to the editor: I noticed this title, “Dealing with the Impaired Physician,” on the November 1, 2009, cover of American Family Physician and went to it with interest, as I am an impaired physician. I was disappointed the authors of this Curbside Consultation included this definition of “impaired physician” by the American Medical Association: “unable to fulfill professional and personal responsibilities because of a psychiatric illness, alcoholism, or drug dependency.”¹ I hope that this is not the current definition, as it is much too narrow. Physicians in a practice need to understand that there are many situations in which a fellow physician may become impaired, and they should be ready and able to offer help and appropriate referral for medical care or professional evaluation by state Physician Health Programs (PHPs) as needed. PHPs are present in most, if not all, states. The Colorado PHP is a nonprofit organization, independent of other medical organizations and the government that provides the peer assistance services for licensed physicians and physician assistants of Colorado. Confidential peer assistance services aid individuals who have any problems (emotional, psychological, or medical) that would affect ones' health.

In my situation, I slipped and fell on ice and “rang my bell.” Unfortunately, it was my sixth concussion and I had significant cognitive consequences. I continued to see patients and managed a primary care medical office for four days after this incident before consulting with a partner about my bothersome cognitive issues. I had commented to peers that I had fallen and hit my head, and that I had been experiencing subsequent double vision (a computed tomographic scan was normal) and was having difficulty with my memory and finding words. No one who heard this information seemed to consider that I might be impaired. In later discussions with patients I had seen during this time, I learned that they were aware that I was not functioning normally, but had not felt it was their place to say anything to me or anyone else.

All practicing physicians need to be aware that many situations may lead to physician impairment, including but not limited to substance abuse and psychiatric illness. Trauma (including mild traumatic brain injury), brain tumors, or progressive neurologic diseases could also lead to impairment. In these cases, the impaired person may not even realize they have a problem as the functions of self-perception and perception could be impaired. We all need to be aware of the potential for impairment with certain trauma and medical conditions and refer fellow physicians for appropriate evaluations.