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A Call to Restore Your Calling

Self-Care of the Emergency Physician in the Face of Life-Changing Stress–Part 3 of 6

Physician Illness and Impairment

Mull, Colette C. MD*; Thompson, Amy D. MD*; Rappaport, David I. MD; Gartner, J. Carlton Jr MD; Bowman, Wesley R. PhD

Section Editor(s): Mull, Colette C. MD; Editor

doi: 10.1097/PEC.0000000000001896
Physician Wellness/Burnout

Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, physician impairment, and substance use disorder (SUD) are defined. We call attention to the potential for harm of dated cultural norms, which often fuel physicians' neglect of their own health and development of ill-advised coping skills.

Although any medical condition may become a functional impairment, the primary cause of physician impairment is SUD. Alcohol and prescription opioids top the list of substances used in excess by physicians. Although SUD is less prevalent in residency, we focus on the rise of marijuana and alcohol use in emergency medicine trainees. A nonpunitive model for the prevention and treatment of SUD in residency is described.

Physicians are ethically and legally mandated to report any concern for impairment to either a state physician health program or a state medical board. However, recognizing physician SUD is challenging. We describe its clinical presentation, voluntary and mandated treatment tracks, provisions for protecting reporters from civil liability, prognosis for return to practice, and prevention efforts. We underscore the need to model healthy coping strategies and assist trainees in adopting them.

In closing, we offer our colleagues and trainees today's to-do list for beginning the journey of reclaiming your health. We also provide resources focused on the practical support of ill and/or impaired physicians.

From the *Division of Emergency Medicine

Division of General Pediatrics, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Sidney Kimmel Medical College, Thomas Jefferson University

Employee Assistance Program, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE.

Disclosure: The authors declare no conflict of interest.

Reprints: Colette C. Mull, MD, Division of Emergency Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd.Wilmington, DE (e-mail:

Online date: July 22, 2019

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