Otolaryngologists Discuss Difficult Ethical Issues

PHOENIX-When faced with sticky ethical issues-such as a colleague who periodically shows up to work smelling of alcohol, or getting complaints from staff about inappropriate behavior from another doctor-what should be done?

At a Triological Society session at the recent Combined Otolarygnology Spring Meeting (COSM), panelists discussed how they would handle a series of uncomfortable scenarios. The panel did not include bioethicists or advocates for a reason, Harold Pillsbury, MD, Professor of Otolaryngology-Head and Neck Surgery at the University of North Carolina School of Medicine and the session’s moderator, told ENT Today. The session was designed to see how otolaryngologists would respond to difficult situations in real-life practice.

Panelists included Gerald Healy, MD, Professor of Otology and Laryngology at Harvard Medical School; Derald Brackmann, MD, Professor of Otolaryngology and Neurosurgery at the University of Southern California; Paul Levine, MD, Professor of Otolaryngology-Head and Neck Surgery at the University of Virginia; and Robert Maisel, MD, Professor of Otolaryngology-Head and Neck Surgery at the University of Minnesota.

First, Protect the Patients

The first scenario was of a 40-year-old surgeon with no history of problems related to his surgeries to date, but was reported to his department chief to have alcohol on his breath at work. The physician is often late for conferences and rounds.

According to Dr. Healy, who previously chaired the Judiciary Committee of the American College of Surgeons, it is not common to see physicians with a drinking problem. But the first and foremost thing is that patients be protected, he said.

It is critical for the chief of staff to collect as much information as possible, and review it so that the physician in question undergoes due process. The doctor needs to be told to deal with it, and he or she should no longer see patients or operate until after he or she has received help. Most states have addiction programs designed for physicians, he said.

However, he noted that many hospitals do not have formal rules or regulations for dealing with this. If this is the case, it’s important that physicians go to the hospital leadership and start the process for creating a system to deal with such issues.

Dr. Levine added that the goal is to help a doctor with an addiction problem get back on track with their career. Make it clear helping them get help isn’t a punishment, he said.