsen and maintain both chronic pain and addiction, according to a research team including faculty at Binghamton University, State University of New York.

Gap in substance abuse data could have long-term implications, study finds
A policy of redacting Medicare claims that included diagnosis or procedure codes related to substance abuse was in effect from 2013-2017, just as the Affordable Care Act and the opioid epidemic were drastically changing the healthcare landscape.

AI tool promotes positive peer groups to tackle substance abuse
When it comes to fighting substance abuse, research suggests the company you keep can make the difference between recovery and relapse.

Investigators highlight potential of exercise in addressing substance abuse in teens
Exercise has numerous, well-documented health benefits. Could it also play a role in preventing and reducing substance misuse and abuse in adolescents?

Read More: Substance Abuse News and Substance Abuse Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to