Impaired physicians helping good people with problems continue to do a good job
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Impaired Physicians: Helping Good People With Problems Continue to Do A Good Job. McGaw Medical Center & Perspectives Housestaff Assistance Program “HAP”. What We Will Cover:. Physician Impairment History of Physician Health Alcohol and Other Mood Altering Substances

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Impaired physicians helping good people with problems continue to do a good job

Impaired Physicians: Helping Good People With Problems Continue to Do A Good Job

McGaw Medical Center

&

Perspectives Housestaff Assistance Program “HAP”


What we will cover

What We Will Cover:

  • Physician Impairment

  • History of Physician Health

  • Alcohol and Other Mood Altering Substances

  • Identification of Addiction in Physicians

  • McGaw Medical Center Housestaff Assistance Program “HAP”


Physician impairment defined

Physician Impairment Defined:

  • “A physician who is unable, or potentially unable to practice medicine with reasonable skill and safety to patients because of physical or mental illness, including deterioration through the aging process or loss of motor skills, or excessive use or abuse of drugs including alcohol.”

AMA “The Sick Physician”, 1973


History of physician health

History of Physician Health

  • 1910 Flexner Report on medical education

    • State Medical Societies and Legislatures began regulating medical practice

    • Requiring physicians and surgeons be free of “vice, moral turpitude and the intemperate use of alcohol and drugs”


History of physician health1

History of Physician Health

  • 1914 The Harrison’s Narcotics Drug Act

    • Began process of classifying, regulating and controlling drugs that have the potential for abuse.


History of physician health2

History of Physician Health

  • 1920 English Parliament Dangerous Drug Control Act

    • Registration of addicts as an attempt to control addiction

    • Nearly 25% of the registered addicts were doctors, dentists, veterinary surgeons or nurses

Stimson, Oppenheimer and Stimson, “Drug Abuse in the medical profession”, British Journal of Addiction 79: 395-402


History of physician health3

History of Physician Health

  • 1970 Florida “Sick Doctor Statute”

    • Defined inability to practice medicine with reasonable skill and safety

    • Revised the grounds for professional discipline under the state’s medical practice act


History of physician health4

History of Physician Health

  • 1973 AMA Council on Mental Health – “The Sick Physician”

    • State Medical Societies establish programs or committees devoted to identifying and helping impaired physicians

    • AMA develops model legislation to amend state practice acts so that treatment was available instead of punitive disciplinary measures


History of physician health5

History of Physician Health

  • 2001 JCAHO Standards

    • Physician Health

      - “Medical staff implements a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function.”

Joint Commission on Accreditation of Healthcare Organizations, Web site, November 2000


History of physician health 2001 jcaho standards

History of Physician Health: 2001 JCAHO Standards

  • Physician Health

    • Design a process that:

      - provides education about physician health

      - addresses prevention of physical, psychiatric, or emotional illness

      - facilitates confidential diagnosis, treatment and rehabilitation of physicians who suffer from a potentially impairing condition

Joint Commission on Accreditation of Healthcare Organizations, Web site, November 2000


History of physician health 2001 jcaho standards1

History of Physician Health: 2001 JCAHO Standards

  • Physician Health

    • The purpose of the process is:

      - assistance and rehabilitation, rather than discipline

      - to aid a physician in retaining or regaining optimal professional functioning, consistent with the protection of patients

Joint Commission on Accreditation of Healthcare Organizations, Web site, November 2000


Alcohol and other mood altering substances

Alcohol and Other Mood Altering Substances

Use, Abuse and Dependence


Niaaa safe levels of drinking

NIAAA – Safe Levels of Drinking

  • Two drinks per day for males

  • One drink per day for females


What is a drink

What Is a Drink?

  • Beer (12 ounces)

  • Wine cooler (12 ounces)

  • Wine (5 ounces)

  • Liquor (1.5 ounces / 80 proof)


Substance abuse dsm iv

Substance Abuse – DSM-IV

A maladaptive pattern of substance use, as manifested within a 12-month period by one of the following:

  • Recurrent substance use leading to failure to fulfill major role obligations

  • Use of substances in situations where it is physically hazardous

  • Legal problems associated with the use

  • Continued substance use despite persistent or recurrent social/interpersonal problems


Substance dependence dsm iv

Substance Dependence – DSM-IV

A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following seven criteria, occurring at any time in the same 12-month period:

  • Tolerance

  • Withdrawal

  • Use of larger amounts or longer than intended


Substance dependence dsm iv continued

Substance Dependence – DSM-IV - Continued

  • Unsuccessful efforts to cut down or control use

  • A great deal of time spent obtaining, using or recovering from effects

  • Important activities are given up

  • Use is continued despite having recurrent or psychological problems


Chemical dependence defined

Chemical Dependence Defined

A chronic, progressive disease characterized by a repetitive, unpredictable, and inconsistent loss of control or drug use that results in problems for user, his/her family, friends, others


Identification of addiction in physicians

Identification of Addiction in Physicians


Identification of addiction in physicians1

Identification of Addiction in Physicians

  • Irritability

  • Irresponsibility

  • Inaccessibility

  • Inability

  • Isolation

  • Incidentals


Identification of addiction in physicians2

Identification of Addiction in Physicians

  • Irritability

    - Mood swings

    - Negative attitude

    - Argumentative

    - Inappropriate anger

    - Overreaction to criticism

    - Altercations with staff, peers, and patients

    - “Personality change”


Identification of addiction in physicians3

Identification of Addiction in Physicians

  • Irresponsibility

    - Shifts Work Load

    - Manipulates Schedule

    - ER, OR, On-Call

    - “Hurry Up – Catch Up”

    - Hasty rounds

    - Short cuts


Identification of addiction in physicians4

Identification of Addiction in Physicians

  • Inaccessibility

    - Frequent tardiness

    - Frequent absence

    - “MIA” – missing in action

    - Frequent trips to bathroom, parking lot

    - Prolonged lunch breaks

    - Unavailable when on call

    - Frequent beeper failure

    - Frequent illness


Identification of addiction in physicians5

Identification of Addiction in Physicians

  • Inability

    - Decreased performance

    - Inappropriate orders

    - Inadequate charting

    - Frequent malpractice action

    - Frequent “forgetfulness”

    - Deviation from standard procedures

    - Drug procedures

    - Use of excessive amounts

    - Unwitnessed wasting

    - Insufficient patient analgesia

    - Excessive spillage/breakage


Identification of addiction in physicians6

Identification of Addiction in Physicians

  • Isolation

    - Odd Hours for rounds

    - Volunteers for “Graveyard shift”

    - Absent from Dr’s Lounge

    - Eats alone

    - Avoids

    - Departmental Meetings

    - CME Events

    - Medical Society events


Identification of addiction in physicians7

Identification of Addiction in Physicians

  • Incidentals

    - Disheveled appearance

    - Tremors

    - “Green tongue” from mints

    - Bruises

    - Needle tracks

    - Heavy drinking at staff or social functions

    - Off-duty intoxication


Identification of addiction in physicians8

Identification of Addiction in Physicians

  • Incidentals

    - Runny nose, raspy voice, alcohol on breath

    - Red, yellow or black and blue eyes

    - Dilated or constricted pupils

    - Staff, patient or peer complaints

    - Slurred speech on phone

    - Black outs

    - Subject of hospital gossip (marital problems, DUI, Financial Problems, “party” reputation)


Identification of addiction in physicians9

Identification of Addiction in Physicians

  • Other

    - Unexplained intervals between jobs

    - Frequent job changes

    - Frequent relocations

    - Indefinite references

    - Unusual medical history


Identification of addiction in physicians10

Identification of Addiction in Physicians

  • Prevalence rates

    - Brewster et al 1986

    - No difference than general population

    - Hughes et al 1992

    - Physicians were five times more likely than controls to take sedative and minor tranquilizers without medical supervision

    - Physicians self prescribing


Identification of addiction in physicians11

Identification of Addiction in Physicians

  • Risk Factors

    - Family history of chemical dependence

    - Family history of psychiatric disorders

    - Mood disorders

    - Certain personality characteristics (overconfidence, sensation-seeking, risk avoidance)

    - Stress and poor coping skills

    - Availability of drugs


Identification of addiction in physicians12

Identification of Addiction in Physicians

  • Early Detection Difficult

    - Physicians tend to have negative consequences to physical health, family, community, finances, spiritual, and emotional health

    - Job performance affected last, therefore disease usually progressed


Colleagues enable by

Colleagues “Enable” By:

  • Believing addiction or mental illness can’t happen to a professional

  • Making excuses for an impaired colleague’s behavior or performance

  • Minimizing the obvious effects of alcohol/other drug use in a friend or colleague

  • Rationalizing changes in a colleague’s performance, behavior or appearance

  • Covering for a colleague’s errors or omissions

  • Not using the peer assistance network available

  • Diagnosing or treating


The good news

The Good News!

  • The success rate of health professionals in programs dedicated to staying clean and sober is 95%!


Mcgaw medical center housestaff assistance program hap

McGaw Medical Center Housestaff Assistance Program “HAP”


Perspectives 1 800 456 6327

Perspectives1 (800) 456-6327

  • Benefit

  • Voluntary

  • Confidential

  • Any Personal Problem

  • Assessment & Referral

  • Short-Term Counseling When Indicated

  • Follow-Up and Monitoring


The hap addresses these problems

Marital/Family

Emotional Stress

Eldercare/Aging Parents

Addiction

Communication

Childcare

Grief/Loss

Legal

Financial

The HAP Addresses These Problems:

Problems

ms


How to access the hap

Problems

Call

How to Access The HAP

  • Call Perspectives at 1 (800) 456-6327 to schedule an appointment

  • Call is answered by receptionist and is transferred to Access Center, staffed by licensed clinicians

  • Demographic information is collected and in-person or telephonic appointment is scheduled, as appropriate

  • Assessment is completed

  • Recommendations are given


Hap flow chart

HAP Flow Chart

Counseling

  • Community Resources

  • Legal

  • Financial

  • Marital/Family

  • Medical

  • Psychological

  • Alcohol/Drug Treatment

  • Self-Help

  • Day Care

  • Elder Care

  • Other

Self-Referral

HAP

Counselor Assessment

Supervisory Referral

HAP

Short-Term Counseling

Follow-Up/Monitoring


Other services provided by perspectives include

Counseling

Other Services Provided By Perspectives Include:

  • Wellness workshops

  • CISD (Critical Incident Stress Debriefing)

  • Management consultation

  • Licensed Counselors available for emergencies 24 hours a day, 7 days a week

  • Perspectives “On Line”


Summary of the hap benefit

Problems

Call

Summary of the HAP Benefit

  • Free

  • Confidential

  • Benefit provided by employer

  • For housestaff and family members

  • Assessment, short-term counseling (when appropriate) and referral services


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