The Impaired Physician

Question 1

What is the definition of an impaired physician?

Answer 1

A physician who is unable to practice medicine with reasonable skills and safety beacuse of:

• A mental illness
• A physical illness or condition that adversely affects cognitive, motor, or perceptive skills
• Substance abuse (most common)

Question 2

Men/women are more at risk for alcohol abuse?

Answer 2

Men

Question 3

What percentage of physicians will become “impaired” during their career?

Answer 3

15%

Question 4

What are the main causes of physician impairment?

Answer 4

• Psychiatric issues
• Alcohol dependence
• Drug dependence

Question 5

What specialty has the highest self reported rate of dependence for substance abuse?

Answer 5

Psychiatrist (benzodiazepines)

Question 6

What specialty has the highest illicit drug use (cocaine, marijuana)?

Answer 6

ER Physicians

Question 7

What drug are Anesthesiologist most likely to abuse?

Answer 7

Major opiates

Question 8

What is associated with substance abuse among physicians?

Answer 8

Family history of abuse (3:1 ratio)

Question 9

In Anesthesiologist , what drug is hard to detect if someone is using it?

Answer 9

Propofol

• Propofol is very short acting and hard to tell if someone is using it (must do hair test to detect up to 3 month previous use)

Question 10

What are the diverted drugs that are commonly abused by Anesthesiologist?

Answer 10

• Fentanyl
• Meperidine
• Hydrocodone

Question 11

What is the most commonly abuse substance?

Answer 11

Alcohol

Question 12

What substance of abuse is most associated with mortality?

Answer 12

Opioids

Question 13

What are some risk factors for substance abuse?

Answer 13

• Family history
• Background
• Control
• Stress
• Personality factors
• Coexisting psychiatric illness
• Self treatment (pain, sleep)
• Thrill-seeking (ER docs); curiosity
• Readily available drugs
• Chronic fatigue
• Low self esteem

Question 14

What type of disorder is substance abuse?

Answer 14

A brain disease

There is also a behavioral component

Question 15

What are some signs and symptoms of substance abuse?

Answer 15

• Insulation from others
• Inappropriate behavior change
• Mood swings
• Less interest in family, friend, sexual relationships
• Easy to anger
• Unusual interest in being early or staying late
• Weight loss
• Unexplained absences (or illnesses)
• Pinpoint pupils
• Alcohol odor on breath
• Withdrawal
• Gambling, extramarital affairs
• Legal probelms
• Found dead/comatose

Question 16

What are the three D’s that the individual with a substance abuse problem might have?

Answer 16

• Delusion - Ideas of grandiosity, invulnerability (doctors think since they have knowledge of drug, they won’t become addicted)
• Denial - See no problem with their behavior
• Defiance - Resistant to help of any sort

Question 17

What are the characteristics of an intervention?

Answer 17

• Life/career saving
• Demonstrating they are ill and need treatment
• People that are close to the physician should be present
• Should be rehearsed, factual, nonjudgmental, caring and compassionate
• Irrefutable evidence presented

Question 18

What is the responsibility of the Physician’s Health Committee (PHC)?

Answer 18

• Aftercare contract for monitoring
• Random urine drug screens
• Relapse protocol
• Advocacy (as it is earned)

Question 19

What are the elements of a successful treatment?

Answer 19

• Intervention
• Treatment at an appropriate center
• Understanding/accepting disease of addiction
• Family involvement
• Mutual help groups (AA/NA)
• Random drug screens
• Aftercare Physicians Health Committee
• Lifelong process

Question 20

What is the comparison between a physician and the general public risk of developing a substance abuse problem?

Answer 20

Physician’s risk is higher (15% compared to 13.5%) than the general public due to more access to the substances