A third-year internal medicine resident notices that their supervising attending physician smells strongly of alcohol, has slurred speech, and is unsteady on their feet right before starting a shift in the intensive care unit. Arrange the following steps in the most appropriate order of action and escalation to manage this professional concern.
- 1Ensure immediate patient safety by preventing the impaired physician from providing clinical care.
- 2Notify the appropriate supervisory authority (e.g., department chair, residency program director, or chief medical officer).
- 3The supervisory authority formally refers the physician to the state Physician Health Program (PHP).
- 4The physician undergoes a comprehensive substance use evaluation and participates in structured monitoring.
Answer
The correct sequence is: Ensure immediate patient safety, notify the supervisory authority, refer to the Physician Health Program, and undergo evaluation and monitoring.
When dealing with an acutely impaired colleague, the first and most critical step is always to ensure patient safety by preventing the impaired individual from providing care. Because the observer is a resident and the impaired individual is an attending, the resident must then escalate the situation to the appropriate supervisory authority (such as the Chief Medical Officer or Department Chair). The institution's leadership will then typically refer the physician to the state's Physician Health Program (PHP) rather than immediately firing them or reporting them to law enforcement. Finally, the physician will undergo assessment, treatment, and monitoring through the PHP.
Step-by-Step Solution
Key Concept
Management and reporting protocol for the impaired physician