Mood swings will occur, ranging from irritability, outbursts of anger, and paranoia to sudden euphoria and hyperactivity. Clues in the employment setting may include numerous job changes, indefinite or inappropriate references, under employment, and unexplained intervals between jobs. The physician may display abnormal behavior during rounds at the hospital, give inappropriate orders, be named in professional liability lawsuits, and be unavailable for the emergency room or call. Allegations by staff may occur regarding inappropriate behavior. The physician may withdraw from involvement in community activities and display embarrassing behavior at parties.
Disorientation occurs with the use of some drugs.
A physician may have significant memory lapses or have inappropriate conversations with patients. Since the physician may not have any memory of this behavior, presentation by a team member during an intervention can have a profound effect. Additional information may be obtained by interviewing practicing associates, family members, other health care professionals, and friends. Clues of chemical dependence or other impairments in the family setting include unexplained absences from home, spouse or child abuse, sexual dysfunction, and enabling by family members. While it is important to evaluate a physician in relation both to the larger social environment and to the risk factors for illness within the family system, discretion is a must to avoid stirring up rumors and destructive gossip.