Your Surgeon May Have an Alcohol Problem
Before you or your loved ones are scheduled to undergo surgery, you might inquire about the surgeon’s skill and knowledge of the procedure. But one question you likely don’t ask is whether your surgeon has an alcohol problem, and the answer in far too many cases may be yes.
Are some surgeons operating under the influence?
It’s been estimated that nearly 10% of the US population age 12 years and older have some sort of substance abuse or dependence problem, including alcohol and other abusable substances. Males are twice as likely as females to have alcohol abuse or dependence problems within the last year.
But is this same level of alcohol abuse or dependence seen in surgeons? This question was pursued by Michael R. Oreskovich, MD, of the American College of Surgeons (ACS) and his colleagues through use of an anonymous e-mail survey sent to more than 25,000 members of the ACS for whom email addresses were available. The ACS has approximately 65,000 members.
The survey consisted of approximately 70 questions about practice characteristics, quality of life, substance use, malpractice suits, medical errors, career satisfaction, and demographic information. A total of 7,197 (28.7%) of the survey recipients completed the self-report.
Of the respondents, 15.4% (1,112 surgeons) had a score on the Alcohol Use Disorders Identification Test that indicated alcohol abuse or dependence. When separated by gender, 13.9% of male surgeons and 25.6% of female surgeons fit the criteria for alcohol use disorders.
The presence of alcohol abuse or dependence was more likely when the following factors were present:
- Younger age
- Surgeons who had an unsatisfactory relationship with a spouse or partner
- Being childless
- Being depressed or burned out. However, prevalence of alcohol abuse or dependence was lower among surgeons who worked longer hours and who had more nights on call.
The researchers explored the prevalence of alcohol use disorders and their relationship to professional issues (e.g., medical errors, malpractice lawsuits), distress, and personal characteristics. They found that surgeons who reported alcohol problems accounted for 77.7% of surgeons who reported a medical error within the previous three months.
The authors of the report, which appears in the February issue of Archives of Surgery, hope that by conducting this survey, the ACS has taken a step toward “destigmatization of this disorder with the intent of promoting appropriate intervention and treatment.”
Previous studies of alcohol use and surgery
In two small studies reported in a 2011 issue of the Archives of General Surgery, Anthony G. Gallagher, PhD, of the Royal College of Surgeons National Surgical Training Center in Dublin, Ireland, and his team found that surgical skills were impaired until as late as 4 PM on the day after surgeons had been drinking alcohol.
The studies included both science students and surgeons and involved the use of simulated surgical procedures, so none of the surgeons actually performed operations on patients. Overall, the surgical performance for all the surgeons and students declined significantly the day following alcohol consumption.
More on surgeons and alcohol use
In this latest study of ACS members, the authors pointed out that “Alcohol abuse and dependence is a treatable and reversible condition with an excellent prognosis when identified early with appropriate intervention, treatment and monitoring.”
An accompanying critique in the same issue of the Archives by John A. Fromson, MD, of Massachusetts General Hospital, Harvard Medical School, pointed out the wide range between alcohol abuse or dependence between male and female surgeons. Fromson noted that “This critical finding must serve as a catalyst for future investigation as to the cause, effective treatment and prevention of alcohol use disorders among female and male surgeons.”
In addition, an accompanying editorial by Edward H. Livingston, MD, of the University of Texas Southwestern Medical Center, and Joseph S. Wislar, MS, Journal of the American Medical Association, noted that the low response rate from the ACS members should “give one pause to consider that responding surgeons may not adequately reflect the universe of surgeons, or even the members of the American College of Surgeons, eligible for study participation,” and thus the results “should be interpreted with some caution.”
In the meantime, however, millions of people undergo surgery every year. For potential surgical patients, the question that may cross their minds is, does my surgeon have an alcohol problem?
Fromson JA. Surgeon, heal thyself: comment on “prevalence of alcohol use disorders among American surgeons.” Archives of Surgery 2012; 147(2): 174
Gallagher AG, Boyle E et al. Persistent next-day effects of excessive alcohol consumption on laparoscopic surgical performance. Archives of Surgery 2011; 146(4): 419-26
Livingston EH, Wislar JS. Minimum response rates for survey research. Archives of Surgery 2012; 147(2): 110
Narrow WE, Rae DS, Robins LN, Regier DA. Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys’ estimates. Archives of General Psychiatry 2002; 59(2): 115-23
Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J, Meredith C, Buhl A, Dyrbye LN, Shanafelt TD. Prevalence of alcohol use disorders among American surgeons. Archives of Surgery2012; 147(2): 168-74
Substance Abuse and Mental Health Services Administration. Results from the 2009 National Survey on Drug Use and Health, volume I: summary of national findings. SAMHSA Web site, Data, Outcomes, and Quality page. Rockville, MD: Office of Applied Studies; 2010. NSDUH Series H-38A, Health and Human Services publication SMA 10-4586.
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