Psychiatrically impaired medical practitioners: better care to reduce harm and life impact, with special reference to impaired psychiatrists.
OBJECTIVE
The aims are to briefly review treatment outcomes for impaired practitioners, and to explore how preventive and early intervention, and the accessing of and retention within treatment systems for impaired medical practitioners, and particularly psychiatrists, could be improved to maximize the doctors' chances of full recovery and to minimize danger to self and others.


METHODS
The literature on the treatment and care of medical practitioner impairment due to mental illness, and substance use, with special reference to impaired psychiatrists is briefly reviewed. The implications of deficiencies of usual clinical management of doctors impaired by mental illness and opportunities for improvement in services for them are explored, including the impact of the experience of being an impaired medical practitioner under psychiatric treatment. The roles of medical boards and advisory services are examined.


RESULTS
Medical practitioner impairment due to mental illness has a severe impact on doctors' lives and the lives of their families due to both the effects of the disorder and the experience of communal, professional and self stigma and discrimination. Deficiencies in usual practice in the treatment and rehabilitation of such individuals are identified, and alternatives explored.


CONCLUSIONS
Prevention, early detection, intervention, and treatment programs that are more continuous more sensitive to the needs of impaired practitioners, that are more continuous, better structured, and rehabilitation and recovery focused, may be more likely to produce a positive outcome.
Rosen
Alan
A
Department of Psychological Medicine, University of Sydney, and School of Public Health, University of Wollongong, Chatswood, NSW, Australia. arosen@nsccahs.health.nsw.gov.au
Wilson
Andrew
A
Randal
Patte
P
Pethebridge
Andrew
A
Codyre
David
D
Barton
David
D
Norrie
Peter
P
McGeorge
Peter
P
Rose
Lynette
L
D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D001315:Australia; D002055:Burnout, Professional / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D015897:Comorbidity; D003219:Confidentiality / Q000331:legislation & jurisprudence; D042241:Early Diagnosis; D054541:Family Conflict / Q000523:psychology; D040261:Harm Reduction; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D019221:Mandatory Reporting; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D008611:Mentors; D009520:New Zealand; D010815:Physician Impairment / Q000331:legislation & jurisprudence / Q000523:psychology*; D010819:Physician's Role; D011287:Prejudice; D011570:Psychiatry; D012752:Shame; D012944:Social Support; D013044:Specialty Boards / Q000331:legislation & jurisprudence; D013240:Stereotyping; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*