Substance Abuse Among Healthcare Providers <ul><li>Dennis Ison </li></ul><ul><li>Professor D. Fahringer </li></ul><ul><li>...
Background <ul><li>1958 – Abuse among providers first recognized by The Federation of State Medical Boards (FSMB) </li></u...
Introduction <ul><li>FSMB -  inability to practice medicine with skill and safety by reason of mental illness, physical il...
Prevalence <ul><li>http://www. sfgate .com/ cgi -bin/article. cgi ?f=/c/a/2006/03/10/BAG5EHLV451.DTL&feed= rss . bayarea  ...
Risk Factors <ul><li>Genetics & Familial Components </li></ul><ul><li>College Atmosphere </li></ul><ul><li>Educational & C...
Specialties <ul><li>High Risk </li></ul><ul><ul><li>Anesthesiologists – Access to Narcotics </li></ul></ul><ul><ul><li>Res...
Drug of Choice <ul><li>Opioids – Younger Anesthesiologists </li></ul><ul><li>Alcohol – Older Anesthesiologists & Female Ph...
Identifiers <ul><li>Marital Problems (undetected) </li></ul><ul><li>Legal Problems - Domestic Violence, Charges of Irregul...
Performance <ul><li>No Longer Available for Extra Shifts  </li></ul><ul><li>Increase # of “Call-ins” </li></ul><ul><li>Usi...
Suicide <ul><li>Most Common Death in Young Physicians </li></ul><ul><li>Depression, Drug Abuse, Alcoholism, Marital Confli...
Confrontation <ul><li>Someone w/ Influence & Authority  </li></ul><ul><li>Caring, Professional, & Well-organized Intervent...
Evaluation <ul><li>VP of Medical Affairs or Admin. on Call </li></ul><ul><li>Meeting w/ the provider to observe conduct, a...
Treatment <ul><li>Provider Self-healing vs. Help from Others </li></ul><ul><li>Referral Self-report or Encouragement from ...
Treatment (cont.) <ul><li>Education about Alcoholism & Drug Abuse </li></ul><ul><li>Stress Management Skills Education </l...
 
Treatment Barriers <ul><li>Accepting the Patient Role </li></ul><ul><li>Stigma Bound Problems </li></ul><ul><li>Fear of Co...
Treatment Outcomes <ul><li>Recovery 73% - 91% </li></ul><ul><li>Education & Prevention </li></ul><ul><li>Mandatory Treatme...
Dentistry <ul><li>Alcoholism & Suicide </li></ul><ul><li>Universal Knowledge vs. Urban Legend </li></ul>
Conclusion <ul><li>Identification </li></ul><ul><li>Confrontation </li></ul><ul><li>Treatment </li></ul><ul><li>Prevention...
REFERENCES <ul><li>Blondell, Richard. 2005.  Taking a Proactive Approach to Physician Impairment.  Postgraduate Medicine. ...
Hagan III, John. 2002.  When Good Docs Go Bad.  Missouri Medicine. 99(4): 153-4.  Kitz, P. Et al. 2005.  Evidence of Addic...
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Dennis Ison

  1. 1. Substance Abuse Among Healthcare Providers <ul><li>Dennis Ison </li></ul><ul><li>Professor D. Fahringer </li></ul><ul><li>April 20, 2006 </li></ul>
  2. 2. Background <ul><li>1958 – Abuse among providers first recognized by The Federation of State Medical Boards (FSMB) </li></ul><ul><li>1974 - AMA acknowledged substance abuse as an illness and developed a model legislation to offer a beneficial option of discipline for providers with addiction. </li></ul>
  3. 3. Introduction <ul><li>FSMB - inability to practice medicine with skill and safety by reason of mental illness, physical illness, and substance abuse, including alcohol and other drugs that impair abilities </li></ul><ul><li>AAPA - one who is unable to practice skill and safety to patients because of physical and mental illness including deteriorations through the aging process, loss of motor skills, or excessive use or abuse of drugs including alcohol </li></ul>
  4. 4. Prevalence <ul><li>http://www. sfgate .com/ cgi -bin/article. cgi ?f=/c/a/2006/03/10/BAG5EHLV451.DTL&feed= rss . bayarea </li></ul><ul><li>Zamora, J. H. (2006). Allegedly Drunken Surgeon Arrested in Operating Room. San Francisco Chronicle. B-3.   </li></ul>
  5. 5. Risk Factors <ul><li>Genetics & Familial Components </li></ul><ul><li>College Atmosphere </li></ul><ul><li>Educational & Career Expectations </li></ul><ul><li>Opportunity & Availability of Substances </li></ul><ul><li>Pharmaceutical Knowledge Provides Immunity </li></ul><ul><li>Self-treatment </li></ul>
  6. 6. Specialties <ul><li>High Risk </li></ul><ul><ul><li>Anesthesiologists – Access to Narcotics </li></ul></ul><ul><ul><li>Residents – Recreation, Performance or ST </li></ul></ul><ul><ul><li>Others – ER specialists & Psychiatrists </li></ul></ul><ul><li>Low Risk (in general) </li></ul><ul><ul><li>Pediatricians, Pathologists, Radiologists & OBGYNs </li></ul></ul>
  7. 7. Drug of Choice <ul><li>Opioids – Younger Anesthesiologists </li></ul><ul><li>Alcohol – Older Anesthesiologists & Female Physicians </li></ul><ul><li>Over All - Benzodiazepines & opiates > Recreational Drugs, such as Marijuana & Cocaine </li></ul>
  8. 8. Identifiers <ul><li>Marital Problems (undetected) </li></ul><ul><li>Legal Problems - Domestic Violence, Charges of Irregularities in Prescription Writing, AIs or DUIs, Elicit Drug Possession & Bankruptcy </li></ul><ul><li>Personality Changes - Mood D/Os, Confusion, Memory Loss, Anxiety, Depression, Lack of Impulse Control, Suicidal Thoughts or Gestures </li></ul>
  9. 9. Performance <ul><li>No Longer Available for Extra Shifts </li></ul><ul><li>Increase # of “Call-ins” </li></ul><ul><li>Using Personal Time Excessively </li></ul><ul><li>Increased Tardiness & Absenteeism </li></ul><ul><li>Inconsistent Work Habits </li></ul><ul><li>Decrease in Efficiency </li></ul><ul><li>Increase in Personal Phone Calls </li></ul>
  10. 10. Suicide <ul><li>Most Common Death in Young Physicians </li></ul><ul><li>Depression, Drug Abuse, Alcoholism, Marital Conflict, Single, Divorced or Widowed & Female </li></ul><ul><li>More than 1/3 of physicians that committed suicide are believed to have had a drug problem at some time in their lives </li></ul><ul><li>More than 1/2 had prescribed a psychoactive drug for themselves </li></ul>
  11. 11. Confrontation <ul><li>Someone w/ Influence & Authority </li></ul><ul><li>Caring, Professional, & Well-organized Intervention </li></ul>
  12. 12. Evaluation <ul><li>VP of Medical Affairs or Admin. on Call </li></ul><ul><li>Meeting w/ the provider to observe conduct, appearance & demeanor </li></ul><ul><li>Submission to a Drug Screen </li></ul><ul><li>Participation in a Rehabilitation Program </li></ul><ul><li>Conard, Jane & S. Allan Adelman. 2004. Impaired Practitioner Policy. Journal of Health Law. 37(4): 693-700. </li></ul><ul><li>  </li></ul>
  13. 13. Treatment <ul><li>Provider Self-healing vs. Help from Others </li></ul><ul><li>Referral Self-report or Encouragement from Others </li></ul><ul><li>Prevent Patient Harm </li></ul><ul><li>Recognition of a Problem </li></ul><ul><li>Identify the Specific Problem </li></ul><ul><li>Acknowledge That One Needs Help </li></ul><ul><li>Help is Available </li></ul>
  14. 14. Treatment (cont.) <ul><li>Education about Alcoholism & Drug Abuse </li></ul><ul><li>Stress Management Skills Education </li></ul><ul><li>Encounter & Discussion Groups </li></ul><ul><li>Workshops & Counseling </li></ul><ul><li>Long-term & Comprehensive </li></ul><ul><li>Consistent, Rigid & Comprehensive Monitoring </li></ul>
  15. 16. Treatment Barriers <ul><li>Accepting the Patient Role </li></ul><ul><li>Stigma Bound Problems </li></ul><ul><li>Fear of Confidentiality Breeches </li></ul><ul><li>Jeopardy to their Reputation, Professional Accreditation, & Employment </li></ul><ul><li>Public Disclosure </li></ul>
  16. 17. Treatment Outcomes <ul><li>Recovery 73% - 91% </li></ul><ul><li>Education & Prevention </li></ul><ul><li>Mandatory Treatment </li></ul><ul><li>Frequent Urine Checking </li></ul><ul><li>Peer Assistance Programs </li></ul>
  17. 18. Dentistry <ul><li>Alcoholism & Suicide </li></ul><ul><li>Universal Knowledge vs. Urban Legend </li></ul>
  18. 19. Conclusion <ul><li>Identification </li></ul><ul><li>Confrontation </li></ul><ul><li>Treatment </li></ul><ul><li>Prevention </li></ul><ul><ul><li>Don’t Drink </li></ul></ul><ul><ul><li>Don’t Do Drugs </li></ul></ul><ul><ul><li>Don’t Curse </li></ul></ul><ul><ul><li>Go To Church on Sunday </li></ul></ul>
  19. 20. REFERENCES <ul><li>Blondell, Richard. 2005. Taking a Proactive Approach to Physician Impairment. Postgraduate Medicine. 118(1): 16-8. </li></ul><ul><li>Bohigian, George. Et al. 2005. The Impaired and Disruptive Physician: The Missouri’s Physicians Health Programs – An Update (1995-2002). Journal of Addictive Diseases. 24(1): 13-23. </li></ul><ul><li>Boisaubin, Eugene & Ruth Levine. 2001. Identifying and Assisting the Impaired Physician. American Journal of the Medical Sciences. 322(1): 31-6. </li></ul><ul><li>Bostrom, Andrea. Et al. 2004. Impaired Practice and the law in Michigan. URL: http://www. minurses .org/ conted / CEModule - Impairedpractice .doc , no date given, accessed 12/4/05. Michigan Nurses Association. </li></ul><ul><li>  </li></ul><ul><li>Broquet, Karen & Rockey, Paul. 2004. Teaching Residents and Program Directors About Physician Impairment. Academic Psychiatry. 28: 221-5. </li></ul><ul><li>  </li></ul><ul><li>Collins, Greg. 1998. New Hope for Impaired Physicians: Helping the Physician While Protecting the Patient. Cleveland Clinic Journal of Medicine. 65(2): 101-6. </li></ul><ul><li>  </li></ul><ul><li>Conard, Jane & S. Allan Adelman. 2004. Impaired Practitioner Policy. Journal of Health Law. 37(4): 693-700. </li></ul><ul><li>  </li></ul><ul><li>Ethics Committee of the AAO-HNS. 1996. Chapter 7: The Impaired Physician. Ethics Committee of the AAO-HNS. 115(3): 213-7. </li></ul><ul><li>  </li></ul><ul><li>Frank, E. & A. Dingle. 1999. Self-Reported Depression and Suicide Attempts Among U.S. Women Physicians. Am J Psychiatry. 156: 1887-94. </li></ul><ul><li>  </li></ul><ul><li>  </li></ul><ul><li>  </li></ul><ul><li>  </li></ul>
  20. 21. Hagan III, John. 2002. When Good Docs Go Bad. Missouri Medicine. 99(4): 153-4. Kitz, P. Et al. 2005. Evidence of Addiction By Anesthesiologists as Documented By Hair Analysis. Forensic Science International. 153(1): 81-4.   Kober, Charles. 1993. Physician Assistant Impairment Issues. Physician Assistant. 73-8.   Krebs-Markrich, Julia & Karen Perrine. 1996. Defending the Impaired Physician. Virginia Medical Quarterly. 123(4): 14-6.   O’Connor, Patrick & Anderson Spickard, Jr. 1997. Physician Impairment By Substance Abuse. Medical Clinics of North America. 81(4): 1037-49. Psychiatric News. 2004. Impaired Physicians Get More Attention. Psychiatric News. 39(20): 11.   Schernhammer, Eva.2005. Taking Their Own Lives - The High Rate of Physician Suicide. NEJM. 352(24): 2473-6.   Strang, John. Et al.1998. Missed Problems and Missed Opportunities for Addicted Doctors. BMJ. 31(6): 405-6.   Truman, John. 2005. Drug and Alcohol Use in Emergency Medicine Residency: Impaired Resident. Physician Wellness/Resident’s Perspective. 46(2): 148-150.   Uretsky, Samuel. 2004. Addicts in the OR? Drug Abuse Among Healthcare Professionals. Medhunters. Virshup, Bernard. Et al.1993. The Primary Prevention of Addiction in the Physician. The Journal of Primary Prevention. 14(1): 29-49. Zamora, J. H. (2006). Allegedly Drunken Surgeon Arrested in Operating Room. San Francisco Chronicle. B-3.  

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