Professionalism: Addiction in Doctors Flashcards
What factor make doctors more susceptible to addiction?
1/6 doctors have an addiction to alcohol or drugs
Half of GMC referrals are linked to substance abuse
- Stress
- Doctors may sometimes believe that ‘knowledge prevent addiction’ but this is not true
- Maladaptive attempts to cope
- They may not seek treatment due to stigma and confidentiality
- They may self-prescribe or have psychiatric ignorance
Why is developing addiction and related health conditions amongst doctors a problem?
- Public protection - Can cause impaired decision making and lack of judgement
- Doctor’s wellbeing
- Up to 40% early retirement is due to psychiatric problems - shortage of doctors
- Middle adulthood - typical age for substance related impairment
What are signs of substance abuse?
- Making mistakes
- Mood changes, more irritable
- Asking to borrow money
- Poor performance and functioning (not always)
- Increased absences and breaks
- Inappropriate unexpected behaviour (sexual indiscretion)
- Drunk - seen misusing alcohol or drugs or experiencing withdrawal symptoms
Indicators can include:
- Inappropriate prescribing
- Administering patient medication in a secretive manner
- Medication wastage or missing particularly opiates
- Poor documentation
- Patients getting inadequate pain relief
- Collecting patient medications from pharmacy
- Unwillingness to respond to on-call responsibilities
How can you prevent yourself from developing an addictive disorder?
Seek help when you feel you need it and don’t be afraid to need help, medicine is a very demanding career
What is the GMCs advice on prescribing for yourself or those close to you?
- Wherever possible, you must avoid prescribing for yourself or anyone you have a close personal relationship with
- If you prescribe any medicine for yourself or someone close to you, you must:
1. Make a clear record at the same time or as soon as possible afterwards; the record should include your relationship to the patient, and the reason it was necessary to prescribe
2. Follow the advice on information sharing and processing
You must not prescribe controlled drugs for yourself or someone close to you unless:
1. No other person with the legal right to prescribe is available to assess and prescribe without a delay
2. Emergency treatment is immediately necessary to avoid serious deterioration in health or serious harm
What should you do if you believe you are developing an addictive disorder?
Seek support:
- British Doctors and Dentist Group
- Deaneries
- Doctors for doctors
- Doctors support line
- Doctors support network
- Mednet
- Alcohols anonymous
- Narcotics anonymous
Self-referral:
Agreed to GMC health assessment:
- Psychiatric reviews and treatment
- Regular drug screening - hair test every 3-6 months
- Attend a pain clinic
- Attend NA & BDDG
- Referred for one to one therapy
Reviews every 6 months by GMC medical supervisor:
- Supervised return to work with conditions
- No self-prescribing
- Cannot prescribe controlled drugs
- No locum
- Notify responsible office
- Notify trust occupational health
What should you do if you believe your colleague has developed an addictive disorder?
ASK:
- Are patients at risk from this health professional?
- Is the health professional at risk themselves?
- Has a criminal offence been committed?
Good medical practice states:
“Any practitioner who has serious reasons to doubt the full fitness of a colleague to undertake his job has a duty to bring those concerns to the attention of other colleagues, especially those in management positions”
- Doctors are entitled to full treatment and employment rights as patients
BALANCE:
- Overriding concern of public protection
- Patient-Doctor receiving stigma-free support and treatment
What should you do:
- Arrange to meet them privately
- Let them know that you are concerned and why
- Ask them to consult with an appropriate practitioner and provide them with contact information (brief intervention)
- Follow-up to make sure that they have taken your advice
- Patient safety comes first… followed by doctors wellbeing
- Get confidential advice: Supervisor, BMA, GMC, MDU/MPS
What are the key principles of treatment for addiction?
- Treat as patient NOT college, they’re your patient first, doctor second
- Register with local GP
- Strict confidentiality and privacy of care
- Treated by senior doctors with expertise
- Provide the same care… same information given as would be for other patients
- If not sure ask for help
- Recognise courage of doctor asking for help
- Assume nothing about their knowledge of their problem, or expect them to take more responsibility for their management
- Assess similarly to other patient: Full history and physical examination
- Be directive about their follow up and do not leave it up to them
- Do not allow them to self-prescribe
- If patient safety is at risk, you should advise the doctor… If they are not receptive you should seek further advice
