This is the most difficult topic I have ever tried to discuss with physicians. Once, teaching a national medicolegal conference, I said to an audience of 400 physicians from all over the country, “OK, most of you will never see each other again. Let’s see a show of hands. Who knows someone on your medical staff that you think may be impaired?” Guess what, no hands.
I was prepared for this response and I congratulated this brilliant group of men and women on being completely protected from the national incidence of substance abuse. Some believe that professionals are more at risk of abuse and addiction than the general population. But this group had no suspicious colleagues. What does this tell us?
Physicians are at high risk for substance abuse and addiction. But physicians protect each other from outside attacks. Protecting colleagues from the reality of substance abuse and addiction does no favors—to the patient population or to the individual physician you may be trying to protect. If you really care about your colleagues, do not let their issues progress to the point that patients may be harmed and your colleagues’ careers damaged. You may have a duty to report. For more information click here.
In Arizona we have a very effective safety net. The Arizona Legislature empowered our medical boards to “discipline and rehabilitate.” Our boards choose to focus on rehabilitation rather than discipline. If a physician wants to be rehabilitated, the program is in place. If not, discipline will occur. Discipline for the willful failure to participate in a substance abuse investigation or recommended evaluation or treatment will be severe. There are times when a physician can say “No” and times when that response will cause serious consequences.
Arizona’s Monitored Aftercare Program (MAP) has had remarkable success. The program has been refined many times and outcomes have improved. The standard MAP stipulation requires multiple layers of monitoring: random biological fluid/hair samples, based on daily call in, a 24/7 phone number for days when the physician’s number is not called, mandatory AA attendance, multiple group therapy sessions, a medication log, a single prescribing physician and other protections. Getting away with a relapse is virtually impossible.
Groups considering what to do about a group member returning from treatment should read my article “The Impaired Physician In Your Group.”