Reported to Impaired Physicians Organization!

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I am a fourth year medstudent, already matched, graduating next month and today I was informed by a psychiatrist that I have only seen once that she has referred to me the impaired physician organization in my state.

I am not a physician, nor am I impaired, and I am wondering about the ramifications of this. I have been told I will be called for an interview, and if I refuse that I will reported to the state board of medical examiners.

A little history, I was diagnosed with a mood disorder in first year but have not been under the care of psychiatrist since third year. I saw this psychiatrist only because I wanted a written eval requested by the administration of a scholarship program (I disclosed my diagnosis to them two years ago). I have had a few symptoms over the past two years, but have always had excellent grades, excellent board scores, and excellent clinical rotation evaluations--never, ever have I been reported for erratic behavior, lack of professional judgment, or any other sign of impairment. Even the psychiatrist said to me "You look great to me right now."

This psychiatrist has never before treated a physician or referred one to the impaired physician organization. She did not know how it worked and when she called them she had to ask them for the details. I was stunned that she had done such a thing--when I asked her why she had done this she said, "You have a mood disorder and could pose a danger to patients at any point in the future and no one knows when that will be. I was obligated to do it."

So I have a few questions. One, does the impaired physician organization (or indeed the state board) have any jurisdiction over a non-physician? Two, what will happen if I do cooperate? She said one possibility is that this will follow me to the state where I will be doing residency--ie they will refer me to that state's version of the impaired physician organization, who will oversee me throughout residency. Three, can this psychiatrist be sued for breach of confidence/malpractice? In my opinion, just on the basis of my having a diagnosis of a mood disorder and nothing else, she has done something that has the potential to negatively impact me professionally. The only physicians I have known to be referred have had severe performance issues, arrests, etc. Not to mention the fact that, at the moment, no patients are in my care. None. I am doing an elective month that doesn't involve any patient care. From all my research, there is no basis for what she has done.

Any info/advice is appreciated.

Originally Posted by Kasnek

I am a fourth year medstudent, already matched, graduating next month and today I was informed by a psychiatrist that I have only seen once that she has referred to me the impaired physician organization in my state.

I am not a physician, nor am I impaired, and I am wondering about the ramifications of this. I have been told I will be called for an interview, and if I refuse that I will reported to the state board of medical examiners.

A little history, I was diagnosed with a mood disorder in first year but have not been under the care of psychiatrist since third year. I saw this psychiatrist only because I wanted a written eval requested by the administration of a scholarship program (I disclosed my diagnosis to them two years ago). I have had a few symptoms over the past two years, but have always had excellent grades, excellent board scores, and excellent clinical rotation evaluations--never, ever have I been reported for erratic behavior, lack of professional judgment, or any other sign of impairment. Even the psychiatrist said to me "You look great to me right now."

This psychiatrist has never before treated a physician or referred one to the impaired physician organization. She did not know how it worked and when she called them she had to ask them for the details. I was stunned that she had done such a thing--when I asked her why she had done this she said, "You have a mood disorder and could pose a danger to patients at any point in the future and no one knows when that will be. I was obligated to do it."

So I have a few questions. One, does the impaired physician organization (or indeed the state board) have any jurisdiction over a non-physician? Two, what will happen if I do cooperate? She said one possibility is that this will follow me to the state where I will be doing residency--ie they will refer me to that state's version of the impaired physician organization, who will oversee me throughout residency. Three, can this psychiatrist be sued for breach of confidence/malpractice? In my opinion, just on the basis of my having a diagnosis of a mood disorder and nothing else, she has done something that has the potential to negatively impact me professionally. The only physicians I have known to be referred have had severe performance issues, arrests, etc. Not to mention the fact that, at the moment, no patients are in my care. None. I am doing an elective month that doesn't involve any patient care. From all my research, there is no basis for what she has done.

Any info/advice is appreciated.

Wow. this really does sound like the Psychiatrist jumped ahead of things a bit. If you are MD then I Would contact the AMA code of ethics bureau and see what steps to take. If you are DO they have a similar committee through the AOA.
Since you are a student, this should not of gone to a board. More like your school, or attending if they thought you or a pt was in immenent danger. I guess another option would be to search out the specific board contacted and see if they have any guidelines. Plus, would it be in your best interest to have a lawyer with you druing the hearing.
This stuff is regulated state by state, so look up the rules in your state. You may also find that there is a psych doc or laywer who specializes in this kind of thing that may provide more indepth knowledge.


Here is an excerpt from the AMA:
According to the American Medical Association policy # H-275.952, Physicians have an
ethical obligation to report impaired, incompetent, and unethical colleagues. Physicians
should be familiar with the reporting requirements of their own state and comply
accordingly. (1) Impairment: (a) Impairment should be reported to the hospital's in-house
impairment program, if available. If no in- house program is available, or if the type of
impairment is not normally addressed by an impairment program, e.g., extreme fatigue
and emotional distress, then the chief of an appropriate clinical service, the chief of staff
of the hospital, or other appropriate supervisor (e.g., the chief resident) should be alerted.(b) If a report cannot be made through the usual hospital channels, then a report should be
made to an external impaired physician program. Such programs typically would be
operated by the local medical societies or state licensing boards. (c) Physicians in officebased
practices who do not have clinical privileges at an area hospital should be reported
directly to an impaired physician program. (d) If reporting to an individual or program
which would facilitate the entrance of the impaired physician into an impaired physician
program cannot be accomplished, then the impaired physician should be reported directly
to the state licensing board.

If this is all true, then this psychiatrist has IMHO acted very unprofessionally and is a disgrace. Not only have you been unfairly stigmatized, but it would have been professional courtesy to inform you first about this rather than going behind your back. Secondly, the AMA states the first step would be to report the physician locally, i.e. to your medical school or hospital and it is their job to refer to the physician health program if they see fit. Thirdly, you need to be currently impaired or previously, not have some vague possibility of becoming impaired in the future.

It is not helpful to regard yourself as a non-physician - you are training to be one and will be very shortly. As such the physician health program likely does provide services to you. It may vary by state, but these programs tend to cover students, some even cover dentists, podiatrists and other non-physicians.

Really if you are perfectly well and just had a bit of depression (although since you had seen a psychiatrist it likely was a bit more severe) then really this will amount to nothing.

There is something a bit psychopathic about law suits, but I do sympathize. I think a complaint about this quack is in order at the very least! If we referred every one who'd been depressed, these programs wouldn't be able to cope!

Originally Posted by splik

If this is all true, then this psychiatrist has IMHO acted very unprofessionally and is a disgrace. Not only have you been unfairly stigmatized, but it would have been professional courtesy to inform you first about this rather than going behind your back. Secondly, the AMA states the first step would be to report the physician locally, i.e. to your medical school or hospital and it is their job to refer to the physician health program if they see fit. Thirdly, you need to be currently impaired or previously, not have some vague possibility of becoming impaired in the future.

It is not helpful to regard yourself as a non-physician - you are training to be one and will be very shortly. As such the physician health program likely does provide services to you. It may vary by state, but these programs tend to cover students, some even cover dentists, podiatrists and other non-physicians.

Really if you are perfectly well and just had a bit of depression (although since you had seen a psychiatrist it likely was a bit more severe) then really this will amount to nothing.

There is something a bit psychopathic about law suits, but I do sympathize. I think a complaint about this quack is in order at the very least! If we referred every one who'd been depressed, these programs wouldn't be able to cope!

Agreed. The psychiatrist went way overboard here, and if anything, the first steps are to address any type of impairment with the physician directly, not to report them to a board, particularly if there is no official/actual "impaired act." Also, I don't think a student can be referred to a board, can they? I thought those boards were for physicians only. I definitely agree with splik's advice, and you may want to get a lawyer to assist you and perhaps file a complaint against the psychiatrist as well.

Btw-what specialty did you match into?

Anesthesiology. That was another part of her explanation to me. She said that as an anesthesiologist, my decisions/actions have 'life and death' consequences, instead of being several steps removed as in the case of a pathologist. Those are her words, and that's the example she gave me.

This is something you should consult a lawyer about. I have no idea what the ramifications of your bone-headed psychiatrist's move are, and neither does anyone else on these forums.

Where'd your psych do residency? I bet it was a crap-ass place.

Originally Posted by Medstudentquest

Agreed. The psychiatrist went way overboard here...?

I don't think we can draw this conclusion without really knowing the facts on which the reporting was based, which I'm quite sure will be part of any report. The psychiatrist has a duty to report an individual in certain circumstances. I don't see any mention of circumstances in the OPs post. All we really know us that a psychiatrist who actually has seen the OP professionally thinks there is a problem. We really cant draw too many other conclusions here.

I'd find a lawyer who specializes in this sort of thing right away. You need to protect yourself. Whether she had good cause to report you or not, I don't feel comfortable judging, but I do think she should have talked to you first. Even in the case of physicians coming in under the influence of drugs or alcohol, where they clearly pose an immediate risk, you are to talk to them first. It's very underhanded to not mention it to you and to go so far above your head, rather than following the proper chain of authority.

Originally Posted by Law2Doc

I don't think we can draw this conclusion without really knowing the facts on which the reporting was based, which I'm quite sure will be part of any report. The psychiatrist has a duty to report an individual in certain circumstances. I don't see any mention of circumstances in the OPs post. All we really know us that a psychiatrist who actually has seen the OP professionally thinks there is a problem. We really cant draw too many other conclusions here.

You are correct in stating that there are few details shared by the OP. The major question seems to be if the psychiatrist had any right to report the student to the impaired physicians organization seeing as how the student is not a physician yet. For this question, and the ramifications thereafter, it would be in the OPs best interest to consult legal counsel.

This is not only about whether or not I should have been reported since I am not technically a physician yet. This is also about the fact that this psychiatrist violated the AMA policy on how to report. I read through the impaired physicians policies last night, and she should have gone to my dean first, or to some other supervisor of mine. She should not have gone to the impaired physicians board unless I had no supervisors.

Also this is about the fact that I am not currently impaired. For the record, the diagnosis is a mood disorder, but I am not impaired. She said to me yesterday, "You seem euthymic to me right now."

I have gotten angrier and angrier since I first posted. My dean is aware of what is going on and he said she has committed a HIPAA violation, but he advised me to cooperate, that these organizations are competent seeing who actually needs supervision.

As I stated above physician health programs see medical students as well (you are after all a physician-in-training and have similar role even if less responsibility) so it is irrelevant you have not graduated yet and I think you are doing yourself a disservice by pretending otherwise. The issue at hand is 1) she did not tell you about this first, 2) she did not have a duty to report to the physician health program, but to your supervisors who should be responsible for determining whether you are 'impaired' in the workplace and what action is needed., 3) thus her action was disproportionate and unprofessional.

Dont worry too much about this, they are actually there to help physicians who need it, and it is a confidential process. It is not the same as being referred to the state medical board.

Originally Posted by Kasnek

This is not only about whether or not I should have been reported since I am not technically a physician yet. This is also about the fact that this psychiatrist violated the AMA policy on how to report. I read through the impaired physicians policies last night, and she should have gone to my dean first, or to some other supervisor of mine. She should not have gone to the impaired physicians board unless I had no supervisors.

Also this is about the fact that I am not currently impaired. For the record, the diagnosis is a mood disorder, but I am not impaired. She said to me yesterday, "You seem euthymic to me right now."

I have gotten angrier and angrier since I first posted. My dean is aware of what is going on and he said she has committed a HIPAA violation, but he advised me to cooperate, that these organizations are competent seeing who actually needs supervision.

I don't think that it's just a HIPAA violation, it's more than that. As I mentioned, even for actual physicians who are impaired, the first step is to talk to them first, and try to find a way to remediate whatever problem there is. That was not even done here. Second, in order for this to be done, there has to be some actual impairment. If you were not complying with your duties in your rotations for example, because you were severely depressed for example, then something could be said about you being impaired, and your attendings/clerkship director/dean might need to be notified and the situation discussed. Again, that did not happen.

I would definitely be upset as well. It's good that your dean is involved, but I would definitely get legal counsel too. Your shrink's actions are not just unprofessional, but I think he/she had very poor judgment as well, and I think this person's behavior is truly concerning. No physician in their right mind goes "reporting" someone who is not currently impaired, and who is not even a physician yet! Is your psych licensed, any notches on their history? I just cannot imagine, unless you are not sharing something that may have happened which may have concerned your psych, a good, well educated psychiatrist saying, Hey! let me report this med student to the physician impairment board. It's kinda nuts imo.

Originally Posted by Kasnek

I have gotten angrier and angrier since I first posted.

Maybe you shouldnt post that on a web forum that could conceivably be traced back to you when its a mood disorder that is concerned in potentially questioning your competence.

Originally Posted by Chakrabs

Maybe you shouldnt post that on a web forum that could conceivably be traced back to you when its a mood disorder that is concerned in potentially questioning your competence.

:-)

At this point I am trying to figure out my next course of action. I was told that the person who interviews physicians at this organization is out of town until next week but that he would be calling me for an interview when he returns. I am not sure what to do in the meantime, if anything. Print out my transcripts and evals? Get letters from all my preceptors, every one of whom would vouch for my competence? I don't have extra funds for an attorney at this point.

I know it sounds like I am leaving something out, but I promise there has been no 'incident', no threats on myself or others, etc. What there has been is a diagnosis of a mood disorder, her feeling that it is getting worse, not better, and that I should be under the care of a psychiatrist, and her feeling that the nature of anesthesia being what it is, and the nature of my disorder being what it is, that I could present a danger to patients in the future.

I think there needs to be some reporting of your psychiatrist as she clearly does not know the process of something that is a very major part of her field of practice. The comment bout going into anesthesia vs pathology shows how out of touch she is- would you want a hematopathologist screwing up a type and cross for a transfusion? Just because the patient dies in seconds vs hours doesn't make a difference. I see what she did as no different than giving a patient chemo because "they might get cancer eventually" and falling back on an excuse of "well I've never given anyone chemo before I just made some crap up and did it"

Honestly if I were you I'd think of filing a civil suit, not for anything punitive but to cover legal fees and compensate for time wasted dealing with something that should have never happened caused by a practitioner's admitted ignorance of what protocol was.

Have you figured out what this means regarding getting a temporary medical license for your state? I know mine asked about psychiatric illness. I would imagine this could pose a big problem as you don't have documented treatment.

Originally Posted by Kasnek

:-)

At this point I am trying to figure out my next course of action. I was told that the person who interviews physicians at this organization is out of town until next week but that he would be calling me for an interview when he returns. I am not sure what to do in the meantime, if anything. Print out my transcripts and evals? Get letters from all my preceptors, every one of whom would vouch for my competence? I don't have extra funds for an attorney at this point.

I know it sounds like I am leaving something out, but I promise there has been no 'incident', no threats on myself or others, etc. What there has been is a diagnosis of a mood disorder, her feeling that it is getting worse, not better, and that I should be under the care of a psychiatrist, and her feeling that the nature of anesthesia being what it is, and the nature of my disorder being what it is, that I could present a danger to patients in the future.

I don't blame you for feeling angry and confused--I think anyone would be for something that is potentially this damaging to come out of nowhere this close to graduation. I'm glad your dean is involved--that was going to be my first suggestion. At the very least he/she should send a letter to this psychiatrist's supervisor raising the issue of unprofessional conduct. With the dean in your corner, I imagine this will settle after your interview with the physician impairment rep.

I think that lining up some personal references and signing a release so that the dean's office can provide your transcript/eval comments is probably a good idea since you have some time to prepare. When you talk to the interviewer go for "amazed and incredulous yet extremely cooperative" rather than "angry." The goal is to resolve the issue before graduation.

Originally Posted by Mattchiavelli

I think there needs to be some reporting of your psychiatrist as she clearly does not know the process of something that is a very major part of her field of practice. The comment bout going into anesthesia vs pathology shows how out of touch she is- would you want a hematopathologist screwing up a type and cross for a transfusion? Just because the patient dies in seconds vs hours doesn't make a difference. I see what she did as no different than giving a patient chemo because "they might get cancer eventually" and falling back on an excuse of "well I've never given anyone chemo before I just made some crap up and did it"

Honestly if I were you I'd think of filing a civil suit, not for anything punitive but to cover legal fees and compensate for time wasted dealing with something that should have never happened caused by a practitioner's admitted ignorance of what protocol was.

I totally second this. Med students don't just have tons of money around to hire lawyers and what not, so it's definitely an additional stressor that would not have been necessary had the correct actions been taken. I think it's scary that a psychiatrist of all specialties would be so non chalant in reporting someone in such a careless manner. I would seriously consider looking into his/her background, potentially reporting them, and possibly taking legal action. This person should not be dealing with other physicians if they don't know how to properly go by the book particularly with serious things like reporting someone!

I would talk with a lawyer if I were in your situation, or at least clarify that going before the board will not "haunt" you for the rest of your career (like having to check in with the board over and over). Remember at many schools consulting with student legal aid is free, that could be a good place to start.

If it's any consolation I think the board would dismiss this immediately if you actually had to come before them, it really just makes the psychiatrist look bad. He/she had no basis for breaking confidentiality in this case in my opinion, assuming you have told us the whole story.

Get a lawyer.

In the coming years you will find this psychiatrist has made licensing and credentialing a living hell for you.

Assuming this is pretty much the whole story and you don't have depression with psychosis or something, this was just stupid.
I agree with the school administrator. I think that if your school administration is reasonable, going to them was the best thing. You have plenty of proof your performance has been adequate and it doesn't seem there is evidence otherwise. Get your evaluations, transcripts, etc. and just go to the impaired physicians board thing and act like a reasonable person. I'm not sure a lawyer would help that much and it's probably going to cost 1k. You might consider asking your school whether it might be possible to talk with one of their attorneys for free for a few minutes, or whether they have any advice about how to present yourself. I think the most likely outcome is that the impaired physicians board will just dismiss you and say that you don't have to be monitored by them right now, or give you something benign to do like that you have to get a report sent to them once or twice a year. This sucks royally and this makes me really mad and it would make me think 3 times before I considered treatment for anxiety or dysthymia, which is the opposite of what we should be aiming for for people who deal with life and death decisions. It is true that anesthesiologists have to deal with stress and make important decisions, sometimes quickly, but I think what "stresses" one person is different than what stresses another one. Also, if you've been depressed maybe it's partly because you are a conscientous, sensitive person, and wouldn't we all want that for our anesthesiologist.

By the way, I wouldn't even think of not going before the board. That will just make you look like YOU'RE the unreasonable one, which you don't want to be. And they are very likely well intentioned. It could be that the psych doc is just very liability-conscious and may have been trying to shielf him/herself from the potential of future lawsuits, on the off chance you ever screw up in the future. And historically anesthesia docs have a higher than average rate of substance abuse, so if you don't have such a history, you should try to make it clear that you don't take drugs and you don't like to drink excessively. If you do drink to relieve stress, now is a good time to break that habit - I actually have concerns about how many people running around in general (docs and nondocs) think it's an OK thing to do...but it can become a slippery slope for many people.

Originally Posted by dragonfly99

Assuming this is pretty much the whole story and you don't have depression with psychosis or something, this was just stupid...

can we assume this? Just to play devils advocate here, a doctor who met with the OP immediately thought it prudent to run and report him. I think a lot of folks on here are focused on whether this psychiatrist actually followed protocol and are ignoring the more pivotal question of whether OP might, in fact be symptomatic of something which makes him presently unfit. Sometimes when people feel the need to report someone, which is usually not a decision taken lightly, they have a basis...

Originally Posted by Kasnek

she has committed a HIPAA violation,.

probably not:

—(1) Permitted disclosures. A covered entity may disclose protected health information to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight of:
(i) The health care system;

http://www.gpo.gov/fdsys/pkg/CFR-201...sec164-512.xml

Yeah I agree it's not a HIPAA violation if it was done in good faith and the person had any type of mood disorder.

But I'm not sure we should assume what the OP says is not the whole truth. I think a lot of people just want to cover their a--es. This could be an example of psychiatrist covering his a-- just in case OP ever gets in any type of trouble in the future.

Originally Posted by dragonfly99

But I'm not sure we should assume what the OP says is not the whole truth. I think a lot of people just want to cover their a--es. This could be an example of psychiatrist covering his a-- just in case OP ever gets in any type of trouble in the future.

Yes. She probably felt obligated.
And I'm guessing the mood disorder involved mania.
I wouldn't want a manic anesthesiologist in my OR or my group. Sorry, that's a whole lot more dangerous than run of the mill depression.
Good luck.

I called the impaired physician people today and spoke with a case manager, asked him how the process works. Apparently they believe that all physicians with mood disorders (bipolar disorder, not depression) should be referred to them and that they should be referred before anything happens, before they become impaired. I asked about AMA policy and he replied that that is what the anonymous line is for, so that people can bypass normal protocol. Anyone can call in on any physician at any time, and if they organization feels the call is legitimate, that physician will be interviewed.

He also said that if any physician has ever been diagnosed with a psychiatric disorder, they should check 'yes' on that section of the licensing documentation (Do you have a psych dx that could possibly impair you), and then the licensing board, once they see the 'yes' will automatically refer the physician to the impaired physician's organization for oversight. If the physician is stable, that oversight might consist of biannual documentation submitted from the physician's psychiatrist.

The case manager asked me, "If you have nothing to hide, why are you so bothered by this idea?"

Personally, I think it was wrong of her to do this without first discussing with you and then discussing with your medical school. However as you are now aware, PHPs do deal with medical students, and they are there to prevent issues arising rather than deal with physicians who have already become impaired (these individuals would likely be referred to the state medical board and not the PHP in the first instance). It's a ridiculous system - where I originally am licensed the licensing body does not ask these sorts of questions as its not their concern. It is up to the occupational health department of the hospital to determine the fitness to practice of the doctor and make any reasonable adjustments. the sort of heavy-handedness you described will only scare students away from receiving help when they need it which will lead to more problems.

Be careful - definitely do not make it sound like you are perfect and the model student - they will use it against you by showing that most impaired physicians start out that way and you lack insight! You can't win! Just remember they really are trying to be helpful, they are not trying to ruin your career but they can!

--

Each state has a seperate PHP. Each of them are different -- some are more "interventional" and want to know about anyone with a "potential" of running into trouble, and some are more "reactionary" and only want to hear about people whom are already in trouble. The OP's physician is fully able and allowed to report them to the PHP if they do so in good faith (i.e. they don't just make something up to cause problems). There's no HIPAA violation, and the OP's doc is not going to "get in trouble". Nor should you get a lawyer -- that's just a waste of money at present.

Simply follow the process. Meet with the PHP representative. If nothing is "going on", then they will leave you alone -- perhaps check in with you once or twice a year.

This doesn't change anything you answer on licensing or credentialing forms. If the form says "do you have a mood disorder?" then you were answering yes, with or without the PHP review.

The OP's doc should have told them about the PHP referral before doing it -- that simply would have been polite and professional. And, they should have explained the process, what it means, and how it progresses. Most likely (and I think as mentioned above), they have never done this before and asked a colleague afterwards. Still, in that case, I would have contacted the patient first. In this case, perhaps you would have recommended contacting the Dean (which actually might be a HIPAA violation without the patient's permission).

I think the key here is: "Don't panic!". If all is OK, it won't go any further than an interview by the PHP. Depending on what state you go to next, they might forward this data onwards, but this should not be disclosed to your program. In some ways, that's why there is a PHP -- so there's an independent body that can help you monitor your ability to practice without having to disclose this to your employer.

That is comforting if the PHP will not "out" him/her to the residency program (comforting to the student I mean).
I agree the doc should have told the student what he was doing...that was just rude.
Also I think the case manager at the PHP was snarky to criticize the student ("If you have nothing to hide..."). I think any medical student about to start a career, or anyone newly referred to such an organization, would have a lot of anxiety related to that and a reasonable person should understand that.

Originally Posted by Chakrabs

Maybe you shouldnt post that on a web forum that could conceivably be traced back to you when its a mood disorder that is concerned in potentially questioning your competence.

Anger is a natural human emotion and I think is appropriate in this situation. The level of expressed anger, however, does matter.

Let's not forget that humans actually have emotions and that not everything is pathologic.

I would talk to a lawyer. You are now in a situation where it is likely that you will have to deal with psychologic evaluations and scrutiny for the rest of your career as a condition of licensure. It appears that boat has sailed so you need someone who is on your side telling you how to deal with it.

You need to get over a few things. Even if your psychiatrist did violate the AMA policy it doesn't matter. It only matters that she followed the policy in your state. According to the case worker you talked to it sounds like she did. I would not try to file complaints against the psychiatrist. That will just look retaliatory and won't help you.

I would not assume that your school administration is unequivocally on your side. They has a school's reputation and liability as their primary concern. If you pose a danger to either of those they will sacrifice your career.

Someone said this is not like being reported to the medical board. In my state it is. The impaired physician apparatus is part of the board so don't take this lightly.

I am always concerned when anyone tells me that if I've nothing to hide I've nothing to fear. That's scary.

So go talk to someone who is unequivocally there to represent you and make sure you can have the career you're working for.

She/he probably doesn't have the money for an attorney, and I'm not sure the attorney can do much to change the outcome here in the short term. If the OP has a family with money, then getting a lawyer's advice would probably be reasonable, but not just any old lawyer...and I'm not really sure how to find the right type...though I have heard that the state or local bar associations sometimes have referral services for different types of attorneys...I guess this would be employment law? I think the OP is going to have to do what the impaired physicians board says and having a lawyer probably won't change that...though might help with knowing what to say. Personally I would just be pleasant and give them whatever information they are demanding/asking for and hope they will go away/stay in the background. I have found success to be the best revenge/response to adversity, but I know it isn't necessarily always that simple.

I hope anyone involved in training psychiatrists will take this as a point to let your residents know how/when to do these things...

Originally Posted by Bartelby

I would talk with a lawyer if I were in your situation, or at least clarify that going before the board will not "haunt" you for the rest of your career (like having to check in with the board over and over). Remember at many schools consulting with student legal aid is free, that could be a good place to start.

If it's any consolation I think the board would dismiss this immediately if you actually had to come before them, it really just makes the psychiatrist look bad. He/she had no basis for breaking confidentiality in this case in my opinion, assuming you have told us the whole story.

Amen. Despite the fact that lawyers cost, they are, in the modern era, an essential part of your existence. Better to get friendly with one sooner, it will cost you less later.

Originally Posted by HondoCrouch

Get a lawyer.

In the coming years you will find this psychiatrist has made licensing and credentialing a living hell for you.

Agreed.

Originally Posted by Law2Doc

can we assume this? Just to play devils advocate here, a doctor who met with the OP immediately thought it prudent to run and report him. I think a lot of folks on here are focused on whether this psychiatrist actually followed protocol and are ignoring the more pivotal question of whether OP might, in fact be symptomatic of something which makes him presently unfit. Sometimes when people feel the need to report someone, which is usually not a decision taken lightly, they have a basis...

For the sake of this discussion, Yes, we can assume this. Believe it or not, medicine is full of pathology, not just the student, but the doctor-god type. And it is not just physicians. Sometimes people report people to these agencies because they just plain don't like them. Or because it gives them a sense of power.

This straw man can be readily resolved. The OP should seek a second opinion with a different psychiatrist, or his/her original treating psychiatrist, if any.

Further, the OP noted that the psychiatrist suggested that he/she'd not be concerned if OP was headed into pathology instead of anesthesia where he couldn't hurt people. This shows the psychiatrist is either incredibly naive or incredibly stupid. Pathologists can kill people if they don't know what they're doing, by missing a tissue diagnosis and reporting the wrong diagnosis to a surgeon, causing a potentially curative surgery to be abandoned (or continued), causing a major change in post op treatment (think primary CNS lymphoma treated with high dose methotrexate followed by whole brain radiation v. a high grade glioma treated with focal radiation therapy and temozolamide). Clearly, if the psychiatrist, based on the OP's statement cannot grasp that simple concept, then what else is this psychiatrist missing?

Originally Posted by Kasnek

I called the impaired physician people today and spoke with a case manager, asked him how the process works. Apparently they believe that all physicians with mood disorders (bipolar disorder, not depression) should be referred to them and that they should be referred before anything happens, before they become impaired. I asked about AMA policy and he replied that that is what the anonymous line is for, so that people can bypass normal protocol. Anyone can call in on any physician at any time, and if they organization feels the call is legitimate, that physician will be interviewed.

He also said that if any physician has ever been diagnosed with a psychiatric disorder, they should check 'yes' on that section of the licensing documentation (Do you have a psych dx that could possibly impair you), and then the licensing board, once they see the 'yes' will automatically refer the physician to the impaired physician's organization for oversight. If the physician is stable, that oversight might consist of biannual documentation submitted from the physician's psychiatrist.

The case manager asked me, "If you have nothing to hide, why are you so bothered by this idea?"

When my government is asking questions about me, and has the authority to take away something of value to me based on the answer to those questions, I have everything to hide. We are not a country (at least not today, anyway) where we must bare our souls to the government. My wife got stopped by a cop. She listened carefully to my coaching on what to do if this happened. C: Do you know why I stopped you? No. Do you know how fast you were going? No. Do you know the speed limit? Yes. Were you going faster than that? no answer. No ticket.

Remember, you do have nothing to hide. You are bothered by a government agency which has the power to adversely impact you seriously asking questions. You should be bothered, even if you have nothing to hide, or everything to hide. You should not be angry at the government or the psychiatrist. You should be fully prepared to deal with the situation quietly, rationally and properly, now that it has arisen. You are likely not going to be an unbiased bystander, and that is where your dean and an attorney's advice will be useful: to give you a clear picture of what is going on.

It is not your job to hand the government your life, because a psychiatrist reported you, whether because the psychiatrist was justified or not. It is the government's job to do what it has the authority to do, to gather information, and not yours to give the government information which it is not entitled to have or is beyond its scope to obtain, which may help it justify an adverse decision. This agency is not your friend, it doesn't work for you, and its job is to protect the public. If there is evidence that you are dangerous, it is the government's job, acting within its authority to find it. Not your duty to volunteer it, unless a medical licensing application makes it your duty.

And you should take it very seriously. Most lawyers advise that anything you say to a government official will be used against you (or to further the goals of the government agent). If you don't say it, it cannot be used against you. If you lie, that can be used against you. If you say something exculpatory, it won't be used, but if that statement can be juxtaposed on another exculpatory statement to make the government's case, you can bet it will be used against you. If you are asked a question, answer that and only that question, provided the government has the authority to ask that question. This is why it is essential that you buy a good lawyer right now, to insure that your words are not taken out of context and twisted into something you did not say to meet a government objective, quota or other motive.

Originally Posted by 3dtp

...

Further, the OP noted that the psychiatrist suggested that he/she'd not be concerned if OP was headed into pathology instead of anesthesia where he couldn't hurt people. This shows the psychiatrist is either incredibly naive or incredibly stupid. Pathologists can kill people if they don't know what they're doing, by missing a tissue diagnosis and reporting the wrong diagnosis to a surgeon, causing a potentially curative surgery to be abandoned (or continued), causing a major change in post op treatment (think primary CNS lymphoma treated with high dose methotrexate followed by whole brain radiation v. a high grade glioma treated with focal radiation therapy and temozolamide). Clearly, if the psychiatrist, based on the OP's statement cannot grasp that simple concept, then what else is this psychiatrist missing?....

While I agree that this statement reflects a naive misunderstanding of what pathologists do (which BTW isn't uncommon in medicine), the statement actually makes me more, not less concerned here -- This psychiatrist met OP, and after a single examination thought it prudent to suggest that maybe OP pick a field without direct patient care or with less time sensitivity. My point is we don't have that side of the story, just the actions, but this person seems to have been professionally concerned about something (and we have no way to gauge how legit this was).

I like the idea of OP getting a second opinion, but am allowing for the possibility that OP might not like the answer.

There is something called the doctor-patient confidentiality. Dont worry too much about being reported, but definitely take precautionary measures to protect yourself, i.e. lawyers, common sense, and legally feasible methods such as recording the conversation to protect yourself. Two, talk to your family and friends about this at length, and for goodness sake, get a new doctor already!!!

As others have said, you need to talk to a lawyer. If anything that your psychiatrist said or if anything in your psychiatrist's report was exaggerated or incorrect, that's tantamount to slander and/or libel and the psychiatrist is responsible for any damages that you suffer as a result.

Originally Posted by Sol Rosenberg

As others have said, you need to talk to a lawyer. If anything that your psychiatrist said or if anything in your psychiatrist's report was exaggerated or incorrect, that's tantamount to slander and/or libel and the psychiatrist is responsible for any damages that you suffer as a result.

It depends on the specific state laws, but there are probably broad protections for the reporting physician, similar to the protections for docs who report child abuse. Minor inaccuracies in the report would probably not lead to liability, as long as the psychiatrist made the report in good faith.

Originally Posted by michaelrack

It depends on the specific state laws, but there are probably broad protections for the reporting physician, similar to the protections for docs who report child abuse. Minor inaccuracies in the report would probably not lead to liability, as long as the psychiatrist made the report in good faith.

That's why the OP needs to talk to a lawyer.

Originally Posted by Sol Rosenberg

If anything that your psychiatrist said or if anything in your psychiatrist's report was exaggerated or incorrect, that's tantamount to slander and/or libel and the psychiatrist is responsible for any damages that you suffer as a result.

Very doubtful. I doubt you could find an examples in which this ever happened, without other significant contributing factors.

Originally Posted by TheProwler

Very doubtful. I doubt you could find an examples in which this ever happened, without other significant contributing factors.

I'm quite certain that I can. A simple google search for "sue doctor for libel" turns up thousands of results, some of which actually appear relevant. Bottom line: If you make false statements in print or by word of mouth that end up causing someone damages that is libel or slander (respectively.) Doctors don't get a pass from this.

The devil, of course, is in the details. Does the psychiatrist saying to the impaired physician organization that the op is a danger to his (assuming the op is a "him") patients while telling the op that he "looked great now" constitute making a false statement? Does the additional bull**** that the op will have to deal with as a result of the psychiatrist's actions (see docB's post) constitute damages? I don't know. I'm not a lawyer, and neither are you. That's why, IMHO, the smart move for the op right now is to speak with a lawyer.

Originally Posted by Sol Rosenberg

A simple google search for "sue doctor for libel" turns up thousands of results

So does a google search for "space aliens". I googled "sue doctor for libel" and didn't really see anything relevant (although I only looked at the first few pages of results, not thousands)

I certainly agree that the OP could contact a lawyer to review what their rights are, and that this is going to be different by state. However, as stated already, every state that I have studied / worked in has a physician peer reporting system where physicians are specifically immunized against legal challenges as long as they report in good faith. This is specifically designed to set the bar low -- to allow physicians to report peer that they "might" think are a risk rather than wait to report when they are "certain". The benefit is that more people are reported earlier. The price is that some people get reported needlessly.

Originally Posted by aProgDirector

So does a google search for "space aliens". I googled "sue doctor for libel" and didn't really see anything relevant (although I only looked at the first few pages of results, not thousands)

I certainly agree that the OP could contact a lawyer to review what their rights are, and that this is going to be different by state. However, as stated already, every state that I have studied / worked in has a physician peer reporting system where physicians are specifically immunized against legal challenges as long as they report in good faith. This is specifically designed to set the bar low -- to allow physicians to report peer that they "might" think are a risk rather than wait to report when they are "certain". The benefit is that more people are reported earlier. The price is that some people get reported needlessly.

How can knowingly making a false statement be in good faith?

Originally Posted by Sol Rosenberg

How can knowingly making a false statement be in good faith?

Who says it is false? The OP?

Originally Posted by Sol Rosenberg

As others have said, you need to talk to a lawyer. If anything that your psychiatrist said or if anything in your psychiatrist's report was exaggerated or incorrect, that's tantamount to slander and/or libel and the psychiatrist is responsible for any damages that you suffer as a result.

Am I the only one on here who thinks that the OP going to a lawyer is a mistake because it will seem like a massive overreaction to the impaired physician organization? Their stated position is that you shouldn't be worried if you have nothing to hide. Lawyering up really makes it seem like you have something to hide. IANAL, but it seems like if this qualified as slander or libel on the part of the psychiatrist then there would be a lot more lawsuits about what physicians write in charts or when pediatricians refer for child abuse, etc.

Just do whatever the impaired physician organization tells you to do and make sure you have your dean on your side. If I were you I wouldn't get a lawyer involved because I think it would hurt more than help.

Originally Posted by physicsnerd42

Am I the only one on here who thinks that the OP going to a lawyer is a mistake because it will seem like a massive overreaction to the impaired physician organization? Their stated position is that you shouldn't be worried if you have nothing to hide. Lawyering up really makes it seem like you have something to hide. IANAL, but it seems like if this qualified as slander or libel on the part of the psychiatrist then there would be a lot more lawsuits about what physicians write in charts or when pediatricians refer for child abuse, etc.

Just do whatever the impaired physician organization tells you to do and make sure you have your dean on your side. If I were you I wouldn't get a lawyer involved because I think it would hurt more than help.

No. Get a lawyer. Always have someone in your corner who knows the rules.

Originally Posted by Dr.McNinja

Who says it is false? The OP?

The psychiatrist made 2 statements:

1. (To the OP): You are fine and look better than you ever have.
2. (To the impaired physician's organization): You are a danger to your future patients.

Seems to me that one of these is false. Also, the psychiatrist knowingly reported the OP to the organization. IF #1 is true, #2 must be false and the psychiatrist knowingly made a false statement with potential damages. You're right -- from what's been posted, we're not really in a position to make the determination about which is correct. That's why the OP should (sounding like a broken record here....) talk to a lawyer.

Originally Posted by physicsnerd42

Am I the only one on here who thinks that the OP going to a lawyer is a mistake because it will seem like a massive overreaction to the impaired physician organization? Their stated position is that you shouldn't be worried if you have nothing to hide. Lawyering up really makes it seem like you have something to hide. IANAL, but it seems like if this qualified as slander or libel on the part of the psychiatrist then there would be a lot more lawsuits about what physicians write in charts or when pediatricians refer for child abuse, etc.

Just do whatever the impaired physician organization tells you to do and make sure you have your dean on your side. If I were you I wouldn't get a lawyer involved because I think it would hurt more than help.

This is absurd. It's like saying that anyone who asks for a lawyer when they get arrested must have something to hide and/or is guilty. Also, no one will know if you just to a lawyer.

As to your point about why aren't there more lawsuits about when parents are reported for suspected child abuse....as I've already conceded, there can be no successful lawsuit without a false statement or without damages. I suspect that the vast majority of those types of cases have neither.

OK, I'm done hijacking this thread now