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is important to draw a distinction between ―impairment‖ and ―illness.‖ The diagnosis of an illness does not equate with impairment. Addiction, as an example, is a potentially impairing illness. Impairment is a functional classification. Individuals with an illness may or may not evidence impairment. Typically, addiction that is untreated progresses to impairment over time. Hence, in addressing physician impairment, it makes sense to identify addiction early and offer treatment and recovery prior to the illness becoming impairment. The Federation of State Physician Health Programs (FSPHP) created a Public Policy regarding ―Illness vs. Impairment.‖ (See Appendix II for the complete policy.) The following is a quote from that policy: According to the Federation of State Physician Health Programs: …[S]ome regulatory agencies equate ―illness‖ (i.e. addiction or depression) as synonymous with ―impairment‖. Physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities. Most physicians who become ill are able to function effectively even during the earlier stages of their illness due to their training and dedication. For most, this is the time of referral to a state PHP. Even if illness progresses to cause impairment, treatment usually results in remission and restoration of function. PHPs are then in a position to monitor clinical stability and continuing progress in recovery… Medical professionals recognize it is always preferable to identify and treat illness early. There are many potential obstacles to an ill physician seeking care including: denial, aversion to the patient role, practice coverage, stigma, and fear of disciplinary action. Fear of disciplinary action and stigma are powerful disincentives to doctors referring their physician colleagues or themselves. When early referrals are not made, doctors afflicted by illness often remain without treatment until overt impairment is manifest in the workplace. It is in the nature of illness and physician identity that many physicians are not motivated for assistance. Providing a voluntary track for participation in a PHP offers a physician an opportunity to obtain assistance. And as long as the physician is willing to abide by contracted agreements struck by the PHP and the physician does not pose a risk of harm to the public, the physician participant can maintain confidentiality. By maintaining confidentiality and avoiding physician discipline, hospitals and medical staffs are incentivized to refer physicians into a PHP early rather than wait for frank impairment and referral to the board for discipline. 7 Policy on Physician Impairment Section III – Definition of Terms 1. ImpairmentImpairment is the inability of a licensee3 to practice medicine with reasonable skill and safety as result of: a. mental disorder (as defined below); or b. physical illness or condition, including but not limited to those illnesses or conditions that would adversely affect cognitive, motor, or perceptive skills; or c. substance-related disorders including abuse and dependency of drugs and alcohol as further defined Note: The above definition is in keeping with the definition offered by the American Medical Association in 1973. Disruptive Behavior and Process Addictions represent significant issues for boards and PHPs and are discussed, briefly in items 2 and 3 below. Impairment is a functional classification which exists dynamically on a continuum of severity and can change over time rather than being a static phenomenon. Illness, per se, does not constitute impairment. When functional impairment exists, it is often the result of an illness in need of treatment. Therefore, with appropriate treatment, the issue of ―potential impairment‖ may be resolved while the diagnosis of illness may remain. 2. Disruptive physician behavior – The American Medical Association (AMA) defines disruptive behavior as ―a style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with
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