Which Specialty Is at High Risk?
Two recent surveys highlight the danger. In the first, a survey of nearly 7200 surgeons published in the Archives of Surgery in February 2012, researchers used the Alcohol Use Disorders Identification Test (AUDIT) to identify surgeons who abuse or are dependent on alcohol. More than 15% of respondents had AUDIT scores consistent with alcohol abuse or dependence, with women having almost twice the rate of abuse or dependence as their male colleagues (25.6% vs 13.9%). Surgeons who reported a high degree of emotional exhaustion and depersonalization—key elements of burnout—were especially prone to abuse or dependence.
A second survey, of nearly 7300 physician respondents from all specialties, published online in the American Journal on Addictions in November 2014 uncovered similar patterns: 15.3% of physicians surveyed met diagnostic criteria for alcohol abuse or dependence.
In both surveys, physicians who met the criteria for abuse and dependence were more likely to say they had committed a major medical error in the previous 3 months than their peers who didn't meet the criteria, according to Michael Oreskovich, MD, a psychiatrist with the University of Washington in Seattle, who conducted the research. Again, female physicians were significantly more likely to meet criteria for use and dependence than were their male counterparts.
Physicians' access to potent prescription medications represents another distinction between doctors and the general public. Whereas alcohol abuse is the most common form of drug abuse for both physicians and the population as a whole, research shows physicians are more likely than the general population to abuse benzodiazepines and opiates.
Like many people, physicians' dependence on these medications may develop after they're treated for a legitimate medical condition. Unlike other persons who might become dependent on painkillers, however, physicians have greater access to the drugs and, because of their medical training, may convince themselves they can handle the situation, says Dr Schorling.
What to Do When You Suspect a Colleague
Unfortunately, the same perfectionistic tendencies that enable impaired physicians to hide their substance abuse may prevent other physicians from intervening.
Although the vast majority (77%) of the 21,000 physicians responding to Medscape's 2014 Physician Ethics Report said they would "report a physician friend or colleague who occasionally seemed impaired by drugs, alcohol, or illness," another 20% said their willingness to do so would depend on the circumstances. Many insisted they'd need proof.
"Some doctors don't want to be wrong," says Dr Schorling, adding that they're conscientious and evidence-driven, and don't want to risk ruining a friendship or damaging a career by acting on a suspicion. But when it comes, he notes, the "evidence" may take a catastrophic form, such as injury to a patient, a conviction for driving under the influence, an overdose, or a suicide.
Rather than waiting for evidence, Dr Schorling says, physicians need to be attuned to personality and behavior changes that may signal a problem.
Long before an impaired physician comes to work smelling of alcohol, slurring words, or showing other obvious signs of impairment, she may exhibit behavior that may signal a problem, such as depression, mood swings, inappropriate anger or irritability, inability to concentrate, or sleepiness. When a formerly jocular doctor withdraws and stops engaging with colleagues or missing meetings, it's time for a conversation, Dr Schorling says.
Inviting the doctor in question for a cup of coffee and gently talking about what you've observed—even if it isn't directly affecting her work—may uncover a problem that needs to be addressed. The clinician may be having financial difficulties or trouble at home.
If you don't know the physician well or aren't comfortable engaging in such a personal conversation, find out what resources your facility has. Many hospitals have wellness committees like the one Dr Schorling directs that are designed to approach, evaluate, and assist clinicians who may be struggling with alcohol, drugs, or mental or physical issues that may impair their performance.
"Corroboration shouldn't be the task of a single individual," Dr Schorling says. "I don't think people should be detectives."
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Cite this: Shelly Reese. Drug and Alcohol Abuse: Why Doctors Become Hooked - Medscape - May 06, 2015.