Psychiatrically impaired medical practitioners: better care to reduce harm and life impact, with special reference to impaired psychiatrists

Abstract

Objective: The aims are to briefly review treatment outcomes for impaired practitioners, and to explore how preventive and early intervention, and the accessing of and retention within treatment systems for impaired medical practitioners, and particularly psychiatrists, could be improved to maximize the doctors’ chances of full recovery and to minimize danger to self and others.

Methods: The literature on the treatment and care of medical practitioner impairment due to mental illness, and substance use, with special reference to impaired psychiatrists is briefly reviewed. The implications of deficiencies of usual clinical management of doctors impaired by mental illness and opportunities for improvement in services for them are explored, including the impact of the experience of being an impaired medical practitioner under psychiatric treatment. The roles of medical boards and advisory services are examined.

Results: Medical practitioner impairment due to mental illness has a severe impact on doctors’ lives and the lives of their families due to both the effects of the disorder and the experience of communal, professional and self stigma and discrimination. Deficiencies in usual practice in the treatment and rehabilitation of such individuals are identified, and alternatives explored.

Conclusions: Prevention, early detection, intervention, and treatment programs that are more continuous more sensitive to the needs of impaired practitioners, that are more continuous, better structured, and rehabilitation and recovery focused, may be more likely to produce a positive outcome.

• impaired medical practitioner
• mental illness
• risk
• stigma
• treatment

Notes

²There are some doctors monitored by a Medical Board whose families do not know of their involvement of the Board (Middleton S, pers. comm. 2004).

³This must be balanced against the obligation of medical practitioners to report any registered medical practitioner they are treating to the Medical Registration Board for any illness which may seriously impair that practitioner's ability to practice, in a way that may result in the public being put at risk (eg Section 37 of the Medical Practice Act (Victoria) l994.(25).

⁵For instance, the Royal Australian College of General Practitioners currently will not accept doctors into their training program with conditions imposed by a Medical Board due to a mental illness, although they will support doctors already in the program who have such conditions subsequently imposed on their registration (Middleton S, pers. comm., 2004).

⁴For instance, the Royal Australian College of General Practitioners currently will not accept doctors into their training program with conditions imposed by a Medical Board due to a mental illness, although they will support doctors already in the program who have such conditions subsequently imposed on their registration (Middleton S, pers. comm., 2004).