Beware The Impaired
Impaired physicians are part of the reality of being a doctor. It always amazed me, the amount of tolerance doctors had for their impaired colleagues. I thought there was less tolerance for this nowadays until a story emerged last year of an impaired OG/GYN physician who was behaving badly in the south part of the state I live in now, and his alcoholism and bad behavior were tolerated because of the amount of revenue he brought to the hospital.
Another example: there was the neurosurgeon in one hospital in a city I worked in who had vodka in an Aqua Velva bottle in his locker in the surgeons changing room near the operating room. Apparently, he’d take a few swigs before he went into surgery. I didn’t know this until I left that city. He had a good reputation, too. I often wondered if the physician and administrative leadership at the hospital knew this. They had to, I always thought. But neurosurgery is a big moneymaker for a hospital.
Another example: there was the internist in a multi-specialty group I worked for. I had interviewed with this physician when I was trying to get a position there. He was a jovial guy, always joking and upbeat. After I was accepted there as a Primary Care Physician, I was going through an orientation, which consisted with meeting for 15-20 minutes with all of the physicians in the group. I was, again, meeting with this physician when one of the leaders of the group came into the office to say “Hi”, when he opened a drawer in the internist’s desk and pulled out a half full bottle of whiskey, saying, “You know, this doesn’t belong here.” The internist said, “Oh, I got that as a gift from a patient. I just hadn’t taken it home yet.” After I left, I realized this guy had been drinking on the job. I was in this group for two years and that internist never went into a rehab program (or and extended “vacation”). It was simply tolerated by the group.
In one place I worked, there was a Primary Care Physician who had been there for a long time. Everyone knew he did both drugs and alcohol. He had been to rehab multiple times. The group I was in let him practice out of the office he had previously owned before the group bought up his practice. When he was in rehab, they would sent some of us over to his office to cover his practice while he was gone so his patients wouldn’t leave for another doctor outside of our group. His patients would say things like, “Hey, Dr. Brown is in rehab again, eh?” while laughing!. One guy said, “I guess Dr. Brown is in rehab again. That’s OK because when my mother was really sick, he was there for her.”
The nurses had many stories about Dr. Brown, like the day he crashed his car into the hospital as he was coming in from being called at night to see a patient. Or that he would be so drunk, he would fall off of his chair at the nurse’s station while doing his charting.
One Saturday, just as I was completing my last patient progress note, the nurse came up to me and asked me if I would be willing to see a child Dr. Brown had admitted the evening before. As usual, I followed the doctor etiquette, saying, “I really shouldn’t see other doctor’s patients without the doctor’s permission. Why do you ask?” She said, “The mother is really wanting you to check out the child and reassure her that Dr. Brown is doing the right things.” I repeated my disclaimer of not wanting to intrude on another doctor’s care of a patient. The nurse said, “Well, would you at least listen to the child’s mother’s story and decide after hearing that?”
I agreed to this, as that had nothing to do with seeing the child. Here is the story the mother told me:
“I live next door to Dr. Brown. One day, my friend and I were sitting on my front porch when Dr. Brown came out of his house, opened his garage door and got into his car. He started the car, put the car in gear, looked over his right shoulder to back out, put his foot on the gas, the car leapt forward and he crashed his car into the wall of his garage. He readjusted the shift lever, again looked over his right shoulder, put his foot on the gas, the car leapt forward and, again, crashed into the wall of the garage. He did this a third time with the same result! When he adjusted the shifter for the fourth time, again, looking over his right shoulder to back out, the care lurched backward and went speeding down the driveway, across the street and into the ditch, out from which he couldn’t get his car. He had to call a tow truck to get it out.
After seeing that, I’m really nervous that he could be making mistakes caring for my son.”
After hearing that story, I took a history, did a physical exam, reviewed Dr. Brown’s care plan and luckily was able to reassure the mother that everything was being done correctly. I never wrote a note about it and neither I nor the nurses ever told Dr. Brown about it.
The attitude of tolerance for other doctor’s bad behavior continues to this day. I had a person who was a “lay person” member of a state’s Medical Board (the folks who approve licenses, hear cases about doctors and have the power to levy sanctions and license revocations) recently tell me about her observations of what she called the “good old boys” behavior of the Medical Board physician members, frequently letting or trying to let badly behaving physicians “off the hook”. They often got away with it, too, she said. The “lay persons” often got out voted.
So….you must beware the impaired.