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Unit 4: Discussion – Physician Impairment


The ability to detect and treat physician impairment in a non-threatening environment is of paramount importance. Instances of physician impairment should be addressed with minimal delay but with the utmost fairness and respect for fellow physicians. However, the absence of physician impairment does not always imply physician wellness.

Aligned to ULO(s)

ULO1: Examine the issue of physician impairment and provide examples of possible symptoms (CLO3)

ULO2: Summarize analysis of the healthcare error event (CLO3)


Initial Post

Nina Smith, Chief Nursing Officer of a healthcare system was concerned. Over the years she had watched the Head Surgeon Dr. James Montgomery as he kept his six days a week operating schedule. Lately Nina noticed the seventy-five-year-old surgeon slowing down. She noticed Dr. Montgomery had gone to a five-day surgery schedule. Last Tuesday he had performed surgery on Mrs. Able, an 80-year-old lady for a growth on her large intestine; which was benign. The surgery went well, however, the next day Nina was informed that the sponge count was incorrectly done and that one sponge was missing in the count. It wasn’t in the operating room waste bag or in the room when it was cleaned.

Nina felt like she had a big problem. She must notify the Medical Director and the hospital CEO about what has occurred. The Medical Director notified Dr. Montgomery what had occurred and ask him to bring the patient back in to take out the sponge. Dr. Montgomery refused to bring the lady back in just for a sponge citing; he believed that there was little or no risk to the patient with the sponge remaining in the patient. He is politically the most powerful doctor at the hospital.

Assume that you are the Risk Manager at this healthcare system, located in the city where you reside. Nina Smith formally reported about the situation to you. Your first reaction is, of course, about the course of action to protect the patient Mrs. Able, but also, you are concerned about protecting the hospital and Dr. Montgomery despite of his attitude about the case.

Prepare a memorandum addressing the risks that need to be mitigated in the situation involving physician impairment and medical error.  Note the location (city and state) of your hypothetical healthcare system at the top portion of your memo. Research and use state specific applicable regulations.

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