COMMENTARY

Doctors and Nurses Should Be Drug-Tested -- Get Used to It

Arthur L. Caplan, PhD

Disclosures

August 01, 2013

Drug Screening Following Adverse Events

The most controversial, but also justified, use of random drug testing is when there is an adverse event. When something serious happens, shouldn't the people involved be subjected to mandatory drug testing? Some people will say that there is no evidence that the kinds of errors and safety problems that occur in hospitals and nursing homes are linked to impairment. That is true, but we don't monitor the situation and we don't have drug testing following adverse events. Because we know that impairment is a problem in a small but significant percentage of physicians and nurses, we need to establish whether drugs, alcohol, or some other type of abuse played a role in a medical mistake.

It is fair to acknowledge that testing is not perfect and that false positives can occur. A test shouldn't be the be-all and end-all of whether a person keeps his or her job. A positive test is probably room for an investigation, not immediate firing. Nonetheless, despite some of the flaws with testing, it seems to me that if we are going to commit to patient safety and putting patients' interests first, we have to make sure that problems, safety difficulties, and adverse events are not linked to impaired physicians or nurses.

As difficult as it is to say "I don't want to be treated like some sort of suspected addict," if we are going to push safety forward and make it a priority; if safety is going to become part of quality care, then we have to get on board with the notion that drug testing has a role in our healthcare facilities, and doctors and nurses should expect to comply with it. I'm Art Caplan from the NYU Langone Medical Center.

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