Published online by Cambridge University Press: 29 July 2009
What should patients know about the degree to which their physicians may be impaired—unable, in the words of the American Medical Association (A.M.A.), “to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence”? What patients do in fact find out about such matters as alcohol or other drug abuse by, say, the surgeon or the anesthesiologist in charge of their care is another matter altogether; most patients learn about such impairment the hard way. But what should they know beforehand, if at all possible?
1. Council on Mental Health of A.M.A. The sick physician: impairment by psychiatric disorders including alcoholism and drug dependence. Journal of the American Medical Association 1973;223:684–7.CrossRefGoogle ScholarPubMed
2. See, for example, Council on Ethical and Judicial Affairs. Ethical issues involved in the growing AIDS crisis. Journal of the American Medical Association 1988;259:1360–1.CrossRefGoogle ScholarPubMed For a discussion of the related legal arguments, see Gostin, L. HIV-infected physicians and the practice of seriously invasive procedures. Hastings Center Report 1989;32–9;Google Scholar and Gostin, L. Hospitals, health care professionals, and AIDS: the “right to know” the health status of professionals and patients. Maryland Law Review 1989; 48:12; 12–54.Google Scholar
3. For a survey of what has, so far, been established regarding the different forms of impairment, see Benzer, DG. Healing the healer: a primer on physician impairment. Wisconsin Medical Journal 1991;90:70–9;Google ScholarPubMed and Nadelson, C. Physician Stress and Impairment. The Sandoz Visiting Professorship Lecture, Medical College of South Africa.Google Scholar
4. See note 3. Benzer, , 1991;90:70. Chemical dependency accounts for about 80% of cases of impairment reported to state physician health programs. See also Nadelson.Google Scholar
5. See note 3. Benzer, , 1991;90:70.Google Scholar
6. See note 3. Benzer, , 1991;90:70.Google Scholar
7. When the doctor's on drugs. Hastings Center Report 1991;21:29–31.CrossRefGoogle Scholar
8. See note 7. 1991;31.
9. See note 7. Comment by Keating, , 1991;29–30.Google Scholar
10. See note 7. Comment by Ackerman, , 1991;30–1.Google Scholar
11. Feldman, MK. Addicted docs: caregivers who need care. Minnesota Medicine 1991;74:17–21.Google Scholar For a discussion of the perennial tension in medicine between a physician's obligations to patients and to colleagues, see May, WF. Code and covenant or philanthropy and contract? In: Reiser, SJ, Dyck, AJ, Curran, WJ. Ethics in Medicine: Historical Perspectives and Contemporary Concerns. Cambridge, Massachusetts: MIT Press, 1977:65–76.Google Scholar
12. For a discussion of the role of the expert vis-à-vis consumers in American medicine, see Reiser, SJ. Consumer competence and the reform of American health care. Journal of the American Medical Association 1992;267:1511–5.CrossRefGoogle ScholarPubMed
13. Bok, S. Confidentiality. In: Secrets: On the Ethics of Concealment and Revelation. New York: Pantheon Books, 1982; 116–135.Google Scholar
14. See note 2. Gostin, , 1989;32–9,Google Scholar and Gostin, , 1989;48:12;Google Scholar 12–54. Also see note 3. Benzer, , 1991;90:70–9.Google Scholar
15. Lo, B, Steinbrook, R. Health care workers infected with the human immunodeficiency virus. Journal of the American Medical Association 1992;267:1100–5;CrossRefGoogle ScholarPubMed and Burke, EC. HIV infection in the medical work place. Are physicians and patients at risk? Minnesota Medicine 1991;74:5–6.Google ScholarPubMed
16. U.S. to let states set rules on AIDS-infected health workers. New York Times 1992 Jun. 16, Section C, p. 7, Col. 1. The Centers for Disease Control estimates, as of 1991, that possibly 3–28 patients in the United States have been infected with HIV from surgeons and possibly 10–100 patients from dentists. By contrast, to the extent that physicians come in contact with patients infected with HIV repeatedly, they run a correspondingly greater risk of being infected in the course of their practice.Google Scholar
17. See note 16. New York Times 1992 Jun. 16.Google Scholar
18. Newsweek 1991; 07. 1:48.Google Scholar
19. For a discussion of the conflict between patient rights and HIV-infected healthcare workers, see Daniels, N. HIV-infected professionals, patient rights, and the “switching dilemma.” Journal of the American Medical Association 1992;267:1368–71.CrossRefGoogle Scholar
20. See works cited in note 2. Also see Schechter, WP. Surgical care of the HIV-infected patient: a moral imperative. Cambridge Quarterly of Healthcare Ethics 1992;1:223–8.CrossRefGoogle Scholar
21. Kolata, G. Hemophiliacs, hit hard by H.I.V, are angrily looking for answers. New York Times 1991; 12. 25:1.Google Scholar
22. Gabbard, GO, ed. Sexual Exploitation in Professional Relationships. Washington, D.C.: American Psychiatric Press, 1989.Google Scholar
23. See note 3. Nadelson.
24. Pope, KS. Therapist-patient sex syndrome: a guide for attorneys and subsequent therapists to assessing damage. In: Gabbard, GO, ed. Sexual Exploitation in Professional Relationships. Washington, D.C.: American Psychiatric Press, 1989:39–55.Google Scholar
25. The College of Physicians and Surgeons of Ontario. Task Force on Sexual Abuse of Patients: The Final Report. 1991.Google Scholar
26. For advice to the public on this score, see Robin, ED. Matters of Life and Death: Risks vs. Benefits of Medical Care. Stanford, California: Stanford Alumni Association, 1984.Google Scholar