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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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26. Impaired Practitioner
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The aim of medicine is to prevent disease and prolong life; the ideal of medicine is to eliminate the need for a physician [medical practitioner].
~ William James Mayo
Diagnostic Deception
The Case of the Impaired Physician
Dr. Sarah Jones was a highly respected physician at Mercy Hospital. She had a reputation for being a compassionate and skilled practitioner, and her patients held her in high regard. However, something had changed. Over the past few months, her colleagues had noticed that she seemed more irritable and forgetful than usual. She had made several mistakes in her diagnoses and treatment plans, and some of her patients had complained of feeling unheard or dismissed.
Dr. Jones had always been an advocate for her patients’ autonomy, but her colleagues were becoming increasingly concerned about her ability to provide safe and effective care. They suspected that she may be struggling with an impairment of some sort. They knew they had a professional obligation to report her, but they also knew that such a report would have serious consequences for Dr. Jones.
The situation came to a head when one of Dr. Jones’ patients was misdiagnosed, leading to a serious medical complication. The patient was lucky to recover fully, but the incident had shaken the staff at Mercy Hospital. They knew they could not ignore the signs any longer and that they had to take action to protect their patients.
Dr. Jones’ colleagues began to discuss the situation, seeking advice from their superiors and consulting with the hospital’s legal department. They knew that they had a duty to report her impairment but wanted to ensure that they did so in a way that would be fair to Dr. Jones and protect their patients. They ultimately decided to approach Dr. Jones directly, expressing their concerns and offering support and resources to help her get the treatment she needed.
Dr. Jones was initially defensive and angry, feeling that her colleagues were questioning her abilities and betraying her trust. However, as they talked, she began to realize that they were genuinely concerned for her well-being and the safety of her patients. She agreed to undergo a medical evaluation and treatment, and her colleagues supported her throughout the process.
The evaluation revealed that Dr. Jones had developed a substance use disorder and was struggling with depression and anxiety. With the help of her colleagues and medical professionals, she began a treatment program and began to make progress towards recovery. Her colleagues monitored her closely and worked with her to ensure that she was fit to return to practice.
The case of Dr. Jones was a reminder to all medical practitioners of the importance of recognizing and reporting impairment in themselves and their colleagues. It was a difficult and challenging situation, but ultimately it led to Dr. Jones getting the help she needed and a renewed commitment to patient safety and professional excellence among her colleagues.
Abstract
Impaired medical practitioners and the importance of recognizing and reporting them to protect patients and maintain public trust in the medical profession is a professional obligation. Impairment can have various causes and occurs at the same rate among practitioners as the general population. Practitioners have a mandatory duty to report an impaired colleague and it is considered to be best practice to seek counsel from other colleagues and institutional officials before reporting. The reporting practitioner is protected from liability if they are acting in good faith, honestly, and without malice. Practitioners also have a professional obligation to help an impaired colleague get the necessary medical care and rehabilitation. The health and wellness of practitioners is essential for fulfilling professional obligations and maximizing patient interests. The mandatory duty to report an impaired practitioner reduces individual liberty but promotes patient autonomy. The duty to report is a professional obligation and a matter of public justice to maintain the social trust in the medical profession. Practitioners must recognize the importance of not being impaired, reporting impaired colleagues, protecting patient safety, and promoting treatment and recovery.
**
Think
[26:1] An impaired practitioner is one whose medical judgment and practice have been compromised such that it:
- 1. violates the patient-practitioner relationship by exposing the patient to increased risks of harm,
- 2. violates the professional duty of maximizing the patient’s best interests, and
- 3. diminishes the community’s trust in the medical profession.
[26:2] Impairment can have various causes: psychoactive agents, prescription medications, aging, substance abuse, Alzheimer’s, psychiatric disorders, emotional disorders, and fatigue, to name a few. It is essential to recognize that substance use disorders (SUDs) occur at the same rate among practitioners as the general population.
[26:3] Medical practitioners, as stewards, have a mandatory duty to report an impaired practitioner legally, professionally, and morally. Reporting an impaired practitioner protects patients from harm and also protects the impaired practitioner from possible malpractice lawsuits. However, because of the sensitivity and potential hostility that can arise from reporting, it is advisable to seek counsel from other colleagues and a designated institutional official as a matter of due diligence when there is no immediate threat to a patient. The same legal protections for liability granted for reporting child and elder abuse will also apply to reporting an impaired practitioner so long as the reporting practitioner is doing so in good faith, sincerely, honestly, and without malice.
[26:4] Practitioners have a professional obligation to protect patients from an impaired practitioner and help the impaired practitioner get the medical care and recovery needed to eliminate the impairment. Reporting should be made first to the impaired practitioner’s local supervisor or superior, like the program director, department chair, or division head, and if that is not possible, then to the Medical Board of Medical Conduct or the State Health or Education Department.
[26:5] If a practitioner is in treatment, that in itself does not mean that the practitioner is impaired. Patient confidentiality and privacy are the same as any other patient-practitioner relationship, except; if confidentiality and privacy were to compromise the safety of patients and if there is a legal, professional and moral duty to divulge the protected health information (PHI). After successful treatment and rehabilitation, someone other than the treating practitioner should assist and monitor the recovered colleague while they resume safe and effective patient care.
[26:6] A practitioner’s health and wellness is an essential part of what it means to be a medical professional because, without it, the practitioner will not be able to:
- 1. honor the patient-practitioner relationship,
- 2. fulfill professional obligations and expectations necessary for maximizing the patient’s best interests, and
- 3. promote a positive public trust in the medical profession.
Every medical institution needs to have a supportive environment that promotes, maintains, and restores health and wellness. Proper diet, enough sleep and exercise, and exposure to art and the humanities are necessary elements for health and wellness.
Assess
Patient: 1) Autonomy
[26:7] The mandatory duty to report an impaired practitioner reduces individual liberty for both the reporter and the reported person. Mandatory reporting promotes patient autonomy (informed consent) because a patient can only make an informed practitioner authorization if the practitioner’s judgments are accurately grounded on evidence-based medicine. The impaired practitioner’s diagnosis, prognosis, risks, and benefits assessments of various treatments, including no treatment, answering the patient’s questions, and patient’s management, are all called into question with an impaired practitioner. Active measures of mandatory reporting must therefore be taken in order to protect the patient’s autonomous decision-making.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[26:8] Practitioners have a professional obligation to report an impaired practitioner, primarily to maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. This professional obligation to report an impaired practitioner is also a collegial duty for the benefit of the impaired practitioner so that the impaired practitioner can be helped and treated to come back and practice medicine effectively.
Public Policy: 4) Justice
[26:9] Justice is the public policy principle of fairness. Legally, practitioners are mandated to report an impaired practitioner to proper authorities. Failure to report is a Class A misdemeanor, and the non-reporting practitioner is legally liable for patient harm caused by non-reporting. Public knowledge of impaired practitioners diminishes the community’s trust in the medical profession, which increases the importance of timely identification of impaired practitioners so that they can be reintegrated through treatment and recovery.
Conclude
[26:10] All practitioners must recognize the importance of:
- 1. not being impaired,
- 2. reporting of impaired practitioners,
- 3. patient safety, and
- 4. treatment and recovery.
There are legal protections for reporting as long as the reporting practitioner sincerely and honestly suspects the medical-provider is impaired while treating patients. If the practitioner believes that a colleague is impaired while treating patients, then there is a legal, professional, and moral duty to report the incident regardless of explanations, justifications, or promises.
[26:11] In summary, practitioners must recognize the importance of not being impaired, reporting impaired colleagues, protecting patient safety, and promoting treatment and recovery. Legal protections exist for reporting practitioners acting in good faith, honestly, and without malice. Timely identification of impaired practitioners is critical to protect patients, help the impaired practitioner, and maintain public trust in the medical profession. Practitioners have a legal, professional, and moral duty to report incidents involving impaired colleagues, ensuring the safety and well-being of all involved.
**
26. Review Questions
1. An impaired practitioner is one whose medical judgment and practice have been compromised such that it:
2. Proper diet, enough sleep and exercise, and exposure to art and the humanities are necessary elements for health and wellness.
3. Mandatory reporting of an impaired practitioner promotes patient autonomy (informed consent) because a patient can only make an informed practitioner authorization if the practitioner’s judgments are accurately grounded on evidence-based medicine.
4. Professional colleagues do not have an obligation to report an impaired practitioner to benefit patients and the practitioner. Rather, the obligation is primarily a legal mandate.
5. Failure to report an impaired practitioner is a Class A misdemeanor, and the non-reporting practitioner is legally liable for patient harm caused by non-reporting.
**
CORRECT! 🙂
[26:1] An impaired practitioner is one whose medical judgment and practice have been compromised such that it:
1. violates the patient-practitioner relationship by exposing the patient to increased risks of harm,
2. violates the professional duty of maximizing the patient’s best interests, and
3. diminishes the community’s trust in the medical profession.
Wrong 😕
[26:1] An impaired practitioner is one whose medical judgment and practice have been compromised such that it:
1. violates the patient-practitioner relationship by exposing the patient to increased risks of harm,
2. violates the professional duty of maximizing the patient’s best interests, and
3. diminishes the community’s trust in the medical profession.
Wrong 😕
[26:6] A practitioner’s health and wellness is an essential part of what it means to be a medical professional because, without it, the practitioner will not be able to:
1. honor the patient-practitioner relationship,
2. fulfill professional obligations and expectations necessary for maximizing the patient’s best interests, and
3. promote a positive public trust in the medical profession.
Every medical institution needs to have a supportive environment that promotes, maintains, and restores health and wellness. Proper diet, enough sleep and exercise, and exposure to art and the humanities are necessary elements for health and wellness.
CORRECT! 🙂
[26:6] A practitioner’s health and wellness is an essential part of what it means to be a medical professional because, without it, the practitioner will not be able to:
1. honor the patient-practitioner relationship,
2. fulfill professional obligations and expectations necessary for maximizing the patient’s best interests, and
3. promote a positive public trust in the medical profession.
Every medical institution needs to have a supportive environment that promotes, maintains, and restores health and wellness. Proper diet, enough sleep and exercise, and exposure to art and the humanities are necessary elements for health and wellness.
CORRECT! 🙂
[26:7] The mandatory duty to report an impaired practitioner reduces individual liberty for both the reporter and the reported person. Mandatory reporting promotes patient autonomy (informed consent) because a patient can only make an informed practitioner authorization if the practitioner’s judgments are accurately grounded on evidence-based medicine. The impaired practitioner’s diagnosis, prognosis, risks, and benefits assessments of various treatments, including no treatment, answering the patient’s questions, and patient’s management, are all called into question with an impaired practitioner. Active measures of mandatory reporting must therefore be taken in order to protect the patient’s autonomous decision-making.
Wrong 😕
[26:7] The mandatory duty to report an impaired practitioner reduces individual liberty for both the reporter and the reported person. Mandatory reporting promotes patient autonomy (informed consent) because a patient can only make an informed practitioner authorization if the practitioner’s judgments are accurately grounded on evidence-based medicine. The impaired practitioner’s diagnosis, prognosis, risks, and benefits assessments of various treatments, including no treatment, answering the patient’s questions, and patient’s management, are all called into question with an impaired practitioner. Active measures of mandatory reporting must therefore be taken in order to protect the patient’s autonomous decision-making.
CORRECT! 🙂
[26:8] Practitioners have a professional obligation to report an impaired practitioner, primarily to maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. This professional obligation to report an impaired practitioner is also a collegial duty for the benefit of the impaired practitioner so that the impaired practitioner can be helped and treated to come back and practice medicine effectively.
Wrong 😕
[26:8] Practitioners have a professional obligation to report an impaired practitioner, primarily to maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. This professional obligation to report an impaired practitioner is also a collegial duty for the benefit of the impaired practitioner so that the impaired practitioner can be helped and treated to come back and practice medicine effectively.
CORRECT! 🙂
[26:9] Justice is the public policy principle of fairness. Legally, practitioners are mandated to report an impaired practitioner to proper authorities. Failure to report is a Class A misdemeanor, and the non-reporting practitioner is legally liable for patient harm caused by non-reporting. Public knowledge of impaired practitioners diminishes the community’s trust in the medical profession, which increases the importance of timely identification of impaired practitioners so that they can be reintegrated through treatment and recovery.
Wrong 😕
[26:9] Justice is the public policy principle of fairness. Legally, practitioners are mandated to report an impaired practitioner to proper authorities. Failure to report is a Class A misdemeanor, and the non-reporting practitioner is legally liable for patient harm caused by non-reporting. Public knowledge of impaired practitioners diminishes the community’s trust in the medical profession, which increases the importance of timely identification of impaired practitioners so that they can be reintegrated through treatment and recovery.
26. Clinical Vignettes
1. David O'Brien is a 45-year-old pharmacist who has been practicing for over 10 years. He has recently been exhibiting symptoms of impairment, including forgetfulness, fatigue, and difficulty concentrating during procedures. He has also been observed with slurred speech and difficulty walking. Clinical differential diagnosis includes substance abuse, psychiatric disorders, emotional disorders, and fatigue. An ethical question that arises is whether David O'Brien's colleagues have a professional obligation to report him for impaired practice.
2. Dr. Bianca Jenkins is a 38-year-old family medicine practitioner who has been practicing for over 10 years. Her colleagues have noticed that she has been having a decline in personal hygiene and physical appearance. Dr. Jenkins has a history of a high-stress lifestyle and has been neglecting self-care, including proper diet, enough sleep, and exercise. An ethical question that arises is whether Dr. Jenkins's colleagues have a professional obligation to report her for impaired practice.
3. Dr. Paloma Patterson is a 35-year-old family medicine practitioner who has been practicing for 8 years. Recently, she has been exhibiting signs of impairment, including poor communication with patients, poor clinical judgment, and difficulty maintaining her schedule. Her patients have complained about her poor bedside manner and inappropriate prescriptions. Her colleagues have also noticed her poor performance and behavior. The clinical differential diagnosis includes psychiatric disorders, substance abuse, and emotional disorders. An ethical question that arises is whether Dr. Patterson's colleagues have a professional obligation to report her for impaired practice.
4. Dr. Aurora Dubber is a 45-year-old pediatrician who has been practicing for over 20 years. Recently, her colleagues have noticed that she has become increasingly forgetful and disorganized. She has been misplacing important patient files and forgetting scheduled appointments. Dr. Dubber has also been slurring her speech and appearing drowsy during patient consultations. Her colleagues have observed that her behavior is not consistent with her past performance, and they suspect that she may have a substance use disorder. The differential diagnosis includes depression, anxiety, and other psychiatric disorders. What is the ethical obligation of Dr. Dubber's colleagues in this situation?
5. A practitioner’s colleagues are starting to have some concerns as to whether or not a fellow practitioner is starting to become impaired. Which of the following are signs that a practitioner's medical judgment and practice have been compromised, leading to impairment?
CORRECT! 🙂
Explanation: Colleagues have a professional obligation to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession [26:3]. The duty to report is a matter of public justice to maintain social trust in the medical profession [26:1]. It is not enough to ignore David O'Brien's impairment and hope it will pass, as this violates the professional duty of maximizing the patient’s best interests [26:2]. It is advisable to seek counsel from other colleagues and institutional officials before reporting, but the reporting practitioner is protected from liability if they are acting in good faith, honestly, and without malice [26:3]. The responsibility of reporting lies with the colleagues who observe David O'Brien's impairment, and it is not enough to leave it to the hospital administration [26:4]. Offering to help David O'Brien is a professional obligation but does not preclude the need to report him for impaired practice [26:4].
Wrong 😕
Explanation: Colleagues have a professional obligation to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession [26:3]. The duty to report is a matter of public justice to maintain social trust in the medical profession [26:1]. It is not enough to ignore David O'Brien's impairment and hope it will pass, as this violates the professional duty of maximizing the patient’s best interests [26:2]. It is advisable to seek counsel from other colleagues and institutional officials before reporting, but the reporting practitioner is protected from liability if they are acting in good faith, honestly, and without malice [26:3]. The responsibility of reporting lies with the colleagues who observe David O'Brien's impairment, and it is not enough to leave it to the hospital administration [26:4]. Offering to help David O'Brien is a professional obligation but does not preclude the need to report him for impaired practice [26:4].
Wrong 😕
Explanation: Practitioners' health and wellness are essential for fulfilling professional obligations and maximizing patient interests [26:6]. Proper diet, enough sleep and exercise, and exposure to art and the humanities are necessary elements for health and wellness [26:6]. Dr. Jenkins's appearance is a result of a high-stress lifestyle and a lack of self-care, which is a known factor that can affect a practitioner's ability to practice medicine [26:2]. While colleagues have a professional obligation to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession, it is not the only course of action in this case [26:3]. Dr. Jenkins should be encouraged to seek help and take time off to care for herself. This may involve encouraging her to take a leave of absence and prioritize self-care [26:6]. Reporting should be made first to the impaired practitioner's local supervisor or superior, but it is not necessary to report Dr. Jenkins in this case [26:4]. While colleagues have a duty to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession, consulting with a mental health professional in this case is not necessary [26:2]. It is not enough to ignore Dr. Jenkins's impairment and hope it will pass, as this violates the professional duty of maximizing the patient’s best interests [26:2].
CORRECT! 🙂
Explanation: Practitioners' health and wellness are essential for fulfilling professional obligations and maximizing patient interests [26:6]. Proper diet, enough sleep and exercise, and exposure to art and the humanities are necessary elements for health and wellness [26:6]. Dr. Jenkins's appearance is a result of a high-stress lifestyle and a lack of self-care, which is a known factor that can affect a practitioner's ability to practice medicine [26:2]. While colleagues have a professional obligation to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession, it is not the only course of action in this case [26:3]. Dr. Jenkins should be encouraged to seek help and take time off to care for herself. This may involve encouraging her to take a leave of absence and prioritize self-care [26:6]. Reporting should be made first to the impaired practitioner's local supervisor or superior, but it is not necessary to report Dr. Jenkins in this case [26:4]. While colleagues have a duty to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession, consulting with a mental health professional in this case is not necessary [26:2]. It is not enough to ignore Dr. Jenkins's impairment and hope it will pass, as this violates the professional duty of maximizing the patient’s best interests [26:2].
CORRECT! 🙂
Explanation: Colleagues have a professional obligation to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession [26:3]. The duty to report is a matter of public justice to maintain social trust in the medical profession [26:1]. It is not enough to ignore Dr. Patterson's impairment and hope it will pass, as this violates the professional duty of maximizing the patient’s best interests [26:2]. It is advisable to seek counsel from other colleagues and institutional officials before reporting, but the reporting practitioner is protected from liability if they are acting in good faith, honestly, and without malice [26:3]. The responsibility of reporting lies with the colleagues who observe Dr. Patterson's impairment, and it is not enough to leave it to the hospital administration [26:4]. Confronting Dr. Patterson directly and giving her a chance to seek help is a professional obligation, but does not preclude the need to report her for impaired practice [26:4].
Wrong 😕
Explanation: Colleagues have a professional obligation to report an impaired practitioner to protect patients from harm and maintain public trust in the medical profession [26:3]. The duty to report is a matter of public justice to maintain social trust in the medical profession [26:1]. It is not enough to ignore Dr. Patterson's impairment and hope it will pass, as this violates the professional duty of maximizing the patient’s best interests [26:2]. It is advisable to seek counsel from other colleagues and institutional officials before reporting, but the reporting practitioner is protected from liability if they are acting in good faith, honestly, and without malice [26:3]. The responsibility of reporting lies with the colleagues who observe Dr. Patterson's impairment, and it is not enough to leave it to the hospital administration [26:4]. Confronting Dr. Patterson directly and giving her a chance to seek help is a professional obligation, but does not preclude the need to report her for impaired practice [26:4].
Wrong 😕
Explanation: Dr. Dubber's colleagues have a professional obligation to report any suspicions of impairment, which can harm patients and diminish public trust in the medical profession. It is best practice to seek counsel from other colleagues and institutional officials before reporting, as the process can be sensitive and potentially hostile [26:3]. Dr. Dubber's colleagues have a professional obligation to protect their patients from harm, and they should encourage her to seek treatment to eliminate the impairment [26:4]. Keeping quiet about their suspicions until there is clear evidence of substance abuse would put patients at risk and violate their professional obligation to report any suspicions of impairment [26:3]. Anonymous reporting is not encouraged, and practitioners have a professional obligation to report an impaired colleague legally, professionally, and morally [26:3]. Ignoring Dr. Dubber's behavior and letting her continue to practice medicine would violate their professional obligation to protect their patients from harm [26:4].
CORRECT! 🙂
Explanation: Dr. Dubber's colleagues have a professional obligation to report any suspicions of impairment, which can harm patients and diminish public trust in the medical profession. It is best practice to seek counsel from other colleagues and institutional officials before reporting, as the process can be sensitive and potentially hostile [26:3]. Dr. Dubber's colleagues have a professional obligation to protect their patients from harm, and they should encourage her to seek treatment to eliminate the impairment [26:4]. Keeping quiet about their suspicions until there is clear evidence of substance abuse would put patients at risk and violate their professional obligation to report any suspicions of impairment [26:3]. Anonymous reporting is not encouraged, and practitioners have a professional obligation to report an impaired colleague legally, professionally, and morally [26:3]. Ignoring Dr. Dubber's behavior and letting her continue to practice medicine would violate their professional obligation to protect their patients from harm [26:4].
CORRECT! 🙂
Explanation: An impaired practitioner is one whose medical judgment and practice have been compromised, leading to a violation of the patient-practitioner relationship by exposing the patient to increased risks of harm, violating the professional duty of maximizing the patient's best interests, and diminishing the community's trust in the medical profession [26:2]. Making frequent errors in documentation and medical records can be considered a sign of impaired judgment and practice, and it can compromise patient safety and the overall trust in the medical profession. Being absent from work due to a chronic medical condition does not necessarily indicate impaired judgment or practice, and it may be a protected medical condition under the Americans with Disabilities Act (ADA) [26:5]. Failing to attend mandatory professional development training sessions may indicate unprofessional behavior, but it does not necessarily indicate impaired judgment or practice. Prescribing medication outside the scope of one's specialty is a violation of professional practice, but it does not necessarily indicate impaired judgment or practice.
Wrong 😕
Explanation: The practitioner has a professional obligation to report Mrs. Kim to the DMV for a possible license suspension. Diabetes can cause complications that can impair a driver's ability to operate a vehicle safely, such as neuropathy, visual impairment, and hypoglycemia [25:1]. Reporting Mrs. Kim's condition to the DMV for a possible license suspension is necessary to ensure public safety and prevent harm [25:1]. Discharging Mrs. Kim without discussing the impact of her condition on her ability to drive is not an ethical option, as it fails to ensure that Mrs. Kim receives appropriate care and may put others at risk. Prescribing medication to manage Mrs. Kim's blood sugar levels and allow her to continue driving is not appropriate in this case, as it does not address the underlying issue of impaired driving and may put others at risk. Advise Mrs. Kim to self-report her condition to the DMV may be appropriate in some cases, but it is the practitioner's responsibility to ensure that the patient understands the mandatory reporting requirements [25:2]. Therefore, the correct answer is to report Mrs. Kim to the DMV for a possible license suspension to ensure public safety. The practitioner should also work with Mrs. Kim to develop a treatment plan to manage her diabetes and minimize the risk of harm to herself and others.
**
26. Reflection Vignettes
1. Dr. Jane Smith, a 40-year-old physician, is out for a night on the town with several colleagues. As the evening progresses, one colleague who is on call begins to get particularly tipsy. Later in the evening, the colleague receives a call related to a patient care issue, and Dr. Smith notices that the tipsy practitioner is providing medication orders over the phone. The differential diagnosis includes alcohol impairment, professional misconduct, and patient safety concerns. Dr. Smith approaches the colleague and expresses concern about the situation, emphasizing the importance of clear and focused thinking when making medication orders or providing patient care. Dr. Smith offers to help and instructs the colleague to hand over the call to another physician who is sober and better able to provide safe and effective care for the patient. Dr. Smith also emphasizes the importance of professionalism and appropriate conduct, even outside of work, and the need to prioritize patient safety above all else.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Mr. James Lee, a 45-year-old physician, works at a local teaching hospital and seems to treat patients effectively but has difficulty remembering patients' names and medical conditions. The differential diagnosis includes age-related memory decline, attention deficit disorder, and other cognitive impairments. Despite these challenges, Mr. Lee compensates for his memory difficulties by diligently reviewing each patient's medical records before each visit. This enables him to provide effective and comprehensive care to his patients, despite his memory limitations. The practitioner also ensures that he takes detailed notes during patient visits to help him remember important details for future reference. While Mr. Lee's proactive approach to managing his memory difficulties seems to ensure that he can provide safe and effective care to his patients, the increased risk of memory lapses in patient diagnosis, treatment and management care is unacceptable.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
