substance abuse among healthcare providers dennis ison dennis ison professor d. fahringer professor...
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Substance Abuse Among Substance Abuse Among Healthcare ProvidersHealthcare Providers
Dennis IsonDennis Ison
Professor D. FahringerProfessor D. Fahringer
April 20, 2006April 20, 2006
BackgroundBackground
1958 – Abuse among providers first 1958 – Abuse among providers first recognized by The Federation of recognized by The Federation of State Medical Boards (FSMB)State Medical Boards (FSMB)
1974 - AMA acknowledged substance 1974 - AMA acknowledged substance abuse as an illness and developed a abuse as an illness and developed a model legislation to offer a beneficial model legislation to offer a beneficial option of discipline for providers with option of discipline for providers with addiction. addiction.
IntroductionIntroduction
FSMB - FSMB - inability to practice medicine with inability to practice medicine with skill and safety by reason of mental illness, skill and safety by reason of mental illness, physical illness, and substance abuse, physical illness, and substance abuse, including alcohol and other drugs that including alcohol and other drugs that impair abilitiesimpair abilities
AAPA - AAPA - one who is unable to practice skill one who is unable to practice skill and safety to patients because of physical and safety to patients because of physical and mental illness including deteriorations and mental illness including deteriorations through the aging process, loss of motor through the aging process, loss of motor skills, or excessive use or abuse of drugs skills, or excessive use or abuse of drugs including alcoholincluding alcohol
PrevalencePrevalence
http://www.http://www.sfgatesfgate.com/.com/cgicgi-bin/article.-bin/article.cgicgi?f=/c/a/2006/03/10/BAG5EHLV451.DTL&fe?f=/c/a/2006/03/10/BAG5EHLV451.DTL&feed=ed=rssrss..bayareabayarea
Zamora, J. H. (2006). Zamora, J. H. (2006). Allegedly Drunken Surgeon Arrested in Operating Room. Allegedly Drunken Surgeon Arrested in Operating Room. San Francisco Chronicle. San Francisco Chronicle.
B-3.B-3.
Risk FactorsRisk Factors
Genetics & Familial ComponentsGenetics & Familial Components College AtmosphereCollege Atmosphere Educational & Career ExpectationsEducational & Career Expectations Opportunity & Availability of Opportunity & Availability of
SubstancesSubstances Pharmaceutical Knowledge Provides Pharmaceutical Knowledge Provides
ImmunityImmunity Self-treatment Self-treatment
SpecialtiesSpecialties
High RiskHigh Risk Anesthesiologists – Access to NarcoticsAnesthesiologists – Access to Narcotics Residents – Recreation, Performance or Residents – Recreation, Performance or
STST Others – ER specialists & PsychiatristsOthers – ER specialists & Psychiatrists
Low Risk (in general)Low Risk (in general) Pediatricians, Pathologists, Radiologists Pediatricians, Pathologists, Radiologists
& OBGYNs & OBGYNs
Drug of ChoiceDrug of Choice
Opioids – Younger AnesthesiologistsOpioids – Younger Anesthesiologists Alcohol – Older Anesthesiologists & Alcohol – Older Anesthesiologists &
Female PhysiciansFemale Physicians
Over All - Benzodiazepines & opiates Over All - Benzodiazepines & opiates > Recreational Drugs, such as > Recreational Drugs, such as Marijuana & Cocaine Marijuana & Cocaine
IdentifiersIdentifiers
Marital Problems (undetected)Marital Problems (undetected) Legal Problems - Domestic Violence, Legal Problems - Domestic Violence,
Charges of Irregularities in Prescription Charges of Irregularities in Prescription Writing, AIs or DUIs, Elicit Drug Possession Writing, AIs or DUIs, Elicit Drug Possession & Bankruptcy& Bankruptcy
Personality Changes - Mood D/Os, Personality Changes - Mood D/Os, Confusion, Memory Loss, Anxiety, Confusion, Memory Loss, Anxiety, Depression, Lack of Impulse Control, Depression, Lack of Impulse Control, Suicidal Thoughts or Gestures Suicidal Thoughts or Gestures
PerformancePerformance
No Longer Available for Extra Shifts No Longer Available for Extra Shifts Increase # of “Call-ins”Increase # of “Call-ins” Using Personal Time ExcessivelyUsing Personal Time Excessively Increased Tardiness & AbsenteeismIncreased Tardiness & Absenteeism Inconsistent Work HabitsInconsistent Work Habits Decrease in Efficiency Decrease in Efficiency Increase in Personal Phone Calls Increase in Personal Phone Calls
SuicideSuicide
Most Common Death in Young PhysiciansMost Common Death in Young Physicians Depression, Drug Abuse, Alcoholism, Depression, Drug Abuse, Alcoholism,
Marital Conflict, Single, Divorced or Marital Conflict, Single, Divorced or Widowed & FemaleWidowed & Female
More than 1/3 of physicians that committed More than 1/3 of physicians that committed suicide are believed to have had a drug suicide are believed to have had a drug problem at some time in their lives problem at some time in their lives
More than 1/2 had prescribed a More than 1/2 had prescribed a psychoactive drug for themselves psychoactive drug for themselves
ConfrontationConfrontation
Someone w/ Influence & Authority Someone w/ Influence & Authority Caring, Professional, & Well-Caring, Professional, & Well-
organized Intervention organized Intervention
EvaluationEvaluation
VP of Medical Affairs or Admin. on CallVP of Medical Affairs or Admin. on Call Meeting w/ the provider to observe conduct, Meeting w/ the provider to observe conduct,
appearance & demeanorappearance & demeanor Submission to a Drug ScreenSubmission to a Drug Screen Participation in a Rehabilitation Program Participation in a Rehabilitation Program
Conard, Jane & S. Allan Adelman. 2004. Conard, Jane & S. Allan Adelman. 2004. Impaired Practitioner Policy. Impaired Practitioner Policy. Journal of Health Law. 37(4): 693-Journal of Health Law. 37(4): 693-700.700.
TreatmentTreatment
Provider Self-healing vs. Help from OthersProvider Self-healing vs. Help from Others Referral Self-report or Encouragement Referral Self-report or Encouragement
from Othersfrom Others Prevent Patient HarmPrevent Patient Harm Recognition of a Problem Recognition of a Problem Identify the Specific ProblemIdentify the Specific Problem Acknowledge That One Needs HelpAcknowledge That One Needs Help Help is Available Help is Available
Treatment (cont.)Treatment (cont.)
Education about Alcoholism & Drug Education about Alcoholism & Drug AbuseAbuse
Stress Management Skills EducationStress Management Skills Education Encounter & Discussion GroupsEncounter & Discussion Groups Workshops & CounselingWorkshops & Counseling Long-term & ComprehensiveLong-term & Comprehensive Consistent, Rigid & Comprehensive Consistent, Rigid & Comprehensive
MonitoringMonitoring
Treatment BarriersTreatment Barriers
Accepting the Patient RoleAccepting the Patient Role Stigma Bound ProblemsStigma Bound Problems Fear of Confidentiality BreechesFear of Confidentiality Breeches Jeopardy to their Reputation, Jeopardy to their Reputation,
Professional Accreditation, & Professional Accreditation, & EmploymentEmployment
Public Disclosure Public Disclosure
Treatment OutcomesTreatment Outcomes
Recovery 73% - 91%Recovery 73% - 91% Education & PreventionEducation & Prevention Mandatory TreatmentMandatory Treatment Frequent Urine CheckingFrequent Urine Checking Peer Assistance Programs Peer Assistance Programs
DentistryDentistry
Alcoholism & SuicideAlcoholism & Suicide Universal Knowledge vs. Urban Universal Knowledge vs. Urban
LegendLegend
ConclusionConclusion
IdentificationIdentification ConfrontationConfrontation TreatmentTreatment PreventionPrevention
Don’t DrinkDon’t Drink Don’t Do DrugsDon’t Do Drugs Don’t CurseDon’t Curse Go To Church on SundayGo To Church on Sunday
REFERENCESREFERENCES
Blondell, Richard. 2005. Blondell, Richard. 2005. Taking a Proactive Approach to Physician Impairment. Taking a Proactive Approach to Physician Impairment. Postgraduate Medicine. 118(1): 16-8.Postgraduate Medicine. 118(1): 16-8.
Bohigian, George. Et al. 2005. Bohigian, George. Et al. 2005. The Impaired and Disruptive Physician: The Missouri’s Physicians Health Programs – An Update (1995-The Impaired and Disruptive Physician: The Missouri’s Physicians Health Programs – An Update (1995-2002).2002). Journal of Addictive Diseases. 24(1): 13-23. Journal of Addictive Diseases. 24(1): 13-23.
Boisaubin, Eugene & Ruth Levine. 2001. Boisaubin, Eugene & Ruth Levine. 2001. Identifying and Assisting the Impaired Physician.Identifying and Assisting the Impaired Physician. American Journal of the Medical Sciences. American Journal of the Medical Sciences. 322(1): 31-6.322(1): 31-6.
Bostrom, Andrea. Et al. 2004. Bostrom, Andrea. Et al. 2004. Impaired Practice and the law in Michigan.Impaired Practice and the law in Michigan. URL: URL: http://www.http://www.minursesminurses.org/.org/contedconted//CEModuleCEModule--ImpairedpracticeImpairedpractice.doc.doc , no , no date given, accessed 12/4/05. Michigan Nurses Association. date given, accessed 12/4/05. Michigan Nurses Association.
Broquet, Karen & Rockey, Paul. 2004. Broquet, Karen & Rockey, Paul. 2004. Teaching Residents and Program Directors About Physician Impairment. Teaching Residents and Program Directors About Physician Impairment. Academic Psychiatry. Academic Psychiatry.
28: 221-5. 28: 221-5. Collins, Greg. 1998. Collins, Greg. 1998. New Hope for Impaired Physicians: Helping the Physician While Protecting the Patient.New Hope for Impaired Physicians: Helping the Physician While Protecting the Patient. Cleveland Clinic Journal of Cleveland Clinic Journal of
Medicine. 65(2): 101-6.Medicine. 65(2): 101-6. Conard, Jane & S. Allan Adelman. 2004. Conard, Jane & S. Allan Adelman. 2004. Impaired Practitioner Policy. Impaired Practitioner Policy. Journal of Health Law. 37(4): 693-700.Journal of Health Law. 37(4): 693-700. Ethics Committee of the AAO-HNS. 1996. Ethics Committee of the AAO-HNS. 1996. Chapter 7: The Impaired Physician. Chapter 7: The Impaired Physician. Ethics Committee of the AAO-HNS. 115(3): 213-7.Ethics Committee of the AAO-HNS. 115(3): 213-7. Frank, E. & A. Dingle. 1999. Frank, E. & A. Dingle. 1999. Self-Reported Depression and Suicide Attempts Among U.S. Women Physicians. Self-Reported Depression and Suicide Attempts Among U.S. Women Physicians. Am J Psychiatry. 156: Am J Psychiatry. 156:
1887-94.1887-94.
Hagan III, John. 2002. When Good Docs Go Bad. Missouri Medicine. 99(4): 153-4.
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