HOPE FOR THE ADDICTED PHYSICIAN

STEPHEN D. LOYD, M.D.

ASSISTANT PROFESSOR OF MEDICINE

QUILLEN COLLEGE OF MEDICINE

OBJECTIVES• To understand that medical professionals are at

high risk for chemical dependency• To learn what to look for in colleagues and

residents whom they suspect may be abusing drugs or alcohol

• To gain knowledge of how to investigate resources available to help physicians and their families with the disease of chemical addiction

• To hear a physician who has personal experience with the problems associated with chemical dependency who is now in recovery

CASE

Steve Loyd, M.D. is a 37 year old internist who practices in the academic setting of internal medicine. He went to medical school and residency at the same institution at which he now works. He did well

through medical school and received the Humanism in Medicine Award from his classmates and graduated near the top of his class, while serving as class President for all four years. Residency was also uneventful, as he received good evaluations and was elected into AOA as a resident.

His final year of residency he served as Chief Resident of Internal Medicine. Upon graduation from residency, he took a job as Assistant Professor of Internal Medicine and stepped into a ready-made practice vacated by a colleague. His practice quickly built and his teaching was recognized by the students as he received the Outstanding Instructor in

Internal Medicine two of his first three years.

About one year into practice, he started to have problems with extreme anxiety and depression for which he sought psychological help. He was placed on sleeping aids and an SSRI. He did not tolerate either of these drugs and took himself off of both. His condition improved and he soon began to work as he thought he was expected to. He had a tremendous

amount of energy and would at times cover three inpatient hospital services, as well as see patients in the clinic. His home life was

deteriorating and he was withdrawn, spending large amounts of time in his bedroom by himself while his wife and kids went about their life. He

had three car wrecks, two in his driveway and one in the mountains of upper East Tennessee, in which he totaled his wife’s Ford Excursion. His behavior in the office was becoming erratic, with frequent absentees and

clinic cancellations. His nurses would try to confront him, but were summarily dismissed. He began to use smokeless tobacco and wear

shorts and baseball caps while seeing patients. He experienced around a 40 pound weight loss and people would often comment on how tired he looked. Charts and dictation were constantly late and he lost interest in

committees and departmental affairs that he previously enjoyed.

DEFINITIONS

• Impaired Physician – A physician whose problems cause him to be dysfunctional with recurring problems in patient care, professional activities, education and private life. He cannot offer reasonable patient care and suffers a decline from his prior level of functioning even if he continues to function adequately.

•ADDICTION – The compulsive use, loss of control and continued use despite adverse consequences.

TWO TYPES:

•CHEMICAL – Alcohol, Opiates, Benzodiazepines, etc.

•PROCESS – Gambling, Sex, Eating

ADDICTIVE POTENTIAL

• Opiates – Hydrocodone(Lortab), Oxycodone(Percocet/Oxycontin), Morphine(MS Contin), Fentanyl, Dilaudid, Tramadol(Ultram)

• Decongestants – Pseudoephedrine, Dextro- methorphan• Benzodiazepines – Alprazalam(Ativan),

Diazapam(Valium), Clonazepam(Clonapin)

EPIDEMIOLOGY• Alcohol or other chemical dependency is the cause

of physician impairment in up to 85% of evaluated cases

• Alcoholism/Drug Addiction in physicians has a 2% point prevalence and a 10% lifetime prevalence

• For our program, 2 ½ physicians are currently addicted and 12 will become addicted at some point in their life

• About 17,000 practicing physicians have substance abuse problems with around 100 dying each year as a result

UNIQUE CHARACTERISTICS

• High denial – medical license• Enabling – nurses, family allow disease to

continue longer than it would for a non-physician• Loners – poor support system• High tolerance – access to pure drugs and can

present detoxification problems• Need for confidentiality – licensing problems, loss

of practice

RECOGNITION

PERSONALITY CHARACTERISTICS

“Just not the same guy we used to know”

• Loss of Enthusiasm

• Negative Attitudes

• Cynical – Fault-finding remarks

• Sarcastic, Complaining, Intolerant, Antagonistic

• Involvement in Administrative Wars

• Overworked martyr

• Abandonment or manipulation of old friends

• Morbid health concerns

• Depression, loss of humor

• Complaints about spouse

• Isolation

• Mistrust

CLUES FROM PERFORMANCE

“We can’t trust his work anymore”• Change in work habits – consistent patterns of

absence• Late charting• Poor notes• Crazy hours• Errors in meds• Procedural errors• Missed appointments and meetings• Complaints from patients

CHANGES IN PHYSICAL CONDITION

• Looks tired• Eyes don’t look right• Personal hygiene changes• Smell of alcohol• Tremulous or sweaty• Agitated and irritated• Speech changes• Weight loss

MENTAL STATE

• Hopeless

• Paranoid

• Overwhelming toxic shame

TREATMENT

• Three month or longer intensive residential treatment

Treatment Facilities:

• Center for Professional Excellence, Nashville, TN

• Talbott Recovery Campus, Atlanta, GA

• Charter Lakeside, Memphis, TN

TREATMENT

• Aftercare program

• Total abstinence

• Monitoring system (including bodily fluids)

• 12 Step involvement

The Stockdale Paradox

Retain faith that you will Confront the most

Prevail in the end, AND at the brutal facts of your

Regardless of the same time current reality,

difficulties. Whatever they

might be.

Admiral Jim Stockdale

Collins, J. Good to Great. HarperCollinsPublishers, New York, 2001

OUTCOMES

• Several studies have shown that approximately 75% of all chemically dependent physicians can recover from their disease and lead productive, worthwhile lives if they are given the chance

• Recent study from JAMA 2001 – 21 of 22 recovering physicians in Florida were clean and sober at five years

ADVOCACY

Tennessee Medical Foundation

• Dr. Roland Gray, Brentwood, TN

• Dr. Jack Woodside, Johnson City, TN

Urine Drug Screens

• 30 per year for the first year

• 15 per year for the next four years

SUMMARY

• We share a moral responsibility for the well-being of the medical profession

• We are to ensure that no harm comes to a patient because of an impaired physician

• The image of the all-knowing physician should be abolished

• The potential for change is there