PHYSICIAN IMPAIRMENT BY SUBSTANCE ABUSE

Because of their unique responsibilities, physicians are under close societal scrutiny concerning their physical and mental functioning. Physician impairment refers to situations in which they are rendered unable to perform their professional responsibilities adequately because of a variety of health problems, including medical disease, psychiatric problems, or substance abuse. This article focuses exclusively on physician impairment because of substance abuse.

Similar to other conditions that may cause physician impairment, substance abuse is a chronic disease characterized by exacerbations that are responsive to treatment. Among the defining elements of substance abuse disorders are the resultant behavioral dysfunction, medical complications, and psychiatric disease. Each of these clinical sequelae has a potential to impair a physician's ability to carry out professional responsibilities in patient care. In addition, characteristics of substance abuse, such as loss of control, overuse, intoxication, and withdrawal, can result in poor occupational functioning and negative patient outcomes. Obviously, physicians are not alone as an occupational group in this regard. In a sense, almost all occupations receive some degree of scrutiny concerning job dysfunction because of substance abuse. Groups such as physicians, airline pilots, subway train operators, and others whose dysfunction on the job may lead directly to harm to individuals, however, are under special scrutiny.

The report of the American Medical Association's (AMA) Council on Mental Health stated that “it is the physician's ethical responsibility to take cognizance of a colleague's inability to practice medicine adequately by reason of physical or mental illness including alcoholism and drug dependence.”³ This report emphasized that a national effort was necessary to identify and help impaired physicians return to optimal functioning and to safeguard the health of patients from the care of impaired physicians. Subsequent to the AMA report, the identification of impaired physicians with mental and physical handicaps, alcoholism, and drug dependency has received wide attention. Hospital boards under close scrutiny for potential legal exposure have explored protective measures against litigation for care provided by impaired physicians. In addition, these boards have established procedures to identify impaired physicians and refer them for rehabilitation, enabling them, it is hoped, to return to work in the future.33, 49

Rehabilitation of the alcohol-impaired or drug-impaired physician is a serious concern of state medical societies as well. All 50 states have developed procedures to identify and bring to treatment physicians who are alcohol or drug dependent. Because American physicians represent a resource of trained medical personnel, successful rehabilitation of these physicians is a national priority. Comprehensive treatment procedures and close monitoring of addicted physicians after treatment have proven to be successful with 75% to 85% of physicians who enter treatment returning to their professional position.2, 13

This article provides an overview of physician impairment because of substance abuse, including a discussion of what is known about the epidemiology of substance abuse in various physicians' groups, special characteristics of impaired physicians, medicolegal issues regarding impaired physicians, and specific treatment approaches for physicians impaired by substance abuse.