Indicators of Impairment


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 ┬átraining. Reluctance to have laboratory tests or physical exam performed. Isolation for professional community. Insurability problems.

Professional Relationships (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 disruptions 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.