Promoting Resident Wellness by Addressing Physician Substance Use and Abuse

Margaret M. Rea, Ph.D.

GME Counselor

Objective:

Increase Awareness of and Promote Treatment of Physician Substance

Use and Abuse

Substance abuse in physicians does exist and needs to be addressed so the system can provide the needed assistance

Assistance that allows the MD to continue to perform, while safe guarding patients

Questions to Answer:

1. How widespread is alcohol and substance use in your colleagues?

2. What behaviors might indicate to you that one of your colleagues had a problem?

3. Have you had experiences with abusing or addicted colleagues?

4. How have you typically responded to a colleague you feel has a substance use problem? Why?

Physicians-Specific Factors

10-15% of physicians develop a substance abuse problem

Family history substance abuse 90% of physicians referred for substance abuse

treatment are males ER, Psychiatry, Anesthesiology, academic

medicine slightly greater risk Other psychological and psychiatric illness High stress

Cont’d

Access control substances (diverting samples meds, self-prescribing, falsifying prescriptions; obtaining prescriptions from colleagues)

Cigarette use >1 pack per day

What are Physicians Using?

Alcohol is number one Marihuana Prescription opiates Cocaine

Signs of Substance Abuse in Physicians

Changes in Personal Behavior

Isolation and withdrawal from family Erratic behavior Legal problems Domestic tension Separation partner Sexual promiscuity

Changes in Social Behavior

Inappropriate behavior at social functions DUI Citation reckless driving down from DUI Detioration personal hygiene Accidents, falls etc

Changes in Professional Behavior Tardiness Rounds at odd times to escape scrutiny Diminished performance Over prescribes meds, diverts meds, request samples Long-sleeved shirts to cover track marks Subject hospital gossip Alcohol on breath Slurs speech Does not respond to pages

Work Behavior Differs Depending On Substance If work is source substance; increased

isolation, longer hours If source away from work like ETOH:poor

work performance, late Mood swings, depression, irritability

Why is it Hard to Recognize?

Addicted physicians continue to function at high levels for a long time only when performance is markedly impaired

Alcohol hard to detect as it is accepted socially and even encouraged

Hard to tell misuse from abuse ETOH Usually detected through complaints

of others

Why is Substance Use by Physicians

Often Not Identified or Addressed?

Physician's Own Denial

Unable to recognize they have a problem If they see the problem they make the

mistake of assuming they can handle it themselves

Physicians do not see themselves as in need of help, they are the ones who help others

Physicians see substance use and abuse as a personal and moral failure not as a disease

Denial by Family

Do not know how to help so they do not voice their concerns

Do not know where to turn for help Fear that the physician will destroy his or

her career if the problem is addressed and in turn their family will suffer

Denial by Peers and Institution

Locked into a conspiracy of silence Fear retribution by physician Risk a friendship or working relationship Seen as trouble maker by other colleagues,

“do not rock the boat” Collude with physician that they can handle

the problem on their own

Physician, Family Members, Peers and the Institution Often do not

Understand the Potential Resources That Exist to Assist Physicians

Which Will Allow them to Continue to Practice

Prognosis Good

Recovery rate for physicians who enter treatment and are followed for 5 years is 90% with monitoring

Physicians respond better than general population to intervention

Treatment can save a career without the risk of loss of license

Where Should Physicians Go for Help?

GME Counselor For Support and Referral

Medical Staff Well-Being Committee

Committee administers a monitoring program for Medical Staff members who are suffering from substance abuse or dependence, or physical or mental health issues that impair their ability to work and function at their best.

The Committee provides advice, recommendations, and assistance to individual physicians and to groups or committees who request assistance or recommendations. 

The committee can also be of assistance in helping residents/fellows navigate issues with the medical board in instances such as a DUI and the possible repercussions from the medical board. The committee can be reached through its chair, Dr. Peter Yellowlees, or through Dr. Margaret Rea, the GME counselor.

Other Resources

AA: (916) 454-1100; (916) 454-1771; www.alcoholics-anonymous.org

NA: (916) 732-2299; (916) 732-2298; www.na.org

CA: (916) 386-3545; (800) 347-8998; www.ca.org

What if a Colleague is Impaired

Make an anonymous complaint to Program Director

Contact the GME Counselor for input Contact the Well-Being Committee for

advice Anonymous complaint to Medical Board Contact physician directly

How to Approach a Colleague?

Start from a clinical perspective and state concern regarding resident and patient safety

Avoid diagnosis and describe the behavior Offer Phone Numbers for Well-Being

Committee and /or other resources