Dr. Jones is a popular and successful primary care doctor. Over the last few months, though, colleagues have noticed that he hasn’t seemed himself. He’s been seen in the hospital at odd hours, his normally professional demeanor has turned snappish, and at times he smells strongly of sweat and cigarettes. Patients have started complaining that he hasn’t been returning their calls and has shown up late for appointments. When the medical director asks Dr. Jones if everything is okay, Dr. Jones angrily replies, “Why shouldn’t it be?” and storms off. Finally, a patient complains that Dr. Jones slurred his speech during a visit, had tiny pupils, and looked like he was about to nod off. In the subsequent emergency staff meeting, the nurse manager reports narcotics and prescription pads have been disappearing from the office. In a panic, the medical director alerts senior management and calls the medical board to report Dr. Jones as an impaired physician.
Doctors and other health care providers are the last people you might suspect of being addicted to drugs or alcohol. Yet, substance abuse is estimated to afflict 10%–15% of physicians (Flaherty JH and Richman JA, Psychiatr Clin N Am 1993;16:189–195). This rate is higher than the rate for the general population, which is estimated at 8.4% (SAMHSA 2014 National Survey on Drug Use and Health). Nurses, dentists, and other health care providers are also particularly susceptible to substance use disorders (SUD).
Why? Perhaps it’s because health care providers have high levels of stress in their work lives. It has been well-documented that we suffer disproportionately from burnout and career dissatisfaction. We also have ready access to abusable pharmaceuticals and, of course, to alcohol. Together, these factors create a “perfect storm” that predisposes health care providers to SUDs.
An addicted coworker can cause a phenomenal amount of stress and disruption in your practice, and often represents a serious threat to the safety of your patients. By law, it is mandated that we report impaired colleagues to their professional boards, but many of us are reluctant to do so. We don’t want to ruin colleagues’ lives by subjecting them to stigma and discipline at the hands of the medical boards, which are perceived—not unjustifiably—as tending to shoot first and ask questions later. Consequently, you may not know what to do if you are confronted with an impaired colleague. The first step, of course, is learning how to recognize an impaired colleague in the first place.
Ideally, an SUD in a health care provider can be recognized as early as possible, before irreparable harm comes to the provider’s career, patients, or family. Overdose and suicide are not uncommon outcomes, and efforts must be focused on preventing these as well as protecting patients.