Not only do colleagues have a duty to protect patients, they put their own practices at risk if they don't intervene, since partners can be liable for each other's malpractice, Dr. Pickering said.
She recommended that physicians concerned about a colleague's impairment begin the intervention with a friendly one-on-one conversation, optimistic in tone and including an offer to help. This could include an offer to join the colleague in answering the CAGE questions, which are aimed at revealing alcohol abuse.
If this approach doesn't end the problem, the next step is to document poor performance with specific evidence, not hearsay. A collegial meeting with a few peers can follow after that.
"Unfortunately, the hallmark of impairment is denial and rationalization, not just on the part of the impaired individual but also on the part of bystanders," said Dr. Pickering, quoting a 2014 article on EyeNet.
Next would come a formal confrontation, such as contacting the chief of ophthalmology or a hospital executive.
She pointed out that state medical associations often offer confidential help lines. Most regulatory bodies allow physicians to return to work after treatment for substance abuse, and only 20% of those who enrolled in a monitoring program relapse within 5 years, according to the Can J Anesth study.
"Self-care has to come before caring for others," Dr. Pickering concluded.