Workablity assessment of the physicians with mental health problems

1. Workability assessment of
the physicians
Dr. Zdenka Čebašek-Travnik, MD
Psychiatrist
University Psychiatric Clinic Ljubljana

2. Conflict of interest
disclosure
I have no potential conflict of interest to
report
Dr. Zdenka Čebašek-Travnik

3. 3
Workability assessment of the physicians has its own specifics
Should we use the same procedure as for all workers?
Vote please …
 YES
 NO

4. 4
What do we have to assess in the case
of physicians?
 Depends on specific workplace and specialty
 Depends on problems to be assessed
 Regular assessment
 Question of actual performance
 Physician-related errors
 It is not a test of medical knowledge
 It is not a task for medical board or court
 It is “just” assessment

5. 5
Content of assessment
 Physical ability to work
 Psychical ability to work
 neuropsychological test performance:
 Attention
 Sequential processing
 Logical analysis
 Eye-hand coordination
 Verbal and non-verbal learning
 Communication skills, professionalism

6. 6
Mental health in physicians - Factors that can
contribute to medical practice errors
- Cognitive impairment
- Personality factors
- Substance use disorders
Physician impairment: a change for the worse
that interferes with their functioning as
physicians in ways that endanger patients.
Bok S. (1993). Impaired physicians: What should patients know?

7. 7
What about substance use disorders
(SUD)?
 Physician with a disease, that is stigmatized
by itself and in by the treatment process.
 Referrals for the assessment???
 Employer
 Medical board
 Colleagues

8. 8
How to achieve objective and proper regard of
workability assessment of physicians:
 who deny /as most addicted persons/ their problems
 minimize the consequences of their SUD
 are stigmatized by their surroundings more for entering the
treatment process than for addiction itself
 In some countries special committees or boards are
occupied with workability of addicted physicians. There
are different experiences, some even negative.
 The goal is not to damage someone’s
reputation – but to get him or her to
appropriate help. Mott JS. Dealing with the impaired supervisor.
Physician Assistant, Sept 90, p. 93.

9. 9
Proposed solutions
 Assessment:
 Done by independent professionals and/or institutions
 Independent form medical board and employer
 Physician advocacy or ombudsman
 Why independent?
 Read Physician Suicide Letters—Answered by Pamela
Wible
Here are private letters and last words from our doctors
who could no longer bear the pain of an abusive
medical system. Dr. Wible takes you behind the white
coat and into the mind, heart, and soul of our doctors—
and provides answers.

10. 10
Proposed solutions for physicians with
mental health problems and SUD
 Successful help programs that
 include professional and independent
assessment and
 versatility help to impaired physicians and their
relatives

11. 11
What do We Physicians need
 Specific workability assessment – with regards of
working place and special demands
 Assessment should be done by independent
professionals/institutions
 Regular assistance of physician advocacy service
or ombudsman should be considered

12. The goal should not be to damage
doctor’s reputation, but to get him
or her to appropriate help.
Take home message