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Should You Report a Fellow Physician for Substance Abuse?

By Debra Wood, RN, contributor

Challenged by what to do when you suspect a physician colleague is abusing substances or otherwise impaired? 

You must act in order to stop the far-reaching effects of physician substance abuse.

“It is important, and if someone is a danger to himself or herself or to his or her patients, you have a moral duty, and, in Massachusetts, a legal duty to take action,” said J. Wesley “Wes” Boyd, MD, PhD, associate professor in psychiatry and faculty member in the Bioethics Center at Harvard Medical School, staff psychiatrist at Cambridge Health Alliance (CHA) and founder and co-director of the Human Rights and Asylum Clinic at CHA.

An ethical obligation to report

The American Medical Association’s Code of Medical Ethics says that physicians have a responsibility to impaired colleagues and must intervene to ensure the person stops practicing and receives assistance from a physician health program. 

That responsibility may include reporting to the state’s licensing authority. 

But that is not the first step. Boyd explained that most hospitals have physician health committees, and The Joint Commission standards require hospitals have a process for dealing with an impaired physician.

“The most obvious [initial action] is to take your concern to the folks on that committee,” Boyd said. “For the most part, hospitals will defer to their attorneys. They know what the AMA says and will refer to the physician health programs.”

In a private practice, leaders might tell a physician that if treatment is not obtained, he or she will not be able to remain part of the practice, Boyd added. 

Physician substance abuse is a serious issue, because it can place patients at risk. Boyd reported that it is as common in the medical professionals as the general public, adding that at some point in their careers, it is estimated that 8 -15 percent of physicians will have a substance use disorder. 

Certain specialties are more likely to misuse drugs common in their practice. For instance, Boyd indicated anesthesiologists are more likely to misuse opioids and psychiatrists benzodiazepines. 

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“Addiction does not discriminate,” said Megan Wilson, BS, CADC, addictions program coordinator at Timberline Knolls Residential Treatment Center in Lemont, Illinois. She explained that it can start with a using alcohol to unwind at the end of the day, but then it turns into a problem. 

When to act on physician substance abuse

Knowing when to report a fellow doctor can be tricky. Warning signs of substance abuse include acting more erratic or out of character. Perhaps the person is frequently absent or coming in late or not paying attention to personal hygiene. 

Such unusual behavior may be due to stress, sleep deprivation or an out-of-control medical problem, such as diabetes. The warning signs are sometimes vague and could occur with other conditions. 

“Any set of warning signs has to be very general and you cannot draw conclusions until you have more data,” Boyd said. 

Confronting an impaired physician or other practitioner depends on your relationship with the person, Boyd said. He advised not being in the room alone with the clinician suspected of substance abuse, but to always have a third party present. 

Additionally, the person confronting should be nonjudgmental and stick to the facts. 

Not all states have physician health programs to deal with physician substance abuse. Boyd questions some of the financial conflicts of interest associated with the programs. In many cases, the evaluation center also serves as the treatment center. 

“There is money going back and forth,” Boyd said. 

The programs have a good success rate, about 75 percent to 80 percent of physicians who enter monitoring programs will come out after three to five years and be able to practice, he said. But he noted that the people who write those papers are the ones running the programs and may not count dropouts or those physicians who go so far as to commit suicide.  

Physicians recognizing they have a substance use disorder can self-refer for treatment. 

Wilson encourages physicians to come forward, because help is available. Treatment may be inpatient or outpatient, depending on severity, withdrawal symptoms and insurance coverage. 

“Self-reporting shows the person has a willingness to change their lifestyle,” Wilson said. “They are seeking out help for themselves and willing to change their path.”

Additionally, physicians can participate in International Doctors in Alcoholics Anonymous (IDAA), a global organization of more than 9,900 health care professionals who help each other achieve and maintain sobriety. IDAA offers online meetings. 

“If you have a problem and are using drugs or alcohol in the workplace, you should get help immediately because of the chance you will harm someone else and possibly your career,” Boyd concluded. “You need to nip it in the bud.”

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