Detecting impairment in others is much more difficult. Psychologically and chemically impaired professionals are often able to delay notice by protecting their job performance at the expense of every other dimension of their lives. The common signs of uncharacteristic behavior are frequently ignored. The phenomenon of family, neighbors, friends, and coworkers becoming involved in an exhaustive conspiracy enabling an impaired physician to appear to be functioning at his or her job is both common and tragic. Training in pharmaceutical use, functional psychiatric problems, and in the medical problems of addicted and abusing patients, helps physicians feel that they are experts capable of treating their own problems.
Intervention is almost always required with impaired physicians, because of the massive denial and other defense mechanisms they employ. Shame, embarrassment, fear, and guilt keep many health care workers from consciously accepting that they are not in control until confronted by either trusted colleagues or, more commonly, authorities. Intervention is a delicate task, requiring sensitivity, clear motives, and specialized training. Members of the physician's support system are consulted, and some are asked to be present at the intervention to deconstruct this "conspiracy of enabling." This will be the critical moment where a firm attitude of concern, without hostility or punitive overtones, has the opportunity to break through the defenses and enable the individual, for maybe the first time, to acknowledge the problem. At this point, the individual is very vulnerable and must be offered options.
The seriousness of the emotional impact of confrontation on the sick physician must be appreciated; it is critical to anticipate and prevent the possibility of a suicide or bodily harm by accident or trauma. These possibilities are not uncommon, particularly among impaired health professionals.
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