How to Intervene with Unethical and Unprofessional Colleagues
All academic health disciplines endeavor to ensure that professionals apply safe and effective interventions to patients, ethically conduct research, and respectfully interact with colleagues and students. Each profession is expected to develop mechanisms to monitor and regulate the performance of its members. Three substrates for ethical and professional violations are identified: impairment, incompetence, and unethical conduct. Though mental health professionals have the awareness of professional ethics and the acumen to identify unethical practices, a significant number of clinicians remain uncomfortable and reluctant to report or intervene with their unprincipled colleagues. Known as the culture of silence, clinicians struggle with the dilemma of either protecting the privacy and confidentiality of their colleague or securing the safety and well-being of the patient, student, research subject, or public. However, there are three fundamental reasons for intervening with an impaired, incompetent, or unethical colleague: prevention of harm to patients or others, prevention of harm to one’s profession, and assistance to impaired peers. Specific interventions depend on the professional’s manifest incompetence and unprofessionalism and the level of risk to a patient and others. Interventions can include a dialogue with one’s colleague, referral to a physician assistance program, report to the colleague’s supervisor or administrator, or a report to a licensing board or other oversight entity. It is important for training programs to integrate ethics and professionalism into their curricula and for professions to maintain self-care.
KeywordsSexual Harassment Unethical Behavior Professional Standard Hippocratic Oath Injured Party
- 1.Council on Ethical and Judicial Affairs. Code of medical ethics of the American Medical Association (2008–2009 edition). Chicago: American Medical Association; 2008.Google Scholar
- 2.American Psychological Association. Ethical principles of psychologists and code of conduct: 2010 amendments. 2010. http://www.apa.org/ethics/code/index.aspx. Accessed 19 Dec 2011.
- 8.Council on Ethical and Judicial Affairs. Reporting impaired, incompetent or unethical colleagues. CEJA Report A – I-91; 1992.Google Scholar
- 9.American Psychology Association Advisory Committee on Colleague Assistance. The stress–distress-impairment continuum for psychologists. n.d. http://www.apapracticecentral.org/ce/self-care/colleague-assist.aspx. Accessed 16 Dec 2011.
- 10.Baldisseri MR. Impaired healthcare professional. Crit Care Med 2007;35(Suppl.):S106–16.Google Scholar
- 12.Roberts LW, Dyer AR. Ethics in mental health care. Washington, D.C.: American Psychiatric Publishing; 2004.Google Scholar
- 13.Wilson A, Rosen A, Randal P, et al. Psychiatrically impaired medical practitioners: an overview with special reference to impaired psychiatrists. Australas Psychiatry. 2009;17:6–10.Google Scholar
- 15.Carinci AJ, Christo PJ. Physician impairment: is recovery feasible? Pain Phys J. 2009;12:487–91.Google Scholar
- 18.University of New Mexico. Board of regents policy manual. 2010. http://www.unm.edu/~brpm/rtoc.htm. Accessed 19 Dec 2011.
- 19.Cohen S. The conspiracy of silence. Can Fam Phys. 1980;26:847–9.Google Scholar
- 22.Lo B. Resolving ethical dilemmas: a guide for clinicians. 3rd ed. New York: Lippincott Williams & Wilkins; 2005.Google Scholar
- 23.Overstreet MM. Duty to report colleagues who engage in fraud or deception. In: American Psychiatric Association, editors. Ethics primer of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 2001, p. 51–55.Google Scholar
- 26.University of New Mexico. University business policies and procedures manual. 2012. http://www.unm.edu/~ubppm/ubppmanual/2200. Accessed 10 Jan 12.
- 27.Koocher GP, Keith-Spiegel P. Ethics in psychology and the mental health professions: standards and cases. New York: Oxford University Press; 2008.Google Scholar
- 28.O’Connor MF, APA Advisory Committee on Colleague Assistance. Intervening with an impaired colleague. n.d. http://www.apapracticecentral.org/ce/self-care/intervening.aspx. Accessed 16 Dec 2011.
- 29.Pope KS, Vasquez MJT. Ethics in psychotherapy and counseling: a practical guide. 3rd ed. San Francisco: Jossey-Bass; 2007.Google Scholar
- 31.Belitz J. On professionalism. In: Roberts LW, Hoop J, editors. Professionalism and ethics: Q & A self-study guide for mental health professionals. Washington, DC: American Psychiatric Publishing; 2008, p. 73–78.Google Scholar