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Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...
Substance Use Disorders Among Emergency Physicians

Substance Use Disorders Among Emergency Physicians

The prevalence of substance use disorders among physicians ranges between 10% and 14%, a rate that is similar to that of the general population. “Research has shown that several specialties have a higher-than-expected rate of these disorders, most notably anesthesiology, emergency medicine, and psychiatry,” says John S. Rose, MD. Despite the reported higher rates of substance use disorders and participation in Physician Health Programs (PHPs) among these specialties, few studies have focused specifically on the prognosis and recovery of emergency physicians (EPs) in PHPs. Important New Data There are little data on whether EPs who receive treatment by PHPs have similar outcomes with these programs as other physicians. To address this research gap, Dr. Rose and colleagues conducted a study using data from 16 state PHPs that followed participants with substance use disorders for 5 or more years. Published in the Western Journal of Emergency Medicine, the study compared outcomes of EPs with other practitioners who were enrolled in state PHPs. “Research has been limited regarding whether EPs perform as well as other physicians after treatment from PHPs,” Dr. Rose says. “We wanted to determine if there were any characteristics for EPs that were significantly different from those of other physicians.” For the study, investigators reviewed data on 904 physicians with a diagnosis of substance use disorders between 1995 and 2001. They compared 56 EPs with 724 other physicians and assessed rates of relapse, successful completion of monitoring, and return to clinical practice within 5 years. Overall, EPs had a higher-than-expected rate of substance use disorders. “EPs were almost three times as likely to be enrolled in a PHP...
Taking Aim at Physician Impairment

Taking Aim at Physician Impairment

When a critical event occurs in professions other than medicine, detailed investigations are conducted to examine systematic and individual factors that caused or contributed to the event. While these policies are the norm in many high-risk industries, they are not in place for medicine. Mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine, but research shows that alcohol, narcotic, and sedative addiction is as common among physicians as the general population. Furthermore, about one-third of all hospital admissions experience a medical error, meaning it’s possible that physician impairment can contribute to patient harm. Learning From Other High-Risk Industries To improve patient safety, medical institutions should take a cue from other high-risk industries and put policies in place that mandate employee testing for drug or alcohol impairment immediately after an unexpected or significant event occurs. Hospitals can take steps to address this overlooked patient safety issue. One such step is to have physicians participate in mandatory physical exams, drug testing, or both before medical staff appointments to a hospital can be made. This already occurs in some hospitals and has been successful in other industries. Hospitals should also consider random alcohol-drug testing and a policy of routine drug-alcohol testing for all physicians involved with a sentinel event leading to patient death.   An important component to addressing physician impairment is the establishment of testing standards by a national hospital regulatory or accrediting body. Medicine is under-regulated when compared with other industries. Hospitals can take the lead by capitalizing on their infrastructure to conduct adverse event analyses and drug testing and by governing...

Reducing Hazardous & Harmful Drinking in ED Patients

Alcohol problems are prevalent in EDs nationwide, often manifesting when individuals seek medical care for acute illnesses and injuries relating to alcohol. Hazardous and harmful drinking has emerged as a major focus of screening, brief intervention, and referral to treatment efforts in various healthcare settings. Hazardous and harmful drinking has been defined as more than 14 drinks a week or more than four drinks per occasion for men. For women, the thresholds have been defined as more than seven drinks a week or more than three per occasion. While some evidence supports the usefulness of brief interventions for alcohol in primary care and inpatient trauma settings, the data from ED settings are less clear. “It is difficult to compare and assess studies of alcohol screening and interventions in the ED because of several factors,” explains Gail D’Onofrio, MD, FACEP. “Screening tools vary and different levels of severity of drinking may have been included, such as hazardous (at-risk) drinking to dependent drinkers. Also, enrollment may have been limited to certain chief complaints (eg, injury), while others screened participants universally. Other analyses may have varied in length and quality.” Examining a Brief Alcohol Intervention In the March 27, 2012 Annals of Emergency Medicine, Dr. D’Onofrio and colleagues had a study published in which they assessed the impact of an emergency practitioner-based intervention on alcohol consumption in 740 patients who were classified as hazardous and harmful drinkers. A brief negotiation interview (BNI)—which takes only about 7 minutes to perform—was administered to 298 patients. The BNI included: 1. Raising the subject of alcohol. 2. Providing feedback by reviewing screening data and connecting alcohol...

Alcohol Use Disorders & Bariatric Surgery

Among adults who have undergone bariatric surgery, the prevalence of alcohol use disorder appears to be greater in the second year after surgery (9.6%) than in the first year after the procedure (7.3%) and the year prior to surgery (7.6%). The following were independently related to increased odds of post-bariatric surgery alcohol use disorders: Male gender and younger age. Smoking. Regular alcohol consumption. Recreational drug use. A lower sense of belonging and having undergone a Roux-en-Y gastric bypass procedure also increased the odds of alcohol use disorders after surgery. Abstract: JAMA , June 20,...
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