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Correction

Committee on Physician Well-Being:
a doctor's advocate

by: Raymond Gaeta

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Among the many committees at the hospital, the Committee on Physician Well-Being is probably the least well-known and the most misunderstood.

Chaired by pediatric gastroenterologist William Berquist, the committee is charged with helping and advocating for members of the medical staff (including community physicians and house staff) whose practice has become or could become impaired by substance abuse or behavioral issues that have been deemed detrimental to the workplace environment. Before I started serving on the committee six months ago, I - like many other physicians - thought a referral to the Well-Being Committee was tantamount to a professional death sentence.

Actually, I couldn't have been further from the truth. The committee acts as an advocate for physicians, helping them deal with their problems so they can successfully continue their medical careers.

The committee is composed of senior clinicians in a variety of specialties, from the university and community, and it also includes clinical psychologists who serve as a valuable resource. Physicians may self-refer, though most referrals come from peers or colleagues. A physician might be referred following a specific incident such as a medical error that's suspected to be related to a drug, alcohol or behavior problem. Or the physician might be referred simply because there are signs that he or she may have a problem. In all cases, the identities of those referred, and the deliberations of the committee, are kept confidential. All physicians, from new house officers to the most senior physicians, are treated the same way regarding due process and non-disclosure.

When a physician is referred to the Well-Being Committee, the first step is an information-gathering process in which the committee speaks with the referring individual and other sources to get a clear picture of the situation. A meeting is then arranged with the referred physician, at which the committee and the physician discuss the situation and attempt to identify the problem. Depending on the circumstances, the physician may be asked to see a psychotherapist, an addiction specialist or other health-care providers. Based on this information and discussions with the physician, an action plan is developed, which may later be formalized into a signed contract between the committee and the physician. The action plan often includes outpatient or inpatient substance abuse treatment. Depending on the circumstances, it may also include limitations on the physician's medical practice.

Those referred to the Well-Being Committee are also assigned a worksite monitor - generally a colleague - who monitors the physician's activities and progress. If any incidents arise in the workplace, the worksite monitor can quickly intervene by investigating the incident or facilitating a drug test if appropriate. A member of the committee serves as a liaison with the worksite monitor to ensure the physician's continued success.

I want to emphasize that at this point, the deliberations of the committee are not punitive but are intended to facilitate the physician's successful reintegration back into medical practice. The group views itself as an advocate for the referred physicians, providing them with guidance and helping them deal appropriately with their specific issues.

When irregularities occur, the physician and worksite monitor may be invited to a committee meeting to explain the circumstances, and in many cases these are nothing more than misunderstandings. In such cases, the physician is counseled on adopting more appropriate behaviors or reactions. In other cases, the physician may be advised that drug and alcohol screens obtained immediately after the incident would be an unequivocal way of demonstrating that the physician was not under the influence of these substances.

Despite best efforts, some physicians do relapse into substance abuse or inappropriate behavior. When this happens, the committee is available to develop new care plans and to continue working with the physician toward success. Physicians who repeatedly fail to comply with the committee's requirements, however, are referred to the chief of staff and the hospital's medical board - and sometimes the state board as well - for review and possible disciplinary action. Clearly this is the last choice of the Well-Being Committee, but in some cases it is necessary to protect the public and the integrity of the medical field.

It's important to note that over the years, the Well-Being Committee has helped many physicians overcome their problems and continue practicing medicine with integrity. In several cases, the physicians involved have said they later realized what a positive impact the group had on them, by helping them gain insight into their behavior and make changes that proved beneficial in their personal and professional lives.

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For more information about the Committee on Physician Well-Being, contact Raymond Gaeta at (650) 725-5352 or at gaeta@stanford.edu, or contact William Berquist at (650) 498-5603 or berquist@stanford.edu.