How broad are state physician health program descriptions of physician impairment?

Abstract

BackgroundPhysician health program websites in 23 states provide many descriptions of possible physician impairment. This study sought to determine whether these descriptions are so broad that almost everyone might potentially be suspected of being impaired given these descriptions.MethodsThe authors randomly selected 25 descriptions of impairment and then presented them anonymously online to members of the general population in full-time employment through Amazon’s Mechanical Turk (N = 199). Half of the respondents randomly received a narrowly worded version, and half received a broadly worded version of the survey questions.ResultsIn the narrowly worded version of the survey, 70.9% of respondents endorsed at least one description of impairment, and 59.2% endorsed more than one. In the broadly phrased version, 96.9% endorsed at least one description, and 95.8% endorsed more than one. These respondents endorsed a median of 10 out of 25 (40%) descriptions.ConclusionsThese findings call into question whether these descriptions really identify persons with poor performance or who pose a high risk of substantial, imminent harm to self or others in the workplace. They also demonstrate the extent to which these descriptions could potentially be misapplied and brand almost anyone as impaired.Electronic supplementary materialThe online version of this article (10.1186/s13011-018-0168-z) contains supplementary material, which is available to authorized users.

How is “stigma” conceived within the biomedical literature on trainee wellness? A directed content analysis

“…Failing to acknowledge disability discrimination and its implications, along with viewing mental health stigma solely in relation to treatment within the medical profession, may contribute to a number of undesirable outcomes. First, attributing stigma as a problem of irrational beliefs on the part of trainees and attending physicians assumed to be “in denial” or “lacking insight” may facilitate coerced mental health treatment ( Lawson & Boyd, 2018a , 2018b ) of persons who may not benefit from treatment referrals and may be harmed. In addition, denial of possible discrimination and inappropriate referrals for mental health treatment may have a censoring effect on trainees and attending physicians voicing concerns or blowing the whistle on institutions ( Lawson & Boyd, 2018a , 2018b ).…”

“…First, attributing stigma as a problem of irrational beliefs on the part of trainees and attending physicians assumed to be “in denial” or “lacking insight” may facilitate coerced mental health treatment ( Lawson & Boyd, 2018a , 2018b ) of persons who may not benefit from treatment referrals and may be harmed. In addition, denial of possible discrimination and inappropriate referrals for mental health treatment may have a censoring effect on trainees and attending physicians voicing concerns or blowing the whistle on institutions ( Lawson & Boyd, 2018a , 2018b ). Such referrals may contribute to unjust cultures and unsafe conditions for patient care.…”

“…Many policies that discriminate against trainees or attending physicians with disabilities remain ( Dhrewsbury, Mogensen, & Hu, 2018 ; Lawson & Boyd, 2018a , 2018b ). There are even some expansions-e.g., the Accreditation Council for Graduate Medical Education’s (ACGME) Common Program Requirements on resident wellbeing (defining wellbeing as a component of competence and listing depression and substance abuse as indicative of poor wellbeing), which have just been implemented ( ACGME, 2017 ).…”