Reuben D B, Noble S
Department of Community Health, Brown University, Providence.
JAMA. 1990 Feb 16;263(7):958-60.
Although physician impairment may have substantial personal and clinical consequences, it is commonly held that physicians fail to act in the case of impaired colleagues. To learn about initial responses when confronted with impaired house officers and attending physicians, we administered five case scenarios to all 76 internal medicine house officers at a large, urban, teaching hospital. House officer responses to an alcohol-impaired physician differed depending on whether that physician was an attending physician or a house officer. Seventy-two percent of house officers would tell the chief resident about the alcohol-impaired attending physician, whereas 96% would confront the alcohol-impaired house officer personally. The most common response to the incompetent attending physician (67%) and the incompetent house officer (49%) was to tell the chief resident; only 25% would confront an incompetent house officer. In contrast, 71% would confront a depressed house officer.
尽管医生的职业损伤可能会带来重大的个人和临床后果，但人们普遍认为，医生在面对同事出现职业损伤时往往不会采取行动。为了了解面对出现职业损伤的住院医师和主治医师时的初步反应，我们向一家大型城市教学医院的所有76名内科住院医师提供了五个病例场景。住院医师对酒精所致职业损伤医生的反应因该医生是主治医师还是住院医师而有所不同。72%的住院医师会将酒精所致职业损伤的主治医师的情况告知总住院医师，而96%的住院医师会亲自与酒精所致职业损伤的住院医师对峙。对不胜任的主治医师（67%）和不胜任的住院医师（49%）最常见的反应是告知总住院医师；只有25%的人会与不胜任的住院医师对峙。相比之下，71%的人会与情绪低落的住院医师对峙。
