promoting resident wellness by addressing physician substance use and abuse margaret m. rea, ph.d....
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Promoting Resident Wellness by Addressing Physician Substance Use and Abuse
Margaret M. Rea, Ph.D.
GME Counselor
Objective:
Increase Awareness of and Promote Treatment of Physician Substance
Use and Abuse
Substance abuse in physicians does exist and needs to be addressed so the system can provide the needed assistance
Assistance that allows the MD to continue to perform, while safe guarding patients
Questions to Answer:
1. How widespread is alcohol and substance use in your colleagues?
2. What behaviors might indicate to you that one of your colleagues had a problem?
3. Have you had experiences with abusing or addicted colleagues?
4. How have you typically responded to a colleague you feel has a substance use problem? Why?
Physicians-Specific Factors
10-15% of physicians develop a substance abuse problem
Family history substance abuse 90% of physicians referred for substance abuse
treatment are males ER, Psychiatry, Anesthesiology, academic
medicine slightly greater risk Other psychological and psychiatric illness High stress
Cont’d
Access control substances (diverting samples meds, self-prescribing, falsifying prescriptions; obtaining prescriptions from colleagues)
Cigarette use >1 pack per day
What are Physicians Using?
Alcohol is number one Marihuana Prescription opiates Cocaine
Signs of Substance Abuse in Physicians
Changes in Personal Behavior
Isolation and withdrawal from family Erratic behavior Legal problems Domestic tension Separation partner Sexual promiscuity
Changes in Social Behavior
Inappropriate behavior at social functions DUI Citation reckless driving down from DUI Detioration personal hygiene Accidents, falls etc
Changes in Professional Behavior Tardiness Rounds at odd times to escape scrutiny Diminished performance Over prescribes meds, diverts meds, request samples Long-sleeved shirts to cover track marks Subject hospital gossip Alcohol on breath Slurs speech Does not respond to pages
Work Behavior Differs Depending On Substance If work is source substance; increased
isolation, longer hours If source away from work like ETOH:poor
work performance, late Mood swings, depression, irritability
Why is it Hard to Recognize?
Addicted physicians continue to function at high levels for a long time only when performance is markedly impaired
Alcohol hard to detect as it is accepted socially and even encouraged
Hard to tell misuse from abuse ETOH Usually detected through complaints
of others
Why is Substance Use by Physicians
Often Not Identified or Addressed?
Physician's Own Denial
Unable to recognize they have a problem If they see the problem they make the
mistake of assuming they can handle it themselves
Physicians do not see themselves as in need of help, they are the ones who help others
Physicians see substance use and abuse as a personal and moral failure not as a disease
Denial by Family
Do not know how to help so they do not voice their concerns
Do not know where to turn for help Fear that the physician will destroy his or
her career if the problem is addressed and in turn their family will suffer
Denial by Peers and Institution
Locked into a conspiracy of silence Fear retribution by physician Risk a friendship or working relationship Seen as trouble maker by other colleagues,
“do not rock the boat” Collude with physician that they can handle
the problem on their own
Physician, Family Members, Peers and the Institution Often do not
Understand the Potential Resources That Exist to Assist Physicians
Which Will Allow them to Continue to Practice
Prognosis Good
Recovery rate for physicians who enter treatment and are followed for 5 years is 90% with monitoring
Physicians respond better than general population to intervention
Treatment can save a career without the risk of loss of license
Where Should Physicians Go for Help?
GME Counselor For Support and Referral
Medical Staff Well-Being Committee
Committee administers a monitoring program for Medical Staff members who are suffering from substance abuse or dependence, or physical or mental health issues that impair their ability to work and function at their best.
The Committee provides advice, recommendations, and assistance to individual physicians and to groups or committees who request assistance or recommendations.
The committee can also be of assistance in helping residents/fellows navigate issues with the medical board in instances such as a DUI and the possible repercussions from the medical board. The committee can be reached through its chair, Dr. Peter Yellowlees, or through Dr. Margaret Rea, the GME counselor.
Other Resources
AA: (916) 454-1100; (916) 454-1771; www.alcoholics-anonymous.org
NA: (916) 732-2299; (916) 732-2298; www.na.org
CA: (916) 386-3545; (800) 347-8998; www.ca.org
What if a Colleague is Impaired
Make an anonymous complaint to Program Director
Contact the GME Counselor for input Contact the Well-Being Committee for
advice Anonymous complaint to Medical Board Contact physician directly
How to Approach a Colleague?
Start from a clinical perspective and state concern regarding resident and patient safety
Avoid diagnosis and describe the behavior Offer Phone Numbers for Well-Being
Committee and /or other resources
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