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We are our brothers' keepers.

We Are Our Brothers' Keepers

An essential element of leadership for the physician executive is working with impaired physicians, whether their handicap is temporary or long-term, to make them fully contributing members of the health care team. Physicians must not only make themselves and their immediate staffs sensitive to the problem and its solutions, but also instill a helping environment for the overall organization.

All health care organizations and systems that contain physicians contain distressed, dysfunctional, and impaired physicians. There are doctors struggling with practice problems, such as deteriorating skills, too many patient complaints, and decreasing interest in practices. There are physicians burdened by environmental and societal stresses: the experienced doctor facing a malpractice lawsuit, the adjustment problems encountered by doctors who have recently left the academic nest, the female physician trying to make it in an arena that is still very much male-dominated. There are men and women grappling with serious personal issues, such as drinking problems or other chemical dependency, their own aging, a dying spouse or child, anger toward themselves or others that results in destructive behavior, physical problems of such magnitude as to cause them to crumble, or a disintegrating marriage. Most religious belief systems acknowledge the imperfection of believers. Likewise, any statement of medical practice, Hippocratic Oath or other, should acknowledge imperfection. All of us health care providers are imperfect and even a little "screwy." John-Henry Pfifferling, PhD, a medical anthropologist and Director of the Center for Professional Well-Being in Durham, N.C., has done extensive studies of medical students and residents. His research shows that the medical training system enhances human imperfections rather than reduces those liabilities.[1] So, we come out of the training programs not perfect, as our patients wish we were, but imperfect; not whole, but marred. We are smarter, but not necessarily wiser; often with "God complexes", but not necessarily more "God-like." In the same human package, we have a deliverer of health care who is a fix-it man, repairing broken bones and sore throats; a resource person to patients, giving information about healthy eating, stress management, and diabetic control; a provider of life-giving, and life-extending, care; a furnisher of hope; a person who acts like the "spitting image of the Creator" at one time and at other times like a lunatic! The same person acts at times as if he is capable of "hanging the moon" and other at times as if he is only capable of "gazing at the moon"--the old definition of a lunatic. All of us are part of organizations or systems. And it is up to the leadership of these organizations and systems to facilitate the help and provide the support that will turn wayward physicians around. At one time or another, each physician has fit into one or more of the following leadership slots: hospital chief of staff or department chairperson; CEO or medical director in a group practice, HMO, or hospital; commanding officer of a military unit; political leader in a medical community or organization; respected clinician; or elder statesman or stateswoman. Irv Rubin, PhD, a long-time member of the faculty of the American College of Physician Executives, has said, "The difference between managers and leaders is that managers do things right. Leaders do the right thing."[2] When you were in a position to act as a leader, did you act to help a distressed or impaired colleague? If not, why not? Were you afraid of a reprisal? Did awareness of your own shortcomings make you hesitate? Were you afraid that patients might find out about imperfections in their "high priests?" Were you afraid of confrontation? I can remember times when I did not act when I should have. I felt bad! I can also remember times when I did act. I was scared to death, but it felt right! Helping physician colleagues who are in distress is the right thing to do. What can we do in these situations and in general that is helpful and healing? Some of the following suggestions are general, and some are very specific. As you read them, you will undoubtedly have some of your own to add. But these suggestions and those of your own can have a healthy effect on the environment in which you and your physician colleagues work. * Develop physician support groups. The

Center For Professional Well-Being

has produced an excellent videotape,

with an accompanying manual that

will teach you how.[3] The tape

describes in detail how five physicians

formed a leaderless support group and

met regularly using an open agenda

and rigorous ground rules. For

instance, whatever is shared in the group

is always confidential, and members

of the group are encouraged not to be

judgmental of one another. * Make it as imperative for physicians to

learn interpersonal skills

(confrontation, negotiation, and conflict

management) as it is for them to take risk

management courses or updates on

drug therapy. What if we had to

periodically verify that we had taken so

many hours of interpersonal skill

building in order to be able to renew our

professional licenses? * Take a careful look at the

environment that your impaired or

dysfunctional people are working in. This

should be the equivalent of taking a

medical biopsy and carefully looking

for disease and etiology. * Take a careful look at yourself. Do

you need counseling or training or

help in some area? Do you see

warning signs of your own stress or

burnout? Are you regularly blowing up at

work? Is your family suffering at the

expense of your dedication to work?

Did you flunk your most recent

physical examination? * See to it that your organization teaches

and fosters coping skills: relaxation

techniques, aerobic exercise,

meditation, to name a few. This is just as

important as having everyone trained

in cardiopulmonary resuscitation. * Honor one another's space. Grant

your colleagues the alone time they

need. * Honor one another's free time. For

instance, don't use lunch time every

day for business meetings. * Honor one another's differences and

peculiarities. Take a personality test

and have your closest working

colleagues take it also. It will help you to

understand and value one another's

work and management styles.

Sometimes realizing that other people are

not trying to aggravate you but are just

working to meet their own needs will

release tension. * Design a professional assistance

program. The Center for Professional

Well-Being offers this service. * Form a malpractice support system

and group so that, when one of your

colleagues issued, a process can be set

in motion that will support the

physician and his or her family through the

crisis. * Teach crying. Healing will follow. * Develop a routine sabbatical program

that makes it financially feasible to

take extended time away from

practice. * Remember that "doctors just

entering practice may be victims of

treatment akin to child abuse."[1] These

initiates into our fraternity may be

smarting from mistreatment, slave

wages, and deprivation of sleep, time

with family, recreational time. * Make it the norm for physicians to

participate in extended retraining

programs or programs to develop new

skills and expertise. * Let us men learn to be more like

women. Let us be less macho. Let us

get help to develop more tenderness,

more empathy, more introspection. * If you are in a high-level position in

your organization, you may have to go

outside the organization to get your

support. Do it! Form a support group

of professionals whom you do not

manage or work with closely. Take

advantage of members of a national

organization such as the American College

of Physician Executives. As Irv Rubin has written, "An inability or unwillingness to see and accept that the profession is out of balance is to risk extinction preceded by a painful disintegration."[4] Physician leaders who can establish an environment that is helpful and supportive of troubled physicians will not let that happen.


[1]Pfifferling, J. Vertices, Fall 1987, p. 12. [2]Rubin, I. Presentation at National Conference on Health Care Leadership and Management, American Academy of Medical Directors, Hilton Head, S.C., May 13-17, 1985. [3]Forming a Leadership Support Group. Durham, N.C.: Center For Well-Being of Professionals, 1985. [4]Rubin, I. "Management of the Impaired Physician." Physician Executive 13(6):6-10, Nov.-Dec. 1987.

George E. Linney Jr., MD, FACPE, is a consultant who specializes in career counseling for physicians. He is a past president of the American Academy of Medical Directors (now the American College of Physician Executives.
COPYRIGHT 1989 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:the need for physician executives to work with impaired physicians
Author:Linney, George E., Jr.
Publication:Physician Executive
Date:Nov 1, 1989
Previous Article:Physician executives in China: a diary.
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