By Matthew Goldenberg, D.O. Are you feeling stressed on the job? Here is some reassuring…
Professional Self-Regulation: 12 Signs That It Is Time to Address your Addiction
By Gregory Skipper, MD, Director of Professional Health Services at Promises
As medical professionals, an important aspect of holding ourselves to ethical guidelines and standards of conduct is recognizing when we may be working while we are impaired by drugs or alcohol.
Although our line of work gives us a keen understanding of how impairment can put patients and others at risk, it is interesting how often physicians and others in the medical field overlook the signs indicating they themselves have a problem with addiction. There may be myriad reasons for this oversight, and many of them are understandable. Yet, a key responsibility of practicing medicine is professional self-evaluation and self-regulation.
How Problems Begin for Many Medical Professionals
It is no secret that medicine is a high-pressure, high-stress profession. Physicians tend to be high achievers, and the tendency to work hard and deny one’s own distress are common failings.
Several studies have shown that medical students, doctors-in-training (residents) and working physicians are at high risk for developing stress-related problems like depression and substance abuse or misuse. Many clients we see in the Professionals Treatment Program at Promises speak of how the daily pressures of a medical career led them to develop unhealthy habits in an effort to meet the dual demands of work and family. Their morning stops at Starbucks for a double espresso weren’t getting them through a busy schedule of clinical work and professional obligations that sometimes didn’t let up until long after dinner.
Having a few drinks of alcohol after work or popping a couple of pills started out as something they tried “just this once” to relieve some of the pressure or help them soldier through a particularly grueling week. This soon became something they relied on to get through even relatively easy weeks, and continued until something happened — perhaps they made a careless mistake that could have been a catastrophe, or a colleague told them to get help.
Getting a wake-up call is one way that medical professionals find their way to addiction treatment, but it would be safer and healthier for everyone if there were a simple and informal system of checks and balances that doctors and other medical professionals could use as a tool for self-monitoring. Periodic self-review of a functional impairment checklist would let doctors know if they have a problem that needs to be addressed, before things get out of hand. This checklist would be an intermediary step before involving a chief of staff, the medical board or a physician health program.
First, Do No Harm: Identifying a Problem with Functional Impairment
To determine whether your substance misuse or addiction has reached a point where it is interfering with your ability to practice medicine safely and effectively, you must determine if your behavior (or a colleague’s behavior) constitutes functional impairment.
Here are 12 signs and behaviors to look for in yourself or a medical colleague that can indicate impairment related to substance misuse:
- Feeling or appearing sleep-deprived
- Increasing absences from work or professional functions
- A change or deterioration in personal hygiene
- Mood changes or increased irritability, temper or sadness
- Concentration problems and more errors in clinical judgment, prescriptions, etc.
- Avoiding professional calls/not responding to pages
- Feeling apathetic or experiencing a decreased concern for patients
- Patient complaints about quality of care or bedside manner
- Reporting pain or injuries (contrived to obtain narcotic prescriptions and refills)
- Self-treating/self-medicating with substances of abuse
- Repeatedly telling yourself you will change, but it isn’t happening
- Knowing that you have a problem, thinking about it, but being too afraid to ask for help
If you recognize any of these signs or behaviors in yourself or a colleague, it is time to consider the options for professional evaluation and assistance with addiction treatment. This is not an easy thing to do, even though it is our ethical duty. It can help to remember that in every case — whether for yourself or a colleague — seeking addiction treatment and recovery before things get worse is nearly always the right thing to do.
Confidential Treatment Programs Geared to Medical Professionals
If and when you seek addiction treatment, either privately on your own or through a formal process, you will want to make sure the program meets a few criteria that ensure it is effective:
- If possible, the program should be designed specifically for adult professionals with a focus on health care personnel and their unique needs. This offers a more individualized, focused and rewarding experience.
- In case you need to go through formal channels to get treatment, make sure the program you enroll in works in concert with regulatory boards and professional monitoring agencies.
- The program length should be at least 30 days, but preferably longer. Studies have shown that 60- and 90-day treatment programs result in the greatest long-term sobriety. Among medical professionals who undergo longer treatment programs, roughly 96% achieve addiction remission and successfully return to work.
- Make sure the program offers ongoing monitoring once treatment is completed to help guard against future relapse. Professionals who receive continued monitoring after treatment have a less than 3% relapse rate per year.
- The program should be staffed with a full-time, onsite addiction psychiatrist who has experience working with medical professionals, and who coordinates care with numerous psychiatric consultants in the area that treat clients for co-occurring mental disorders.
- Alternatives to 12-step approaches to recovery should be included in the program so that if the 12-step approach (e.g., Alcoholics Anonymous) doesn’t resonate with you, there are other options for peer support.
Physician impairment: When should you report? Douglas Mossman, MD. Current Psychiatry, September, 2011. http://www.mdedge.com/currentpsychiatry/article/64440/physician-impairment-when-should-you-report
Physician Health Program. Addiction Treatment for Doctors. Signs of Physician Addiction. Elements Behavioral Health, 2015. http://www.physicianhealthprogram.com/signs-of-physician-addiction/