Physician Impairment

Question 1

name the top 3 abused substances among physicians

Answer 1

1. alcohol
2. opioids
3. cocaine

Question 2

describe which physicians abuse which drugs

Answer 2

• emergency medicine: cocaine and marijuana
• anesthesia: opioid drugs
• psychiatry: benzodiazepines
  
  • above 3x higher than other groups
• female doctors have higher alcohol abuse rate than public, and female surgeons have higher incidence of alcohol use than other female physicians
  
  • female surgeons > female physicians > normal females

Question 3

_____ is the most common reason for disciplinary action by state boards

Answer 3

substance abuse is the most common reason for disciplinary action by state boards

10% of physicians will have some level of substance related impairment during their careers

Question 4

describe professional lapses

Answer 4

• writing prescriptions for narcotics, stimulatns or sedatives for self or office staff
• requesting prescriptions for narcotics, stimulants or sedatives from colleagues
• diverting patient’s narcotics, stimulants or sedatives for self use

Question 5

physicians disciplined by their regulatory boards were 3x as likely as to have demonstrated ____

Answer 5

physicians disciplined by their regulatory boards were 3x as likely as to have demonstrated unprofessional behavior in medical school

the largest number of disciplinary actions were related to the use of alcohol and drugs

Question 6

explain the suicide rates in physicians

Answer 6

due to the physician’s greater knowledge of lethal drugs and access, rates of completed suicides are higher in the physician population

Question 7

describe barriers to getting help

Answer 7

• doctors are trained and conditioned to be self-reliant and self-sufficient and are subsequently more likely to self-treat then the general population
• the ability to perform under great stress and with great personal difficulties is a hallmark of the profession
  
  • physicians have difficulty admitting their impairment and often perceive that they are still providing excellent medical care
• physicians often have sophisticated denial with elaborate justification and rationalization, making intervention difficult

Question 8

describe how to intervene

Answer 8

• avoid confronting the physician alone
  
  • ask several others (colleages, staff, administrators, family) to participate
• express positive regard for his/her abilities
• describe specific observable problem behaviors and incidents that have led to the need for the intervention
• avoid accusation or blame
• avoid arguing or negotiating

Question 9

describe physician burnout and causes

Answer 9

51% reported burnout

• too many bureaucratic tasks
• spending too many hours at work
• debt
• electronic health records
• symptoms
  
  • emotional exhaustion
  • depersonalization
  • reduced personal accomplishment