During morning rounds on an inpatient hematology-oncology service, a senior resident obser… — USMLE Step 3

During morning rounds on an inpatient hematology-oncology service, a senior resident observes concerning behavior from the attending physician. The attending, who has practiced for over thirty years, appears profoundly disoriented. She repeatedly confuses a patient admitted for a sickle cell vaso-occlusive crisis with another patient receiving induction chemotherapy for leukemia. Furthermore, she attempts to order a contraindicated intrathecal medication for a patient with a deep vein thrombosis. When the resident gently questions the orders, the attending becomes combative and states she has no memory of writing them. The attending is scheduled to perform several invasive procedures, including bone marrow biopsies, later this morning. Which of the following is the most appropriate next step for the resident?

A
Speak with the attending in a closed room to strongly advise a voluntary leave of absence.
B
Submit an urgent complaint directly to the state physician health program.
Contact the departmental chair or chief medical officer immediately to intervene.Answer
D
Reassign the scheduled procedures to another attending without disclosing the behavioral observations.
E
Perform the procedures independently and list the attending as the supervising physician in the record.

Answer

The resident must immediately notify the departmental chair, chief medical officer, or other appropriate institutional leadership to intervene and prevent the attending from performing patient care.

The correct answer accurately identifies that the primary ethical duty when encountering an impaired colleague is the immediate protection of patients. Because the attending physician is scheduled to perform invasive procedures shortly and exhibits profound cognitive deficits, there is an imminent threat to patient safety. Institutional leadership, such as a departmental chair or chief medical officer, has the immediate administrative authority to relieve the impaired physician of their clinical duties. Bypassing local leadership or attempting to handle the issue privately fails to guarantee patient safety.

Step-by-Step Solution

Identify the immediate threat to patient safety.

The attending physician is exhibiting severe cognitive impairment and is scheduled to perform invasive procedures.

Patient safety is the absolute highest priority in any case of suspected physician impairment.

Determine the appropriate reporting channel for acute impairment.

The resident must report the impairment to local institutional leadership (e.g., department chair, chief medical officer).

Local leadership has the immediate administrative authority to suspend clinical privileges and prevent imminent harm, whereas state boards or health programs take time to investigate.

Key Concept

When a physician exhibits signs of impairment that pose an immediate threat to patient safety, colleagues must prioritize immediate patient protection by reporting the behavior to institutional leadership (e.g., Chief Medical Officer, Department Chair) who can instantly remove the physician from clinical duties.

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