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Dr Ross' letter raises several questions about our case scenarios, the interpretation of our results, and suggestions for further research. In response to the question about the first scenario, the physician in this case had alcohol on his breath, was abusive on the telephone and in person, and had had similar encounters with another resident. We believe that this scenario raised enough questions about alcohol impairment in this physician to cause the residents to consider taking action. Our consultants who reviewed the case agreed, and obviously the house officers did by their responses in the study.In the second case, the resident had several months' experience caring for patients of an attending physician who was widely regarded as incompetent. Once again, this impression was confirmed by colleagues. We deliberately decided against including detrimental effects on patients in the case scenario because it might have been too persuasive in
Reuben DB. Reporting Impaired Physicians-Reply. JAMA. 1990;264(2):184–185. doi:10.1001/jama.1990.03450020036020