CMDA's The Point

Redemptive Treatment of Healing Professionals

August 12, 2021
06102021POINTBLOG

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

Editor’s Note: This is the second 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. In Part 1, we discussed ways of identifying issues in clinical care which may indicate a need for a healthcare professional to seek significant retraining or a transition out of direct patient care. In Part 2, we 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.

Some systems have treated healthcare professionals with clinical skill loss in an almost punitive manner. Aside from careless incompetence, abandonment of patients or grossly unprofessional behavior, this is inappropriate, damaging to the professionals and harmful to society.

We should encourage and support efforts to assist healthcare professionals to maintain their clinical competence through continuing education, institutional quality control measures, concurrent and retrospective clinical accountability measures within our organizations and ways to foster and maintain group accountability in addition to our individual efforts at maintaining competence. Many specialty organizations have maintenance of certification programs. While this concept is laudable, many of these are very expensive in terms of time and money, and not all of these are helpful or appropriate. Additionally, continuing education alone is often insufficient for true maintenance of professional competence.

Thus, despite our above efforts, if we identify patterns of practice that may indicate a need for improvement or transition out of active clinical practice in ourselves or in others, we must we address these. We must maintain respect for all people, and, in this context particularly for healthcare professionals, at all times. When addressing any issues of competence in our healthcare professional community, we must always act with humility and recognition that we ourselves are fallible, and we are accountable to our professional communities in the same ways as those we are assessing.

Nonetheless, the safety and welfare of our patients should take priority over all other personal considerations, such as financial needs of the professional, diminution of a sense of professional identity, previous years of competent caregiving or concern for financial implications for the hospital, clinic or practice associated with the healthcare professional.

We should seek ways, when possible, to allow healthcare professionals who are no longer capable of fulfilling their previous clinical responsibilities in a competent fashion to retrain, rehabilitate or contribute to medicine and society through other available avenues. These roles may include mentoring, medical teaching, public education or service in non-clinical capacities.

Retraining. There are times when retraining may be appropriate. Some physicians who have been out of medicine, or who wish to transition from a more physically demanding specialty (general surgery, for instance), while remaining in medicine, may find help through qualified retraining programs.

Others may be able to work directly with their previous residency or a new residency training program to complete a six to 12-month refresher mini-residency. Some who have done this have chosen to transition to a part-time, telemedicine or prompt care setting. The new training can give them the skills and confidence to perform competently in their new roles.

Rehabilitating. When identified, healthcare professionals with alcohol, drug or other addictions should be required to participate in rehabilitation programs to address their addictions. After rehabilitation interventions, responsible leadership should implement ongoing monitoring of behavior and clinical competence including close observation. A probationary period after intervention with accountability guidelines is mandatory. Many physicians have overcome their addictions and been able to return to active medical careers.

Alternative roles. These may be the most frequent transitions for senior healthcare professionals who still have much to add in medicine with their years of experience and wisdom.

  1. Mentoring—Healthcare professionals can work directly with young healthcare professionals to instill habits of professionalism, approaches to complex issues and encouragement in their medical education. Done correctly, mentors can serve as wise collaborators in educating new students.
  2. Administration—Many systems require insightful administrators who have served in the trenches for many years as caregivers. Some master’s degree level programs in healthcare administration or business administration are available remotely, or with limited time away from home. In general, many healthcare professionals seem to have more intrinsic confidence in administrators who have “walked in their shoes.” Physician-administrators manage many large hospital systems, such as Cleveland Clinic, Mayo Clinic and others. Other administrative positions, requiring less intense time investment, may be available.
  3. Other Possibilities—Some healthcare professionals may find it rewarding and mutually beneficial to re-train in limited areas, such as Advance Cardiac Life Support or Basic Life Support, and to continue to help others stay abreast of new developments and necessary certifications in these areas. Community health, including direct education, recruitment of talented young people to careers in nursing, medicine or allied health fields can be very rewarding. Assuming leadership roles in philanthropic organizations or administrative leadership in short-term mission trips may be a valuable way to continue to use accumulated knowledge and experience to help others.

Take-home lesson: when physical, medical or other issues prevent a healthcare professional’s full, usual clinical roles, a transition to new responsibilities need not be considered punitive or disappointing. While our primary call will always be to Christ, not healthcare, there still may be rewarding, satisfying ways to serve others within the broad field of healthcare. Some characterize Christians as the only soldiers who shoot their own. This should not be so. We ought to be wise as serpents, but innocent as doves in the manner in which we redemptively nurture our own.

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.

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