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 bylaws to guide physician conduct.
Potential Benefits of Physician Impairment Programs
The development of a physician impairment program does have potential risks for physicians and their institutions, but the key is to consider opportunities for benefit. Patients might be better protected from preventable harm. For physicians and their employers, there may be less absenteeism and fewer unintentional adverse events or injuries. Hospitals can also identify debilitating problems earlier and guide physicians to highly effective treatment programs when necessary. These programs can turn around the lives and careers of affected physicians.
The need to detect and prevent physician impairment must be balanced with the rights of privacy and autonomy. Patients and their family members have a right to be protected from impaired physicians. In other high-risk industries, regulations and surveillance further support this right. Medicine needs to follow suit and work toward developing a robust system to identify impaired physicians and get them the help they need. Such proactive efforts may enhance the professionalism that medicine seeks to protect.
Pham JC, Pronovost PJ, Skipper GE. Identification of physician impairment. JAMA. 2013 Apr 29 [Epub ahead of print]. Available at: http://jama.jamanetwork.com/article.aspx?articleid=1682565.
McLellan AT, Skipper GE, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337a2038.
Leape LL, Fromson JA. Problem doctors: is there a system-level solution? Ann Intern Med. 2006;144:107-115.
Fitzsimons MG, Baker KH, Lowenstein E, Zapol WM. Random drug testing to reduce the incidence of addiction in anesthesia residents: preliminary results from one program. Anesth Analg. 2008;107:630-635.