Suicidal behavior among physicians referred for fitness-for-duty evaluation.

OBJECTIVE: We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not. METHOD: Assessments of 141 physicians evaluated at the Vanderbilt Comprehensive Assessment Program were retrospectively compared between those who later either attempted (n = 2) or completed (n = 5) suicide versus the remainder of the sample. RESULTS: Subsequent suicidal behaviors were associated with being found unfit to practice (86% vs. 31%, P < .05), being in solo practice (71% vs. 33%) and chronically using benzodiazepines (57% vs. 11%, Fisher's Exact Test, P < .05). CONCLUSION: Being found unfit for practice may trigger a cascade of adverse social and financial consequences. Those engaged in solo practice may be particularly vulnerable due to isolation and lack of oversight by supportive colleagues. Finally, chronic benzodiazepine use may impair resilience due to associated brain dysfunction. Although these characteristics must be investigated prospectively, our observations suggest that they may be important signals of increased risk for suicidal behavior in physicians. The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk, so that appropriate preventive actions can be taken.

Restoring professionalism: the physician fitness-for-duty evaluation.

OBJECTIVES: We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct. METHOD: Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001-2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search. RESULTS: Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10-0.47, P<.001; mental health, %: OR=0.14, 95% CI=0.06-0.31, P<.001; sexual boundaries, %: OR=0.27, 95% CI=0.13-0.58, P=.001]. CONCLUSIONS: The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.

Transformative learning in a professional development course aimed at addressing disruptive physician behavior: a composite case study.

Disruptive physician behavior presents a challenge to the academic medical center. Such behaviors threaten the learning environment through increasing staff conflict, role modeling poor behaviors to trainees, and, ultimately, posing a risk to patient safety. Given that these physicians are often respected and valued for their clinical skills, many institutions struggle with how to best manage their behaviors. The authors present a composite case study of an academic physician referred to a professional development program for his disruptive behavior. They outline how transformative learning was applied to the development of concrete learning objectives, activities, and assessments for a curriculum aimed at promoting behavior change. Important themes include a safe group process in which the physician's assumptions are critically examined so that through experiential exercises and reflection, new roles, skills, and behaviors are learned, explored, and practiced. Timely feedback to the physician from the institution, colleagues, and administrators is critical to the physician's understanding of the impact of his or her behavior. Ultimately, the physician returns to practice demonstrating more professional behavior. Implications for medical education, prevention, and other professional development programs are discussed.

Problematic physicians: a comparison of personality profiles by offence type.

OBJECTIVE: This exploratory study compares objective personality test findings among physicians exhibiting different forms of misconduct. The importance of delineating distinctive personality characteristics by type of offence is that such characterizations can direct therapy and prognosis for remediation. METHOD: Eighty-eight physicians referred to the Vanderbilt Comprehensive Assessment Program for Professionals (V-CAP) completed the Minnesota Multiphasic Personality Inventory-2, the Personality Assessment Inventory, or both, as part of their evaluation. On the basis of referral information, physicians were partitioned into 3 groups of offenders: "sexual boundary violators," "behaviourally disruptive," and "other misconduct." RESULTS: On both personality measures, the sexual boundary violators generated the greatest percentage of profiles indicative of character pathology. CONCLUSIONS: Although all 3 groups exhibited unacceptable behaviours, the pervasive personality features of the sexual boundary violators are associated with greater therapeutic challenge, and these individuals likely pose the greater risk of reoffending.