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How to handle substance abuse in a colleague. (Never Confront the Person Alone).

Last year, Dr. Dana Ware was stunned when a fellow physician arrived for work clearly impaired.

"If he came into the ER as a patient, you would say, 'this person is under the influence of something,'" recalled Dr. Ware, a family physician at Seneca District Hospital, Chester, Calif. "He was so high. His eyes were glazed, and he was staring off."

With the hospital's administrator and director of nursing present, she told him, "I have to relieve you of your duty."

He staggered around, sat down, and said, "I'm shocked."

"So am I," Dr. Ware replied.

A local pharmacist revealed that the young physician--who had a locum tenens arrangement at the hospital--had been filling out prescriptions for a narcotic and Ritalin in other people's names. Dr. Ware kept him at the hospital under observation, but the next day he disappeared.

She phoned colleagues from his previous job and his residency program, who knew about his propensity for substance abuse but had never taken action. She reported the incident to the Medical Board of California, which said it had never heard of him.

"This guy had a clear employment history of substance abuse, and no one had ever done anything about it," Dr. Ware said. "By the time you start using Ritalin to keep yourself alert enough to use narcotics, that indicates a pattern of abuse that has been going on for a long time." She later heard that he had been dismissed from another medical assignment in the state for working while impaired.

A family history of a substance abuse disorder is the greatest risk factor for substance abuse among physicians, noted Dr. Peter Mansky, a psychiatrist with the department of pharmacology and toxicology at Albany (N.Y.) Medical College.

Telltale behaviors vary but can include erratic work absences, mood swings, and making rounds during unusual hours.

If you suspect that a colleague is engaged in substance abuse, Dr. Mansky recommends taking these steps:

* Contact your state Physician Health Program. Physician Health Programs (PHPs) exist in all 50 states; most are members of the Federation of State Physician Health Programs. Staffed by physicians and other professionals, a PHP provides, confidential support for colleagues who suffer from stress, substance abuse disorders, or other psychiatric illnesses.

"When you call, do so anonymously" advised Dr. Mansky, medical director of the Medical Society of the State of New York Committee for Physicians' Health, "Tell them about your friend and ask what they can do to help him or her out. If what they say makes sense to you, go ahead and give them the physician's contact information." In most states and most situations, the impaired physician will get the help he or she needs "because they're pros at this."

PHPs base their treatment plan on medical and clinical standards "just like referral to a practice," he said. "This type of program allows you to recognize doctors very early in their disease, enough so we can intervene, get them into treatment, and back to practice with appropriate monitoring."

* If you can't get help from your state PHP, confront the person. Never confront the person alone. Instead, follow Dr. Ware's example: Confront with other concerned colleagues and, if possible, with a close family member. You might also enlist the help of an intervener recommended by your local medical society or a nearby substance abuse treatment center.

Physicians tend to respond well to treatment. The recovery rate for physicians who participate in PHPs is 70% or higher with abstinence as the criterion, and more than 90% if persistent recovery and return to premorbid functioning by returning to practice are used as the criteria.
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Author:Brunk, Doug
Publication:OB GYN News
Date:May 15, 2003
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