The Impaired Physician Flashcards
What is the definition of an impaired physician?
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)
Men/women are more at risk for alcohol abuse?
Men
What percentage of physicians will become “impaired” during their career?
15%
What are the main causes of physician impairment?
- Psychiatric issues
- Alcohol dependence
- Drug dependence
What specialty has the highest self reported rate of dependence for substance abuse?
Psychiatrist (benzodiazepines)
What specialty has the highest illicit drug use (cocaine, marijuana)?
ER Physicians
What drug are Anesthesiologist most likely to abuse?
Major opiates
What is associated with substance abuse among physicians?
Family history of abuse (3:1 ratio)
In Anesthesiologist , what drug is hard to detect if someone is using it?
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)
What are the diverted drugs that are commonly abused by Anesthesiologist?
- Fentanyl
- Meperidine
- Hydrocodone
What is the most commonly abuse substance?
Alcohol
What substance of abuse is most associated with mortality?
Opioids
What are some risk factors for substance abuse?
- 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
What type of disorder is substance abuse?
A brain disease
There is also a behavioral component
What are some signs and symptoms of substance abuse?
- 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
What are the three D’s that the individual with a substance abuse problem might have?
- 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
What are the characteristics of an intervention?
- 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
What is the responsibility of the Physician’s Health Committee (PHC)?
- Aftercare contract for monitoring
- Random urine drug screens
- Relapse protocol
- Advocacy (as it is earned)
What are the elements of a successful treatment?
- 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
What is the comparison between a physician and the general public risk of developing a substance abuse problem?
Physician’s risk is higher (15% compared to 13.5%) than the general public due to more access to the substances
