Authors: Fitzsimons M G et al.
Journal of Clinical Anesthesia, 2026.
A framework for success: Compassionate interventions to support healthcare colleagues when concerns arise.
This article describes a structured and compassionate framework for addressing concerns about impaired healthcare professionals, particularly anesthesiologists. Physicians, like individuals in other professions, may experience medical, psychological, or substance-related conditions that can negatively affect their professional performance. Because anesthesiology involves high-risk patient care, impairment can have significant consequences. Despite this, physicians are often reluctant to intervene when concerns arise regarding a colleague’s behavior or performance.
The authors highlight several reasons why physicians avoid confronting impaired colleagues. These include fear of making false accusations, uncertainty about appropriate procedures, concerns about damaging professional relationships, and lack of established institutional systems for handling such situations. Additionally, physicians experiencing mental health issues or substance use disorders often avoid seeking help due to stigma, fear of professional consequences, licensing concerns, and worries about malpractice or insurance implications.
The article describes a program implemented in 2003 within the Department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital. Initially designed as a substance use disorder prevention program, the initiative evolved over two decades into a broader framework for professional intervention when performance concerns arise.
The program was developed by a multidisciplinary team including anesthesiologists, CRNAs, trainees, institutional leadership, legal counsel, and occupational health specialists. Its goal was to create a structured process that allows early identification of performance issues and provides a consistent, fair, and supportive pathway to help affected clinicians receive appropriate care.
Over the first 20 years of the program, 36 formal interventions were conducted. Of these:
• 21 involved trainees (residents or fellows)
• 8 involved CRNAs
• 7 involved faculty physicians
The interventions were evenly distributed between male and female clinicians. Most interventions (78%) were initiated “for cause,” meaning that they were triggered by observed performance issues or concerning behaviors. The remaining cases were identified through monitoring systems or preventive screening.
A central principle of the program is that interventions must be conducted in a compassionate and non-confrontational manner. When interventions are performed in an accusatory or punitive way, individuals may become defensive, withdraw from support systems, or refuse help. In contrast, the authors emphasize that interventions should prioritize professionalism, respect, privacy, and dignity.
The framework stresses several core elements for successful interventions:
• Early recognition and prompt action when concerns arise
• Acknowledgment of uncertainty when assessing potential impairment
• A multidisciplinary team approach
• Strict attention to confidentiality and fairness
• Consistent application of policies across all personnel
Although the program originated as a strategy to address substance use disorders, the authors argue that the same principles can be applied to other situations involving physician impairment or concerning behavior. These may include burnout, mental health disorders, disruptive conduct, or other medical conditions that affect performance.
The authors conclude that compassionate and structured professional interventions are essential to protecting both patients and healthcare providers. Establishing clear systems that emphasize support rather than punishment can reduce fear among colleagues, encourage early action, and connect impaired clinicians with appropriate treatment before more serious consequences occur.
Key Points
• Physicians experience mental health and substance-related disorders at rates similar to the general population.
• Many clinicians avoid seeking help due to stigma and fear of professional consequences.
• Colleagues are often reluctant to intervene when impairment is suspected.
• A structured intervention program implemented at Massachusetts General Hospital has conducted 36 interventions over 20 years.
• Most interventions were initiated due to observed performance or behavioral concerns.
• Compassionate, multidisciplinary interventions emphasizing privacy, fairness, and professionalism help connect clinicians with needed care.
Thank you to the Journal of Clinical Anesthesia for allowing us to summarize and share this article.