Is Your Doctor Drunk or High on Drugs?
It seems unthinkable: the very person whom you trust with your life may be drunk or high on drugs. Although I could be talking about airline pilots, train operators, or bus drivers, here I’m referring to physicians. Healthcare professionals are just as likely to have a substance abuse issue as the general public, so is your doctor drunk or high on drugs?
Why aren’t doctors tested for substance abuse?
In a new article appearing in JAMA, three physicians point out that while pilots and truck drivers are routinely tested for alcohol and other drugs following a near miss or crash, and that police officers are sometimes checked after a fatal shooting incident, “Mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine.”
In fact, a 2006 article published in the Annals of Internal Medicine noted that at least one third of all doctors go through a time “during which they have a condition that impairs their ability to practice medicine safely.” In a subsequent article, it was reported that:
- Up to 16 percent of doctors have been addicted to drugs or alcohol, or both, at some point during their medical career
- One third of male junior doctors and nearly 20 percent of their female peers have used marijuana, cocaine, and other hallucinogenic substances
A 2012 study reported that anesthesiologists make up the majority of physicians being helped in programs for doctors who abuse psychoactive substances. The authors pointed out that use of opioids usually begins during medical residency or during the early years of clinical practice, which suggests that “addiction to opioids is an occupational issue among anesthesiologists.”
All of this information, along with another statistic which states that about one-third of all people admitted to hospital are subjected to a medical error (although not all are attributed to doctors), you may be wondering if your doctor or surgeon is among those who have abused alcohol or drugs.
Finding impaired physicians
One problem is, you may never know, but other doctors might. Among the medical community, physicians watch out for each other, as “self-monitoring is the essence of medical professionalism” and “peer review is the accepted modality to identify physicians with impaired performance," according to the JAMA authors.
Physicians who are impaired and who are discovered and referred for help through a designated physician health program, available in most states, are typically treated successfully. A 2009 national survey of physician health programs found that treatment outcomes are encouraging, with only 22 percent of doctors testing positive at any time during the five years they are monitored after treatment, and 71 percent were still licensed and working at the five-year point.
However, as the authors of the JAMA report point out, states without proactive programs for substance abuse are more susceptible to cases of patient harm before something is done. In fact, they emphasized that many incidents could occur before any investigative action is taken against the offending physicians.
The authors of the JAMA article have proposed how the medical community might set up doctor impairment regulations. Here are some of their suggestions:
- Mandatory physical exams, drug testing, or both before an individual is appointed to a medical staff position. Only some hospitals currently use this approach.
- Random alcohol and drug testing, a practice that is now required for most federal employees and is performed in the military.
- Routine drug and alcohol testing for any doctor involved in an event resulting in the death of a patient
- Establishment of a national hospital regulatory body that could determine consistent standards for all states
Naturally, there are pros and cons associated with instituting such a regulatory program. One con, for example, is that drug tests are not perfect and could falsely identify doctors as impaired when they are not. However, confirmatory testing can be conducted with nearly 100% accuracy.
Positives include better protection for patients, reduced injuries in hospitals, and early identification of abuse problems, which can then be addressed quickly by admitting doctors to treatment programs. Such response could save the doctor’s life and career.
Healthcare consumers have the right to safe, efficient care from their doctors. If your doctor is drunk or high on drugs, can you expect to get that quality of care?
Classen DC et al. Global trigger tool shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs 2011; 30(4): 581-89
DuPont RL et al. How are addicted physicians treated? A national survey of Physician Health Programs. Journal of Substance Abuse Treatment 2009 Jul; 37(1): 1-7
Leape LL, Fromson JA. Problem doctors: is there a system-level solution? Annals of Internal Medicine 2006; 144(2): 107-15
Palhares-Alves HN et al. Clinical and demographic profile of anesthesiologists using alcohol and other drugs under treatment in a pioneering program in Brazil. Rev Bras Anestesiol 2013 May; 62(3): 356-64
Pham JC et al. Identification of physician impairment. JAMA 2013 April 29. Doi:10.1001/jama.2013.4635