The physician should report his colleague's behavior to the colleague's supervisor. Physicians may be reluctant to report colleagues suspected of impairment because of discomfort associated with “speaking up,” fears of retaliation, and desire to protect colleagues. However, physicians have a duty to speak up, as an impaired and disruptive colleague's behaviors may harm patients, negatively affect team morale, and impede learning. This physician's colleague manifests multiple behaviors suggestive of impairment, including frequent absences, altered mood, lapses in judgment, and changes in clinical performance. Since the physician has already directly confronted his colleague and his concerns were dismissed, he should report the impaired colleague to the appropriate supervisor.

Asking other physicians if they have made similar observations delays the reporting process and does not relieve the observing physician of his responsibility of reporting the suspected impaired colleague.

Physicians should not review the medical records of patients who are not under their care; therefore, the observing physician should not review the colleague's patient care notes for evidence of negligent care. Conducting such record reviews delays and does not relieve the observing physician of his responsibility of reporting the suspected impaired colleague. Additionally, assuming the observing physician is not the colleague's personal physician, it would be unethical and illegal (breach of confidentiality) for the observing physician to review the colleague's medical record to determine if there might be a medical or psychiatric reason for his behavior, even under circumstances of possible impairment.

The observing physician has a professional and ethical responsibility to report the impaired colleague. Taking no further action may result in patient harm.