Physician Heal Thyself

Ask ten health care professionals to describe the statutory threshold for reporting professional impairment or misconduct in their state, and you will get ten different answers. In some states you must report across professional lines, that is, a psychologist, for example, must report an impaired physician.

Until a few weeks ago I assumed I must only report a professional I suspected might pose a danger to patients, but when I called the state physician health program on an unrelated matter I inquired, and the medical director disabused me of that notion. I made a quick call to my professional liability carrier for advice about a physician I had examined a few years ago who did not return and I did not report. The risk management consultant advised me not to report.

A few days ago someone left a message on my voice mail identifying themselves as Dr. ________. Not wanting to put myself or the "doctor" in a bind it occurred to me that I should warn that I might have a duty to report to the health program or the licensing board if I heard evidence of impairment. After all I try to warn all patients of other limitations of confidentiality. The doctor indicated willingness to take chance it, but I had to refer elsewhere when the doctor admitted to having Medicare. You might ask whether I should still report, but all I have at this point is a phone number, and for all I know he could be a "doctor" of divinity rather than a physician. I will not play detective.

What were the legislators thinking when they passed such laws? Did it never occur to them that the law of unintended consequences might intervene? How many physicians, knowing the duty of a treater to report them, eschew getting help and with what consequences?

Workarounds occur to me. One might seek help from a professional licensed in another state, paying cash to avoid a data trail. One might purchase medication out of state as well. Telephones and the Internet could facilitate both.

A physician who fears the consequences might indeed try to "heal thyself" rather than seeking help. Is that what we want?