2 Substance Abuse In HCPs Flashcards
What are the different causes of clinician impairment?
Substance abuse and dependence Psychiatric disorders Disruptive behavior Sexual misconduct Incompetence Inappropriate prescribing*** Physical/medical disability
What are the different consequences of clinician impairment?
Community Family Financial Legal Physical and Mental Health Professional (public/patient safety, decreased quality of patient care, increased medical legal risk)
How is physician impairment defined by the AMA?
The inability to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence
_____ of health care professions are impaired due to substance use
~10%
Similar to rates in general population
General signs of an abuse problem
Substitution
Preoccupation
Isolation
Compulsion
Denial
Giving up important activities
Substitution
Drinking or using regularly
Preoccupation
Avoiding people in order to use
Isolation
Legal, family, or health consequences associated with use
Compulsion
Distortions in thinking related to one’s use
Denial
Risk factors for substance abuse in the general population
Family history
Childhood abuse
Age of first use
Drug of choice
Risk factors for substance abuse specific to health care providers
High standards (some unrealistic) Pressures (social, economic, and role pressure) Access to controlled substances Notion of “occupational hazard” (BS) Self-treatment Chronic stress
What is the greatest predictor for substance abuse in health care providers?
Conduct in professional training
What are the different components of substance abuse treatment for health care providers?
Screening, intervention, assessment, and referral
—> Inpatient (Detox or rehab)
—> Out-patient residential
—> Out-patient rehab (intensive out-patient)
—> Therapy
—> Non-judgmental support
What types of therapy are generally used for substance abuse?
Individual counseling and group therapy
12-Step Model (acceptance, willingness, inventory, amends, service, etc)
What did the 1990 AAPA position paper on Physician Assistant Impairment (amended in 1992 and reaffirmed in 2013) conclude?
“Physician assistants have an ethical responsibility to protect patients and the public by identifying and assisting impaired colleagues. “Impaired” means being unable to practice medicine with reasonable skill and safety because of physical or mental illness, loss of motor skills, or excessive use or abuse of drugs and alcohol. PAs should be able to recognize impairment in physician supervisors, PAs, and other health care providers and should seek assistance from appropriate resources to encourage these individuals to obtain treatment.”
What is your main responsibility as a HCP when it comes to substance abuse?
Protect public and patient safety
Early identification and assistance
Scenario: Colleague with alcohol on breath, continual tardiness, interpersonal difficulties, tremor, and difficulty processing.
What do you do?
- Define nature of impairment
- Informal discussion with colleague
- Subsequent follow-up; bring in another colleague
- Enlist expert if no change occurs
- Report to Chief of Staff, Dept Chair, Medical Supervisor
- Finally, may file formal complaint with State Board
Scenario: Supervising physician caught using office’s controlled substances
What do you do?
Recognize criminal nature of activity
Mandatory reporting to board
• Voluntary or involuntary
• Self-referral strongly encouraged
Know your state laws! There is always a list of reportable offenses
Scenario: You get a DUI
What do you do?
Mandatory reporting under ARS32-3208 if DUI, extreme DUI, or Aggravated DUI
AZ DUI - can be either Class I misdemeanor or Class 4 Felony (depending on BAC, record, moving violations etc)
Once you are reported to the board for possible impairment…
Case usually confidential if no related criminal charges, no adverse patient consequences, or statutory violations
Otherwise, Monitored Aftercare Program (MAP) participation under probationary order
Will request professional assessment
If chemical dependency is found, treatment is required
Violations of Unprofessional Conduct may receive…
Warning Advisory Letter Letter of Reprimand Decree of Censure License Suspension License Revocation
The result of a board report for unprofessional conduct will be much more favorable if…
You self-report
Ostrich approach doesn’t work
The majority of board actions are due to…
Improper prescribing or dispensing of controlled substances
