A second-year anesthesiology resident is preparing a patient for a complex elective spinal fusion. The patient is awake on the operating table, and induction has not yet begun. The attending orthopedic surgeon enters the operating room to examine the surgical site. The resident notices that the surgeon has a strong odor of alcohol, is uncharacteristically irritable, and exhibits a fine motor tremor. Arrange the following actions and institutional responses in the correct procedural and chronological order, prioritizing immediate patient safety and adhering to standard professional guidelines for managing an impaired physician.
- 1Delay the induction of anesthesia and immediately inform the attending anesthesiologist of the observations.
- 2Notify the Chief of Surgery and the hospital's Chief Medical Officer regarding the suspected impairment.
- 3The surgeon is removed from all clinical duties and required to undergo an urgent fitness-for-duty evaluation.
- 4The surgeon is referred to the state's Physician Health Program (PHP) for comprehensive assessment and rehabilitation.
- 5The State Medical Board is formally notified of the impairment and the physician's status.
Answer
The correct sequence begins with protecting the patient by delaying induction, followed by administrative reporting to the Chief of Surgery, institutional suspension of privileges, referral to a therapeutic Physician Health Program, and finally, involvement of the State Medical Board if compliance fails.
The correct sequence reflects the ethical and legal consensus on managing an impaired colleague: immediate patient safety, local administrative escalation, institutional suspension, therapeutic rehabilitation, and finally, regulatory discipline if necessary.
Step-by-Step Solution
Key Concept
Impaired Physician Reporting and Procedural Escalation