Resident/physician alcohol withdrawal ethics question

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janprincetondoc

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So I’m curious and was talking about this with a few other students. If u were at an ED and a resident/physician came to the ED with shakes, HDUS, etc. and they said they hadn’t drank in 24 hours, would you report to state medical board or is that a hippa violation. Interesting question
 
If I were the treating physician absolutely not. FWIW I’m addiction psych and regularly work with the state PHP. If it were a colleague and I knew they were working while impaired that’s a different scenario, however I would talk to the person first and if I felt reporting was necessary would go to the state PHP before the board unless something egregious happened. Reporting to the board for ANYTHING should not be taken lightly and can have SERIOUS consequences. I say this as someone who was wrongly reported to the board for a non-mental health/substance use issue and luckily got off without any action taken but the whole process took almost 2 years.
 
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If I were the treating physician absolutely not. FWIW I’m addiction psych and regularly work with the state PHP. If it were a colleague and I knew they were working while impaired that’s a different scenario, however I would talk to the person first and if I felt reporting was necessary would go to the state PHP before the board unless something egregious happened. Reporting to the board for ANYTHING should not be taken lightly and can have SERIOUS consequences. I say this as someone who was wrongly reported to the board for a non-mental health/substance use issue and luckily got off without any action taken but the whole process took almost 2 years.
So let’s the surgeon admitted he drank every day for the past year. Then report? Or still no?
 
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So let’s the surgeon admitted he drank every day for the past year. Then report? Or still no?
Again, as the treating physician I wouldn’t. I would strongly encourage the patient self-reporting to the state PHP, which depending on the state should circumvent any board involvement. However, PHPs are not regulated/have no oversight and can be very difficult and frustrating to deal with. I’m aware of my ethical obligations, but also (un)fortunately know how the sausage is made which is why even reporting to a PHP is something I don’t take lightly.
 
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Isn't this a fairly common Step question?

At any rate, agreed with @Taddy Mason's advice: if you are just the treating physician and don't have personal experience with the patient in a strictly clinical setting e.g. know that they were impaired while on call, then treat the patient and look what the reporting laws in your state of practice are when it concerns physician-patient dynamic.
 
Isn't this a fairly common Step question?

At any rate, agreed with @Taddy Mason's advice: if you are just the treating physician and don't have personal experience with the patient in a strictly clinical setting e.g. know that they were impaired while on call, then treat the patient and look what the reporting laws in your state of practice are when it concerns physician-patient dynamic.
I’ve never seen it on step prep and I got a 272 (no brag)
 
Medical boards are not our friends. Well, it depends on the board I guess.

I’ve seen so many horror stories that I personally would never report a physician to a medical board unless they were actively doing something unethical involving patient care (showing up to work high? Etc? Ok, maybe. I’d still probably go to them first though).

Now, the answer on the test is to say “talk to them privately-> report”

But it’s not the kind of thing that you need to do Willy-nilly because most medical boards in this country are pretty backwards and don’t believe in mental healthcare for physicians. I think this is improving, but it’s dependent on your state.
 
…most medical boards in this country are pretty backwards and don’t believe in mental healthcare for physicians. I think this is improving, but it’s dependent on your state.
They do, but the places that do “independent” (they’re not truly independent because you can only go to ones allowed by a state’s PHP or medical board) medical evals for physicians and physician specific treatment programs are unregulated and some predatory with conflicts of interest (i.e., many places that do “I”MEs also have their own physician specific treatment programs, so there’s a monetary incentive to diagnose someone regardless of the clinical picture) - anyone can hang a shingle and say they do physician specific “I”MEs or treatment. Additionally, they tend to massage data to fit round pegs into the square holes of DSM criteria when someone doesn’t meet DSM criteria, thus forcing them into unnecessary treatment, monitoring, and potential board actions. The cost of “I”MEs and physician treatment programs are also exorbitantly expensive (most “I”MEs cost ~$10k) and not covered by insurance. This is why even reporting someone to a PHP is something I don’t take likely. And again, state PHPs have no oversight or regulatory bodies.
 
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Yes but that’s for colleagues not just if a random surgeon shows up to an ED on his off time
Everyone’s posts in this thread imply the same answer including the paper @NotAProgDirector posted. Do you think a random physician should be reported by someone in the ED? And why does it have to be a surgeon? Taking it further what about a nurse, SW, psychologist, attorney, dentist, etc.? They all have licensure boards as well.
 
I would never report them as a patient. However, there are some states where if you have a medical license you would be mandatory reporter of an impaired colleague. I've seen a case (can't find right now) where the impaired doc made a medical error, lawyers were able to prove other docs knew, and they all got pulled into the mud too.
 
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Not a brag. You're talking to people on SDN--our average USMLE 1 and 2CK is 290.

We also can eat just one Lay's potato chip

We have counted to infinity. Twice

We stayed at the Virgin Islands. They're now just called the Islands

We are... the most interesting forum on the internet.

You Got This Dos Equis GIF
 
The reddit premed/med student forums seem to be a lot of the blind following the blind. I just cannot.
Blind, deaf, but unfortunately not mute. /r anything medical is generally a weird spiral of gripes and s***posts raging against some perceived machine (usually common sense).

If folks like vox (hello again) think premed/med school is hard, they should look at how basically every residency post is apocalyptic.
 
Would yall report?

A hospitalist who covers a cardiac ward in a tertiary care medical center notices that a hospital-based cardiologist, with whom she has worked for several years, is increasingly difficult to reach. The cardiologist now takes several hours to respond when he is paged while on call, appears distracted and irritable during discussions, and leaves his patient consult notes incomplete for longer than 48 hours. The hospitalist has also noticed that the cardiologist has been rounding at 11:00 PM; she once heard him mention "a family emergency" to one of the nurses. He has told the hospitalist that she can always call one of his partners as a backup if he does not answer pages. The hospitalist has not noticed any medical errors made by the cardiologist. Which of the following is the most appropriate next step by the hospitalist?

A) Ask cardiologist's partners if they are aware of any trouble he is experiencing at home
B) Continue monitoring his performance for a month prior to determining action
C) Inquire among staff whether they are concerned about his behavior
D) Inquire if there are any patient complaints about the cardiologist related to patient care
E) Report the cardiologist to Physician Health Program
 
Would yall report?

A hospitalist who covers a cardiac ward in a tertiary care medical center notices that a hospital-based cardiologist, with whom she has worked for several years, is increasingly difficult to reach. The cardiologist now takes several hours to respond when he is paged while on call, appears distracted and irritable during discussions, and leaves his patient consult notes incomplete for longer than 48 hours. The hospitalist has also noticed that the cardiologist has been rounding at 11:00 PM; she once heard him mention "a family emergency" to one of the nurses. He has told the hospitalist that she can always call one of his partners as a backup if he does not answer pages. The hospitalist has not noticed any medical errors made by the cardiologist. Which of the following is the most appropriate next step by the hospitalist?

A) Ask cardiologist's partners if they are aware of any trouble he is experiencing at home
B) Continue monitoring his performance for a month prior to determining action
C) Inquire among staff whether they are concerned about his behavior
D) Inquire if there are any patient complaints about the cardiologist related to patient care
E) Report the cardiologist to Physician Health Program
If this is a board vignette the “correct” answer is “E.” In reality though I would try talking with the cardiologist or his/her supervisor.
 
I agree E but it’s a weird question in that usually they give “ask the cardiologist to go home and see the remainder of his patients for the day”
 
Blind, deaf, but unfortunately not mute. /r anything medical is generally a weird spiral of gripes and s***posts raging against some perceived machine (usually common sense).

If folks like vox (hello again) think premed/med school is hard, they should look at how basically every residency post is apocalyptic.
Not vox btw but at least as a resident you know that you will be a physician in a desired speciality. Also these days non surgical residents have it very chill. Psych, IM, family, pmr, path, EM etc. at my program all work banker hours. It’s just that the hours that they’re there are the most boring hours in existence. Imagine rounding for 6 hours talking about nonsense that won’t even affect patient outcomes