Virtual Mentor. December 2003, Volume 5, Number 12.
Identifying an Impaired Physician
Physicians who suspect a colleague might have a substance use disorder can intervene in various ways in order to help facilitate recovery.
Stephen Ross, MD
The misuse of drugs and alcohol by physicians is compounded by their critical role as caregivers. Historically, addicted physicians either went unnoticed or were treated punitively. In 1973, the American Medical Association recommended, in a landmark report entitled "The Sick Physician," that state medical societies establish programs to identify and treat impaired physicians. Since that time, every state has established a program or committee for that purpose.
It is estimated that approximately 6 percent of physicians have drug use disorders and that 14 percent have an alcohol use disorder---figures that mirror addiction in the general population . But considering the degree of responsibility entrusted in doctors, this significant number of impaired physicians is cause for concern. Patterns of use vary but, in general, alcohol is most commonly misused, followed by opioids and cocaine. Anesthesiologists and emergency room doctors are 3 times more likely to abuse substances than the general population of physicians . Both fields entail high-risk situations and performance under pressure. Hence, both tend to attract physicians who are more likely to engage in high-risk behaviors in their personal lives. Some specialists give in to temptation from easy access to addictive pharmaceuticals.
Signs and Symptoms
Substance use disorders (SUDs) commonly affect several domains in the impaired physician's life, especially his or her ability to function at work and at home. Detection of the addicted physician tends to be delayed because job performance is often the last dimension to suffer. The following are potential signs of an increased problem with a substance use disorder (SUD) .
Problems at home:
Intervention and the Role of Physician Health Programs
If a colleague is concerned that a physician has an SUD that is impairing
All states now have PHPs, which are usually sponsored by state medical societies. They were developed to help identify impaired physicians and then to be intimately involved in evaluation, treatment, and monitoring. They also serve to protect the public from impaired physicians as well as to help the impaired physician achieve sobriety. If an impaired physician voluntarily seeks treatment and monitoring, the PHP can then advocate for the physician before the state medical board. If, however, physicians are initially reported to the state medical board before any involvement with a PHP, they are then required to have a formal disciplinary relationship with the board and are in greater danger of license suspension and revocation.
Abstinence is always the final goal if the physician hopes to return to
Most PHPs monitor addicted physicians for 5 years, which includes the monitoring of bodily fluids (ie, toxicology screens), ongoing treatment, and their performance when they return to practicing medicine. Many programs have demonstrated recovery rates of up to 90 percent, which is likely due to close monitoring and also to highly motivated physicians who have a tremendous amount to lose professionally and personally if they relapse. Although many physicians are grateful for assistance with their SUD, they may feel intense guilt and shame. Others might resist treatment, despite the need, and will feel enraged that their right to practice medicine has been suspended or revoked.
In summary, alcohol and drug use among physicians is a significant problem that can lead to impairments in the ability of physicians to function both at work and at home. Early detection and aggressive treatment are key aspects to dealing with this serious problem. PHPs, available in every state, play a vital role in the advocacy and treatment of impaired physicians.
Stephen Ross, MD, is clinical assistant professor of psychiatry at NYU School of Medicine, and director, Bellevue Dual Diagnosis Training Unit. He is associate director for addiction fellowship training, Division of Alcoholism and Substance Abuse. His areas of interest include dual diagnosis, personality disorders, impaired physicians, psychiatry residency and Addiction Fellowship addiction training.
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