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State of NevadaBoard of Medical Examiners
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Nevada State Board of Medical Examiners'
Diversion Program
Administered by the Nevada Health Professionals
Assistance Foundation
The
Nevada Health Professionals Assistance Foundation (NHPAF) was formed in the fall
of 1996 to provide support to health care professionals in the state of
Clinicians
suffering from psychiatric illnesses, especially drug addiction and alcoholism,
may be referred to the NHPAF by themselves (most often under pressure from
others), their colleagues, regulatory agencies, hospitals, families, pharmacies,
a physician who is treating them, hospitals and others.
Initially, the illness is manifested as difficulties in marital,
financial, social and legal areas. The
last area affected by the illness is the practice setting.
1. Change in Personality.
2. Increasingly irritable and
moody at work or social events.
3 Difficulties or
arguments (with nurses and other hospital personal progressing to colleagues and
patients).
4. Absences from work or
canceling office hours especially on Monday or the day after a major holiday
weekend.
5. Absences often attributed
to other illnesses as well as to financial or social crisis.
6. Rounds at unusual hours,
late in the evening or very early in the morning.
7. Deficits in clinical record
keeping.
8. Difficulties reaching the
physician by page or phone.
9. Arrests for a drinking and driving offense or for unacceptable
behavior.
10. Intoxicated at social functions including job-related
functions.
11. As the illness continues into more severe stages there is obvious impairment at the worksite, including the odor of alcohol on the clinician’s breath, signs of intoxication and passing out after using intravenous medication on a bathroom break (seen in anesthesiologists addicted to high potency anesthetic agents).
12. Finally, withdrawal from social activities and isolation from
colleagues and social support systems.
If
you notice the above changes in clinicians, they may be suffering from an
illness which can be treated so that they can continue or return to the safe and
effective practice of medicine.
Contact
to refer or ask questions:
The
NHPAF can be helpful when an intervention is needed.
After physicians are identified
or suspected to have an illness they may need an intervention which may utilize
confrontation or techniques of persuasion and motivation (with stages of pre-contemplation,
contemplation, preparation, action, and maintenance).
Most interventions today use a combination of approaches personalized to
the specific clinician, his or her work setting and his or her support system.
A major point to remember is to never
confront the physician or other health care professional who you think may be
suffering from an illness described above alone by yourself.
He or she will just tend to disqualify you and may avoid you in the
future. Always approach with at
least one other person, and preferably under the guidance of the NHPAF.
Among
other things, NHPAF works with hospitals, group practices and surgical centers
in developing policies and using techniques in approaching physicians who are
disruptive. Although disruptive
behavior may take many forms, there are usually two categories of observed
behavior. The first is inappropriate
response to patient needs or staff requests, which includes late or
unsuitable replies to pages or calls, unprofessional demeanor or conduct, lack
of or refusal to be cooperative with others and approaching problems with rigid,
inflexible responses to requests for assistance or cooperation.
The second is the progression from the lack of regard for personal
comfort and dignity of others to the use of inappropriate
or offensive words or actions directed toward another person, including sexual
comments or innuendoes, sexual harassment, behavior which is seductive or
aggressive, including verbal or physical assault, along with, racial, ethnic, or
socioeconomic slurs.
When
clinicians are referred to NHPAF, they are first sent for an independent medical
evaluation, since the behavior may be due to a variety of illnesses such as
bipolar depression, major depression, alcohol or drug dependence, other
addiction, a neurological illness or a metabolic disorder.
One of the most tragic results of such an evaluation was a physician who
was diagnosed to suffer from Huntington's
Disease. Where there is no
identifiable illness, NHPAF uses a wellness model to promote better coping by
aiding clinicians in the development of effective coping styles related to their
work or practice. Mentoring and
coaching by a fellow clinician is also helpful.
Sometimes brief consoling identifies and addresses issues contributing to
the behavior. NHPAF may refer
clinicians to courses which review boundary issues and elements of
professionalism inherent in their work environment.
Clinicians who participate in the NHPAF may appreciate the positive
changes they see in themselves as well as in their professional, social and
family lives.
The
NHPAF is a member of the Federation of State Physician Health Programs (FSPHP).
Additional information about the FSPHP can be found at the http://www.fsphp.org
internet site.
You
may make a confidential referral to NHPAF or may want to ask questions about the
program.
If
so, contact the NHPAF:
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