Confrontation

Vignette #4 considers physician impairment and physician to physician relationships: Actors: Confronting physician (Larry), impaired physician (David) Scene: Larry and David are in the surgeon’s locker room. David has a towel over his shoulder. Larry: Hey Dave. Have you got a minute? David: Yeah, sure Larry. What’s up? Larry: Uh, Dave, this isn’t an easy subject for me to bring up, but I know you are using drugs. David: Whoa Larry! Where did that come from? Nothing could be further from the truth. Larry: That case we just finished. I agree it was difficult, but you were jumpy as a cat on coals. David: That was just it. The case was a bear. Six hours into the case… the clotting factors were depleted. Everything just bled and bled and bled. It was very frustrating. Of course, I was jumpy. Larry extends his hand with a capsule in his palm: Dave, this fell out of your pocket in the locker room last week. I took it to our hospital pharmacist. She tells me it's a type of meth-amphetamine. What are you thinking? Dave in defensive posture: Nah! That pill could belong to anyone. Larry: Cut the crap, Dave. I'm your friend, but I have to go to the Medical Director if you don’t come clean. David: OK, I take them once in awhile. It’s not like I’m addicted or anything. You know the divorce and all. I don’t sleep at night. Then I have to be alert here at work. You know the ridiculous hours we put in here. You’ve got to cut me some slack. Keep it quiet, and I’ll clean up my act. Action freezes to signal the end of the vignette. Questions for the small groups: How can you respond to an impaired physician? What are the characteristics of a stressed physician? What prevents us from offering help? How do you recognize the right time to approach another physician? To what extent are we responsible for our fellow physicians? Can you think of a successful intervention? Without disclosing identities, can you say why it worked well. Questions for the large group: What was the most important concept that you discovered during your conversation? Can you name one thing that you will do personally to help your colleagues?