Physicians Practice - February 2008 - (Page 66)

HUMAN RESOURCES solution, but two things are universally guaranteed: Avoiding the problem will not make it go away and the longer you wait, the more risk and pain your practice will suffer,” Roediger says. The risks of delaying action can be high for the practice. Even if you do everything right, malpractice lawsuits frequently name the practice or practice partners. DENY, DENY, DENY IDENTIFYING THE PROBLEM Warning signs that a physician colleague may be abusing alcohol or other substances or having serious emotional or psychiatric problems are sometimes hard to spot. Look for changes in: Reliability • Doesn’t respond to pages or phone calls • Misses appointments • Skips meetings • Calls in sick more often • Comes late, leaves early • Unavailable when on call Efﬁciency • Sloppy charting and record-keeping • Deteriorating handwriting • Complaints by staff and patients Prescribing patterns • Wastes more pharmaceuticals • Prescribes more controlled substances ordering by mail Denial and secrecy aren’t just for substance abusers. Friends, families, and professional colleagues of substance abusers often refuse to acknowledge warning signs even when they are clear. “Colleagues feel very uncomfortable confronting colleagues,” says Betsy White Williams, a psychologist and clinical program director of the Professional Renewal Center in Lawrence, Kan. “There may be obvious signs of the problem right in front of you, but it is human nature for people not to want to believe that something really bad like this is happening to them or a colleague.” Williams says that when physicians do become patients at outpatient centers like the one where she works, it’s often because their drug or alcohol abuse was exposed involuntarily. Maybe it’s a ﬂurry of complaints from patients or other physicians, she says. Or a payer’s chart audit turns up suspicious prescribing patterns. Sometimes, the physician is even arrested for drug possession or impaired driving. “Smaller practices represent the best and the worst with these situations,” she says. “Physicians and staff are in close contact so they should be able to spot the signs of trouble early, but they don’t always have the experience to know what to look for or what to do.” HOW TO DOCUMENT protected domain and people go to great lengths to hide these problems in the workplace.” Once suspicions are raised, Krall says to begin documenting the behaviors and incidents. It will be harder for the substance abuser to deny or downplay a problem if confronted with solid evidence rather than vague impressions. Those notes will come into play when you take the next step, which is to confront the physician, usually through an orchestrated intervention. And yes, it will be a painful and uncomfortable experience for all concerned, he says. “You tend to want to look the other way and hope it will resolve itself but it usually doesn’t,” Krall says. “Denial is often the biggest hurdle to get over.” Don’t let worries about your notes becoming fodder for future lawsuits stop you from beginning the task of documenting the behavior, says Roediger. True, noting one’s suspicions for a year or two while doing nothing will pose a problem if a patient is injured. But you are headed for a mess either way, she says, so choose the path of action. READ MORE ABOUT IT! Visit PhysiciansPractice.com for additional information and tools on maintaining good relationships with your physician colleagues: • Excessive ordering, or Work patterns • Volume becomes extremely high or low • Conducts hospital rounds at unusual hours • Frequent job changes/relocations Appearance and behavior • Talks more rapidly or slowly • Disheveled • Wears heavier clothes in summer • Wears tinted glasses • Weight changes • Mood changes 66 | PHYSICIANS PRACTICE | FEBRUARY 2008 Williams says that changes in the physician’s behavior and appearance can give early clues that a problem exists. (See sidebar: “Identifying the Problem.”) Even with a sharp eye out for potential problems with colleagues, keep in mind that you are probably spotting the problem at an advanced stage, says Edward Krall, a psychiatrist with the Marshﬁeld (Wis.) Clinic. “The practice is the last place you’ll see the problem; the family sees it ﬁrst,” says Krall, who also is director of the physician health committee at the 800-physician multispecialty practice. “The practice is • Type “Peaceful Partnerships” in our Search Articles box to learn how to move beyond discord and get back to medicine. • You give annual reviews to staff, why not to physicians? Type “Physician Evaluation Form” in our Search Site box to download a helpful tool for evaluating physician performance. • Visit the Federation of State Health Programs at www.fsphp.org to find the physician health program in your state. WWW.PHYSICIANSPRACTICE.COM http://PhysiciansPractice.com http://www.fsphp.org http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - February 2008

Physicians Practice - February 2008 Contents The Bigger Picture: Your Future is in Your Hands Letters Physicians Practice Pearls: Creating an A+ Practice Noteworthy Cover Story: Conquering Time: 5 Keys to a More Efficient Practice In Balance: A Family Affair Technology: Making EMRs Work in the Exam Room In Practice: "I've Got Some Bad News" The Tech Doctor - The EMR: Savior or Poseur? Ask the Experts NEW! Healthonomics: How to Handle Health Savings Accounts The Administrator's Desk: Finishing School for New Managers Human Resources: Is Your Partner Impaired The Great Practice Makeover: Too Well-Liked for His Own Good? Coding Idealab: 'Why I Blog' Classifieds Advertiser Index

Physicians Practice - February 2008

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