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    Ophthalmologists called upon to help impaired colleagues

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    Ophthalmologists must take an active role in preventing impaired colleagues from hurting patients, according to Terri Pickering, MD.

    "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, clinical instructor, California Pacific Medical Center, at the Glaucoma 360 22nd annual glaucoma CME program.

    Ten percent of all physicians become impaired at some point during their careers. But 90% of physicians recover and return to a functional life, compared with only half of the general population, she said, citing a study in Can J Anesth (2017;64:219-235).

    Physicians fall prey to career burnout, substance abuse, neurologic disease, vision pathologies, common aging decline, emotional and psychological problems, orthopedic issues, and anger and boundary issues.

    Burnout predicts medical error more strongly than fatigue, and half of orthopedic surgeons report suffering from it, which is close to the 54% reported for all specialties, Dr. Pickering said, citing a study in CMAJ (2017:E1236-7).

    "It's not only the number of patients and hours but the frustrations," she said. That sensation comes with a territory that includes fluctuating reimbursements, fears of malpractice, complex regulations, shifting electronic health records and coding systems, and patients who don't follow advice.

    Aging and mid-life diseases take their toll but don't necessarily end the practitioner's career. For example, a doctor with Parkinson's disease may retain the fine-motor control and reaction time necessary for medical procedures despite a tremor. Orthopedic problems can also be overcome.

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