Indicators of Impairment
Personal
- Negative world view characterized by anxiety, depression, guilt, anger
- Multiple medical problems:
- Hypertension
- tachycardia
- gout
- gastritis
- sleep disturbances
- sexual problems
- Self-medication including mood altering chemicals
- Delusional ideation i.e. “It can’t happen to me.”
- Frequent or unusual accidents
- DWI charges or other legal difficulties
- Behavior that is in conflict with personal values
Family and Interpersonal
- Family conflict
- Isolation and withdrawal from family and family activities
- Unexplained absences
- Acting out behavior by children
- Dissolution of marriage
- Increasing dysfunctional family system
- Spouse and other family members assume duties and obligations of impaired person
- Family attempt to “cover up” for the impaired person’s behavior
- Family members accept blame for the person’s impairment
- Unsuccessful attempts to “Normalize” the family
- Family or spouse develop a negative world view characterized by fear, anxiety, depression, guilt and anger
- Withdrawal from normal community activities and relationships
Work History or Resume Clues
- Unexplained gaps in resume
- History of previous limitations on licensure
- Frequent job changes and “geographical cures”
- Problem of verifying references or resume itself
- Unusual medical problems or disabilities
- Application for specific job does not seem compatible to level of professional training
- Reluctance to have laboratory tests done or physical exam performed
- Isolation from professional community
- Insurability problems
Office
- Inappropriate behavior at medical meetings
- Concern by Associates of change in attitude and/or behavior
- Adverse changes in professional demeanor
- Long absences from the office with disruption of patient appointments
- Associates become “professional enablers”
- Assume impaired person’s duties
- Makes excuses for impaired person
- Try to “wait it out”
- Become embarrassed by the impaired person’s behavior
- Complaints by office personnel and/or patients
- Malpractice suites
- Complaints to grievance committees
- Changes in ordering and prescribing practices regarding mood altering drugs
Professional Relationships (Hospital)
- Avoidance of peers
- Making rounds at unusual times
- Missing rounds
- Patient complaints
- Inappropriate dress and/or hygiene
- Change in handwriting
- Change in quality of progress notes
- Unusual or inappropriate orders
- Excessive laboratory tests
- Excessive consultation
- Poor response time to hospital pages, i.e. “The broken beeper syndrome”
- Hospital personnel question competence and/or behavior
- Frequent citations by review panels i.e., quality assurance panels
- Involvement in litigation against hospital
- Practice in areas of medicine for which the person is not qualified
Resources for Chemical Dependency
On Impulsivity: The Neuroscience of Behavior Associated with Addiction
ASAMAGAZINE | June 12, 2014
Impulsivity – or the inability to inhibit responses despite their negative consequences – may partly explain why some individuals are more prone to develop addiction when exposed to drugs of abuse and offer clues for providing treatment. Read the complete article.