When unforeseen circumstances arise, such as illness or injury, physicians should work together to come to the best solution on a case-by-case basis. Departments should strive to develop a jeopardy call system if feasible. If this is not feasible, such as in a small group, physicians should work together to ensure that physicians are functioning at their best to ensure patient safety and quality of care. This may necessitate trading shifts or working extra shifts to cover for a physician who is not fit for duty.

Case 3: I Smell Alcohol

Dr. A arrives at work late, disheveled, and with alcohol on her breath. What is the duty of the physician she will be relieving?

Emergency physicians routinely interact at shift change. This is an opportunity to interact with each other to ensure fitness for duty. On rare occasions, it may be evident that a colleague is impaired in some way, such as by fatigue, stress, mental health issues, or substance abuse. In such cases, physicians have a duty to work together to support each other and arrive at a plan of action to ensure patient safety. In the short term, a physician who is impaired should not be providing patient care. This may be very uncomfortable to address and may necessitate involvement of the department chair or medical director. A plan of action may include temporary removal from clinical duties, a mental health evaluation, and inpatient or outpatient treatment to ensure physician recovery. Failure to address issues that directly affect patient safety are an abdication of professional responsibility.

Case 4: Caring for the Career

Dr. B, one of your longstanding colleagues, returned from a tour of duty in Iraq within the last year. Lately, he has appeared more quiet and withdrawn and is slower and less interested in his patients. As quality assurance (QA) director, you know he has also had several patient complaints in the last three months with the similar theme of patient dissatisfaction with not receiving opioids for chronic pain. Has he provided a lower quality of care for not “adequately” addressing pain? For lacking empathy? Does your role as QA director give you any additional insights in helping your friend navigate under the circumstances?

Dr. B’s decreased interest in his patients is worrisome and the central issue of this case. This decreased interest may represent a lack of empathy or something else. Physician empathy is a crucial part of interacting with patients. Conversationally, it often provides hope and the shared understanding needed by the patient for healing purposes and provides a meaningful dimension to the medical professional’s work life. If it is potentially missing or coincides with personality changes, it may be indicative of underlying psychiatric issues or substance abuse or dependence. Dr. B should be reminded of any services or resources offered by the department or hospital.