Risk Management

Substance Abuse and the Physician at Risk

By Byron H. Demorest, MD

Argus, January, 1994

Substance abuse exposes physicians to an alarming risk of malpractice claims. One $52 million claim in 1988 resulted from the death of a patient while under the supervision of an addicted anesthesiologist. Other judgments have been awarded in cases precipitated by poor diagnosis, unnecessary surgery, and improper treatment by physicians who abused drugs or alcohol.

Physician impairment from addiction is a serious problem. If you are faced with the need to help a fellow ophthalmologist who is drug or alcohol impaired, you should follow certain guidelines. Most medical communities have support systems in place either through the local medical society or hospital staff. Most states have statutes requiring physicians to report colleagues who require or are undergoing treatment for substance abuse.

The Problem

It is estimated that about 10% of the general population, and possibly an even greater percentage of the physician population, suffers from drug or alcohol abuse. The reasons for addiction are many. First, the condition truly is a disease. The fact that some individuals crave a substance while others can take it or leave it encourages us to recognize that there are certain genetic and physical aspects to drug abuse. Second, physicians generally have easy access to drugs and, in prescribing medications for their patients, may become nonchalant about drug use. Add to this the stress of practicing medicine and some physicians may feel the need to use substances to relax, sleep or, conversely, to stay awake and maintain concentration.

Physician drug use is not new. Twenty years ago, with alcohol abuse a major problem, the AMA belatedly recognized the need to establish guidelines for physicians assisting alcoholic colleagues in its report, “The Sick Physician.” In recent years, “designer” drugs, particularly fentanyl, have caused many physicians (primarily anesthesiologists and surgeons) to become addicted. What starts out as experimental or recreational drug use can easily become an addiction.

As the problem of substance abuse among physicians received more attention, some states passed “whistle blowing” laws to encourage and, in some instances, require the reporting of addicted and impaired physicians. However, most practitioners were reluctant to report their colleagues due to the punitive nature of the legal system. As a result, many states amended their laws to suspend the reporting of physicians already enrolled in treatment programs. Hospitals and medical societies established physician well-being committees to encourage early intervention for “sick doctors.”

What To Do

The substance abuse problems of a colleague can easily become our own. Without realizing it, we may become “co-dependents.” The first rule is, do not cover up. Do not make up alibis or excuses, or cover for the problems arising from a colleague’s drug or alcohol use.

Second, enlist the help of an expert in the drug abuse field for what is called an intervention. The physician should not be confronted one-on-one; several people should be involved including someone trained to deal with addicted physicians, as well as friends and family of the physician who are aware of the problem and want to help.

Third, do not abandon the physician after this intervention. Have someone stay with the person until he or she is safely enrolled in a treatment program. If your state requires you to report your colleague, you must do so, but voluntary admission by the addicted physician into a treatment program before a report is made is likely to work in his or her favor.

Finally, encourage the addicted physician to participate in ongoing counseling or a recovery program. Recidivism is less likely and recovery is more likely if the impaired ophthalmologist continues to be surrounded by a caring and supportive environment.