I gave this talk to a group of suspended doctors on 10 May 2013.

1. My talk to the
Practitioner Health Programme
Shibley
Queen’s Scholar, BA (1st), MA, MB, BChir, PhD (all Cambridge);
MRCP(UK), LLB(Hons.), LLM, MBA, FRSA
PRINCE2 registered practitioner
May 10th 2013

2. How do I know if I’m alcoholic?

3. The popular press

6. The major difficulty
• Insidious progression between problem
drinker and ‘serious alcoholic’.

7. I am now physically disabled.

8. Coma and physical rehabilitation
• 13 August 2007 admittted with cardiac arrest
and epileptic seizure
• Then six week coma (Staff in NHS saved my life
effectively.)
• September 2007 woke up disabled; but
successfully neurorehabilitated by physicians
Queen Square
• I came under the management of a Consultant
Psychiatrist

9. Mental rehabilitation
March 2009 awarded my LLB(Hons) from BPP Law School
January 2011 awarded my LLM with Commendation; also
given full enrolment with Solicitors Regulation Authority
after full disclosures
September 2012 awarded my Master of Business
Administration
May 2013 Around 70 months in continuous recovery
2007-2013 No conduct problems thus far as
demonstrated by a clear police national computer check
pursuant to onset of my coma (successfully managed for
alcoholism; regulated by the SRA in any case.)

10. Some immediate thoughts
• Humility
• Insight
• Now physically disabled
• No regular salaried employment since erasure
• Huge amount of personal perceived stigma
• Supervisors who can pick up on the problem early on
(patient safety is imperative, health implications for
Doctor, training record, needs of hospital).
• Need to build a culture of trust between all involved.

11. Problems and issues
• A referral to a regulatory body can be potentially used by
many parties ‘cover their backs’, but this unfortunately
does not help to resolve the actual problem of the patient
who is alcoholic.
• Vital NOT to airbrush the horrors of the past
(Continuously reminded of my past through media;
divorced; lost job; nearly died; previous PNC record).
• Prone to overintellectualise – common attributes of an
alcoholic can include telling lies and concealing the truth.

12. Secretive behaviour – barriers to
regulation/barriers to recovery
Mitchell and Hirschman (2006) : “Forty-one of
those patients (87%) kept the drinking hidden
from treatment staff.”.

13. THE EVENT WHICH CHANGED MY
LIFE

14. The Royal Free – i.e. the NHS – saved
my life.

15. Initial emergency admission to the
Royal Free

18. Start of my physical disability

19. Comment by a previous supervisor at
one of the Trusts I worked at

20. Regular review from my Psychiatrist

21. Past history of alcoholism

22. SELF-REFLECTION

23. My father
• My parents came to live with me after my
coma.
• I had a full-time carer provided by Camden
Council to help me with ‘activities of daily
living’.
• My father passed away on 10 November 2010.
• I am eternally indebted to him.
• My Psychiatrist feels my father ‘knew’ my
recovery had started.

24. Recovery is an ongoing commitment
• Delicate balance: regulators cannot ‘criminalise’ people who are sick.
• Dignity is paramount.
• Nobody is potentially untreatable for mental illness: this would be a
helpful mindset for regulators to remember. Recovery is a bumpy road,
requiring time and patience.
• Regulatory proceedings are very demanding.
• Stress can make addictive symptoms worse, but if right regulatory process
can help encourage people in recovery.

25. Learning from the event?
• Regulators hate it if the patient blames everyone except him
or herself.
• Impossible to expect any of the regulators to do ‘pre-emptive’
outreach.
• The legal doctrine of proportionality.
• However this should not ignore widespread issues of culture
which need a mature sensitive debate (can healthcare staff,
for example, ‘whistleblow’ constructively on other staff in the
pursuit of patient safety?)
• Learning from mistakes: nice in theory but difficult in practice
– rehabilitation v retributive justice. “Zero fault” approach.
• Unreliable memory of ‘defendant’.

26. Ways in which an alcoholic may
exhibit ‘denial’ of symptoms
If you have a drinking problem, you may deny it by:
• Drastically underestimating how much you drink
• Downplaying the negative consequences of your drinking
• Complaining that family and friends are exaggerating the
problem
• Blaming your drinking or drinking-related problems on others
and lack of insight

27. 12 steps

28. How do you know if
I have a drink problem?
• Feel guilty or ashamed about your drinking.
• Lie to others or hide your drinking habits.
• Have friends or family members who are worried about your drinking.
• Need to drink in order to relax or feel better.
• “Black out” or forget what you did while you were drinking.
• Regularly drink more than you intended to.
• Start drinking before you go out socially
• Drink on your own in bars
• Go to off-licences or supermarkets to buy cheap alcohol
• Don’t care if you’re ‘performance’ is substandard at work

29. Common manifestations of
alcoholism
• Repeatedly neglecting your responsibilities at home or work, because of your
drinking. ?house untidy, deferring ‘activities of daily living’ e.g. culture, shopping
• Using alcohol in situations where it’s physically dangerous, such as drinking and
driving, or drinking the day before a heavy workload
• Experiencing repeated legal problems on account of your drinking. ?
• Continuing to drink even though your alcohol use is causing problems in your
relationships.
• Drinking as a way to relax or de-stress/coping with ‘success’ your boss.

30. Why are professionals particularly
vulnerable?
• Gossop et al. (2000): “There are several reasons why doctors
and other health care professionals may be at risk of drug and
alcohol misuse. The long years of medical training are
characterized (sic) by intense competition, excessive workload
and fear of failure, and few occupations face the intense
stresses experienced in the daily practice of medicine.”
• Personal experience from recovery meetings: city lawyers,
traders, hospital managers, journalists

31. “Presenteeism”
• Dr Max Henderson, from King's College London's Institute of
Psychiatry, believes that these numbers represent the tip of
the iceberg because “doctors are often deterred from
admitting that they are sick and need time off by feelings of
shame.”
• A recent study led by Dr Henderson showed that medics who
do fall ill fear being perceived as "weak" or "a failure" by
colleagues.
• "There is a feeling among doctors, that illness shouldn't
happen to them – that they should somehow be invincible"

32. The “dry drunk” phenomenon
• A real problem for regulators.
• For most serious alcoholics, it is easier to abstain altogether,
rather than to engage in controlled, responsible, non-
intoxicated drinking.
• The idea of controlled drinking (or controlled drug use) is the
one hope almost every addict brings to his or her initial
encounter with treatment.
• As one AA veteran put it: “If it were possible for a majority of
alcoholics to revert to controlled drinking, every alcoholic in
AA would have found out about it a long time ago.”

33. Cardinal features of alcoholism
• Alcoholism is the most severe form of problem drinking.
• Tolerance: The 1st major warning sign of alcoholism
• Do you have to drink a lot more than you used to in order to
get buzzed or to feel relaxed? Can you drink more
• Withdrawal: The 2nd major warning sign of alcoholism
• Do you need a drink to steady the shakes in the morning?

34. Symptoms of alcohol withdrawal
• Anxiety or jumpiness
• Shakiness or trembling
• Sweating
• Nausea and vomiting
• Insomnia
• Depression
• Irritability
• Fatigue
• Alcohol withdrawal fits
• Loss of appetite
• Headache

35. Two myths of alcoholism
• I’m not an alcoholic because I have a job and I’m doing okay.
• You don’t have to be homeless and drinking out of a brown
paper bag to be an alcoholic.
• The myth about “the high functioning addict”.
• Drinking is not a “real” addiction like drug abuse.

36. Support networks
Tendency to ‘get the certificate’ than to understand the process
of recovery.
Now live with my mum in a small flat in Primrose Hill.
1. Practitioners Health Programme
2. British Doctors and Dentists After Care
3. “After Care” at my local hospital
4. Psychiatrist/GP (nb GMC Good Medical Practice)
5. Friends/family/peers
6. Some regulatory bodies
7. AA or similar entities.

38. And these people have been
wonderful for my recovery..

39. THANK YOU!