Case No. 1: A doctor has a disease that interferes with his ability to treat patients.

An anesthesiologist on staff at a hospital went to see a fellow doctor as a patient. He was having brief lapses of consciousness related to complex partial seizures, a form of epilepsy that had gone unrecognized during his residency. He admitted to having at least one seizure in the OR that was so brief that no one observed it. The condition was treatable but left the second doctor uncertain about whether to uphold the privacy of the doctor-patient relationship or to inform the hospital staff.

---

The Issues
Hospitals have systems in place to ensure that doctors don’t operate while intoxicated, and the same standards apply here: The protection of patients in the OR trumps doctor-patient privilege. Unless proper treatment is certain to allow the anesthesiologist to practice safely, his condition should be disclosed to the hospital. “The threat of serious harm to the patients goes beyond the limits of confidentiality,” says Dan Sulmasy of St. Vincent’s. It’s then up to hospital administrators, says Deborah Korzenik of Beth Israel, to decide whether the doctor should be allowed to treat patients and under what conditions. In this case, the doctor treating the anesthesiologist would ideally encourage the anesthesiologist to report himself. It’s less contentious for everyone, says Rosamond Rhodes of Mount Sinai. If the anesthesiologist refuses to cooperate, however, his doctor would be obliged to go to the hospital administration against his patient’s wishes. There’s a risk of scaring other doctors away from seeking medical treatment, notes Rhodes. But again, that risk is outweighed by concerns for patient safety.

The Outcome
Though the anesthesiologist’s condition was treatable, his doctor told him it was serious enough that he could not honor his privacy if the anesthesiologist did not notify his chairman. The anesthesiologist did and subsequently resigned his position. A note in his file ensured that this information would be forwarded to any hospital he might apply to for a position. It would be up to that hospital to further evaluate the anesthesiologist to see if he was capable of working safely with patients.