Physician Impairment due to Substance Use Disorders

John B Schorling, MD, MPH

Disclosures

November 20, 2009

The Case

Dr. Z, a 40-year-old family physician, was under increasing stress at work and at home. He continued to accept new patients and expand his practice despite already having such a great number of patients. Dr. Z was in a salaried position, so there was little financial incentive to work harder, but he just had difficulty saying "no" to patients and colleagues. He was married and had 3 children. His wife was not employed, and there were financial pressures.

Dr. Z then suffered a bicycle accident, sustaining multiple injuries that required an emergency department visit, where he was given oxycodone/acetaminophen for pain. He found that in addition to relieving his pain, this medication also helped reduce his anxiety. When the medication ran out, his own primary care physician refilled the prescription once, but then encouraged him to take nonnarcotic pain medication. Dr. Z tried this, but did not feel as good without the oxycodone. Thinking that he would need the pain medication for just a little longer, he wrote a few prescriptions for himself using other doctors' names. When Dr. Z tried to stop taking the medication and found that he could not do without it, he began to steal parenteral narcotics from work. He was subsequently noted to be less alert at work, and a discrepancy was found in the office narcotic count. His physician supervisor suspected that he was diverting narcotics and confronted him. Dr. Z initially denied taking drugs from the workplace, but then admitted to doing so when, in accordance with worksite police, a drug test was ordered "for cause."

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