CMDA's The Point

Identifying Healthcare Professionals Who May No Longer Be Able to Care for Patients

June 10, 2021
06102021POINTBLOG

by Robert E. Cranston, MD, MA (Ethics)

Editor’s Note: This is the first of a two-part blog post addressing the issues of identifying healthcare professionals who may no longer be fully able to perform their roles and functions in caring for patients. The second part will focus on finding appropriate ways to remedy practice deficits, alter job descriptions or support such healthcare professionals in continuing to serve the Lord, in or out of their professional roles.

Introduction
As Christian healthcare professionals, God has granted us the high privilege and responsibility of serving others through healthcare. Part of this responsibility is that of maintaining clinical knowledge and skill in order to provide high quality care to our patients. If we lose some of our skills due to trauma, physical or mental illness, or due to normal aging, this may not always be optimally possible.

God’s Calling in Our Lives
God calls all Christians to love Him with all our hearts, minds and strength. He also calls us to love our neighbors as ourselves. He further calls us, as in 1 Corinthians 12, to employ the gifts He has given us for the edification of His church and in the service of others. Scripture does not specifically talk about a calling that many of us seek, and that is to a specific job, task or profession. Scripture talks in many places about God directing our steps, however, and career choice clearly would fall under this umbrella.

I have been a physician for many years, and especially for my first 20 years or so as a doctor, I believed that His call to me was to be a physician, and more specifically to be a neurologist. As I have aged, however, it has become clearer to me that I am to obey His leading, wherever it takes me, and my call is to show His love to others at all times and in various ways as He directs. I have come to realize that my call was to Him, to the role of being His child and to the task of loving His children.

With that in mind, approaching retirement, I rest assured that these primary callings will never change, nor will they change for any of His children.

As healthcare professionals, we occupy an important and honored role in society. For some of us, there will come a time when our obedience to His primary call may lead us out of direct patient care or even out of healthcare completely. Education, administration, writing, mentoring, speaking or other non-clinical roles may be His will for us.

Within this framework, Scripture offers us some guidance as we seek to know if, and when, the time is right to transition within our profession. We can use these guidelines to evaluate ourselves. As wise leaders within our profession, we can also use these to help our colleagues in addressing changes in their lives.

  1. Scripture instructs us that we are to treat others as we wish to be treated (Luke 6:31).
  2. Scripture requires that we place the interests of our patients and of society before our own interests (1 Corinthians 10:24).
  3. We are to wisely use the talents the Lord has given us and realize that these are a gift from God (Matthew 25:1-30).
  4. Scripture instructs us that we are to work heartily as unto the Lord (Colossians 3:23), and we are to give our best efforts in our work (Proverbs 22:29).
  5. We are to realize the finitude of our own energy, bodies and minds (Psalms 39:4-5), and recognize that loss of physical or mental abilities or aging itself may make it impossible to provide the quality of care we know to be God-honoring (1 Peter 1:24, Ecclesiastes 12:1-8).
  6. Scripture teaches us that as fallen humans we may not recognize our own loss of ability, acuity of thinking or physical dexterity. David, not realizing the effects of his advancing age, almost died in battle. His men then insisted he not go to war anymore (2 Samuel 21:16-17, Romans 12:3).
  7. Scripture emphasizes the importance of serving each other (Galatians 5:13), speaking the truth in love (Ephesians 4:15, 25) and bearing one another’s burdens (Galatians 6:2).

God, the wise Creator, gave us the abilities, drive and persistence to become healthcare professionals in His service. In contrast to many today who wish to deny normal changes in our bodies and minds related to a multitude of factors, we know God has ordained times for everything (Ecclesiastes 3:2-13). Skills, dexterity, judgment and knowledge are susceptible to decline or loss for a number of reasons. These include, but are not limited to, acute traumatic injury; acute or chronic illness; mental illness; failure of motor abilities or sensory faculties, such as hearing, vision, touch and hand-eye coordination; problems with addiction to alcohol, opiates or other mind-altering substances; emotional or spiritual burnout severe family or personal stress; or the natural processes of aging.

When changes occur in us or in our colleagues due to any of the above reasons, we need to evaluate these changes kindly, but honestly, and address them appropriately.

As professionals, society has granted us unique privileges and responsibilities based on trust that the members of such professional groups will:

  1. Attain and maintain knowledge and skill in their professional disciplines.
  2. Attest to the competence of professional group members in fulfilling the requisite education, attaining the appropriate skills and clinical judgment, and maintaining those levels of expertise in their professions.
  3. Self-police, monitoring as necessary, and restricting, disciplining or disqualifying members of such professional groups who no longer evidence the requisite abilities, cognitive skills or moral rectitude to perform the functions of their unique roles.
  4. By such supervision, protect society from inappropriate, unnecessary, incompetent or primarily self-serving advice or services from members of the profession.
  5. Monitor their individual actions so as to ensure delivery of competent care to the society which has entrusted them with their privileged status as professionals.

In the process of self-policing, we must first examine ourselves, and then we must remain vigilant regarding our colleagues. Some signs and symptoms often present in the workplace include:

  1. Being late to appointments; increased absences; unknown whereabouts
  2. Having unusual rounding times, very early or very late
  3. Increase in patient complaints
  4. Decrease in quality of care; careless medical decisions
  5. Incorrect charting or writing of prescriptions
  6. Decrease in productivity or efficiency
  7. Increased conflicts with colleagues; increased irritability or aggression
  8. Smell of alcohol; overt intoxication; needle marks

When we observe these signs or symptoms in our colleagues or in ourselves, we need to kindly but directly address them. A universally accepted ethics principle is that of “protecting the vulnerable.” In most societies, this has included orphans, widows, children, women, elders, those with physical or mental disabilities and often immigrant populations.

Vulnerability entails an inherent power differential between two persons or groups of persons. Respect for the vulnerable entails prohibition of abusing this power to injure or harm the weaker person(s). A classic example of this is the unique position healthcare professionals have in respect to their patients, with the former having a distinct knowledge advantage over the latter.

In the next part of this two-part blog, we will review appropriate ways of working with the persons (which at times may include ourselves) whom this article has helped identify.

About Robert E. Cranston, MD, MA (Ethics)

Robert E. Cranston, MD, MA (Ethics), MSHA, FAAN, CPE, is a board certified neurologist, with additional training and experience in palliative medicine, executive coaching and medical leadership. He is completing his 30th year serving at Carle Health, (formerly Carle Foundation Hospital) in Urbana, Illinois, as an attending neurologist, and (Past Chair—14 years) of the Carle Ethics Committee. He is a clinical professor of medicine (neurology) at Carle Illinois College of Medicine in Urbana-Champaign and is on the clinical faculty of University of Illinois, Urbana-Champaign. He is a member of the CMDA Ethics Committee. He and his wife Tammy are grateful for their five grown children, their daughters- and sons-in-law and their 11 grandchildren.

1 Comment

  1. DR P EDWARDS CONRAD on June 30, 2021 at 12:05 pm

    Thanks, Dr. E. Robert Cranston.
    We need a registry so that physicians who are ‘targeted’ with false accusations can identify the source and refute every false accusation also.
    Dr. P. Edwards Conrad.

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