Mar 25, 2008

HEALTH MATTERS: Impaired doctors get treatment to practice safely

By LJ Anderson / Daily News Columnist

Certain occupations pose a greater risk of harming the public, and we typically read about performance lapses in these jobs as human tragedies or averted ones - from the painkiller-impaired ferry operator in the 2003 Staten Island ferry crash to an American Airlines pilot who showed up for work at Heathrow Airport with six and one-half times the legal alcohol limit for flying an aircraft - and was arrested after failing a Breathalyzer test.

The goal of physician health programs is to protect the public by identifying and referring impaired medical professionals to treatment programs, and then monitoring them when and if they return to practice. These organizations exist in every state and may be independently run, or part of licensing boards and state medical societies. Warren Pendergast, MD, a psychiatrist trained in addictions, is medical director of the North Carolina Physicians Health Program (NCPHP), a nonprofit physician health program. National statistics for these programs indicate a 75 to 90 percent success rate with the practitioner eventually returning to practice.



Q: How does access to substances contribute to the problem of impaired medical professionals?

A: It used to be that medical professionals had easier access to substances than others. That may be somewhat true, particularly for anesthesiologists and nurse anesthetists who work day in and day out with substances. The thing that's really changed is that nonmedical professionals have fairly easy access to things they didn't (have before) via the Internet. Fentanyl now comes in patches, for instance, and it used to be that if you were addicted to fentanyl, you were an anesthesiologist. Access is definitely a factor, but it's not necessarily the biggest factor in terms of risks for medical professionals becoming addicted. There are systems in place such as having to take medications out of Pixus machines, and controls in hospitals are tighter than they used to be.


Q: How hard is it for an impaired medical professional to admit to having a problem?
A: They have all the usual difficulties - the shame and guilt, and that can differ depending on what substance you're talking about. For example, alcohol is somewhat more acceptable in our society than other drugs. There is another layer for them that the general public doesn't have, and that is twofold. There is the fear of license issues that many walks of life don't have - the other population that is probably more comparable is pilots. Medical professionals are worried about their license. The other more abstract issue is that we're sort of trained and told by society that it's not OK for us to have problems, and we buy into that to a certain extent, so the physician's own expectations can make it harder to admit to having problems. There's also a lot more shame and guilt about use of illegal substances than improper use of prescribed substances. Licensing boards will not only look at potential impairment in the workplace, but they will look at use of cocaine and other illicit substances. It becomes a character issue. Physicians are held to higher standards of behavior and to the extent that addiction is seen as a moral weakness, which can play into action against licenses. The word "impaired" is very important, and the AMA (American Medical Association) defines it as the inability to practice with reasonable skill or safety. Many physicians - probably the vast majority with addiction problems - don't necessarily reach the impairment stage. They may have other problems, but very often the job is the last to go. They're certainly at risk for impairment but they may be drinking on the weekend, for instance. It's relatively unusual to get a referral of a physician having alcohol on his or her breath at work - folks will try to preserve their job.



Q: How good are medical professionals at hiding an addiction?

A: People who have addiction problems, in general, are pretty good at hiding it, until things really start to fall apart. It's hard to say if medical professionals are better at it, but there is more motivation to hide it. The issue really is that other preimpairment signs of addiction can be subtle, and folks who might be in a position to help the physician identify a problem may minimize it themselves or be motivated to help the person hide it out of fear. Most hospitals have policies that are pretty clear-cut about the need to protect patients, but how implementation plays out varies from hospital to hospital. The interest of colleagues or hospital administrators may be in keeping the physician functioning, and they may be concerned about the fallout if they report a problem.


Q: What role do family and friends play in the person's seeking treatment?

A: It can be very powerful, and a more powerful (incentive) than the fear of losing a license. Family and friends can play a huge positive role, and they can also be major enablers. "Why do you need to go to so many meetings if you're not drinking anymore?" Often in long-term success, family support is one of the biggest prognosticators for maintenance and recovery. One big difference these days between medical professionals and others is that physicians are expected to get extensive treatment, and may be asked to be in a residential program for three months. Reimbursement for outpatient treatment has declined, and for inpatient treatment beyond detox, it is minimal. Families can be part of supporting that.



LJ Anderson writes on health issues every Tuesday. She can be reached at lj.anderson@yahoo.com.