Risk Management Considerations When Treating Fellow Physicians

Historically, physicians are reluctant to seek treatment for mental illness, including substance use. Various barriers to treatment may include confidentiality concerns, licensing/practice issues, stigmatization by patients or colleagues, and the potential for professional liability issues. But the price for not seeking help is high: an estimated 300 to 400 physicians die by suicide in the United States annually. The suicide rate among male physicians is 1.41 times higher than the general population and 2.27 times greater in the female physician population than the general population. Moreover, the care and safety of patients may be undermined when they are treated by an impaired physician.

Physician wellness has become a major concern of APA, and psychiatrists contribute significantly to the health and well-being of their colleagues. This article addresses some risk considerations when treating a colleague with a psychiatric disorder.

• Self-treatment: When establishing the therapeutic relationship, determine to what degree, if any, the patient has been self-prescribing. Most attempts at self-care are unsuccessful. Document what the patient has tried to date.

• “VIP syndrome”: Are you underestimating the severity of the problem because the patient is a fellow physician? Deference to a patient should not be given due to his or her profession. Assessment and treatment planning must be the same as for any other patient, along with comprehensive documentation.

• Education: If you avoid educational discussions with the patient out of concern that the patient has extensive knowledge about his or her condition or may be offended, you are denying the patient of your complete assessment and plan. It is important to have a discussion that you would have with any other patient.

• Informed consent: As with any patient in treatment, a thorough informed-consent process should be completed and documented. Simply because the physician may have information about a particular medication does not absolve you from the duty to inform. It is important to accomplish this process as you would with any other patient.

• Need for hospitalization: Do not underestimate the patient’s risk of overdose or suicide. Establish a safety plan. The patient may have knowledge of how to respond to you to avoid answering inquiries about suicidal risk and the need for hospitalization. At each visit, thorough assessment, education, and documentation are critical.

• Licensure and practice concerns: Psychiatrists who treat other physicians have the same confidentiality obligations as with other patients. You may be required to report to the state licensing authority a physician who continues to practice impaired despite your best efforts at a comprehensive treatment regimen. Seek risk management or legal advice before taking this step.

• Unique considerations: The treating psychiatrist may need to insist that the patient find practice coverage and assist in the process; the psychiatrist may also need to be more available for supportive sessions when the physician returns to practice. The treating psychiatrist must have an individualized treatment plan and, when indicated, a suicide re-assessment every visit with appropriate, comprehensive documentation. The Federation of State Physician Health Programs and the Federation of State Medical Boards offer physician health programs that provide confidential treatment and assistance to physicians with substance use or behavioral health problems. More information is available at www.fsphp.org/.

Depression, bipolar disorder, and substance use disorder are the most common diagnoses of physicians who complete suicide. Ignoring the need for treatment can be detrimental. Additional resources can be found on the APA website. If you have any questions about treating other physicians, obtain risk management or legal advice. 

This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. ■