Tipsheet: Physician Substance Abuse in the Workplace

Many barriers can prevent physicians who have a substance use disorder from obtaining the help they need. Here, signs, symptoms, and intervention steps. The Tipsheet below can apply to anyone struggling with addiction but is especially sensitive to physicians in the workplace. For intervention strategies, see the next page.

TIPSHEET: SIGNS OF PHYSICIAN SUBSTANCE ABUSE IN THE WORKPLACE

Job related

■ Tardiness or absenteeism; frequent breaks; missed appointments

■ Charting mistakes, medical mishaps

■ Rounding at inconsistent times; volunteering for extra shifts

■ Memory lapses/forgetfulness

■ Patient complaints; Board of Medicine complaints; lawsuits

Diversion

■ Missing or broken vials; failure to document wastage, or have wastage witnessed

■ Paying extra attention to patients receiving mood-altering drugs

■ Volunteering to give medications to patients

■ Asking peers to prescribe for them; obtaining prescriptions for family members

■ Obtaining prescriptions "for family members"

Physical

■ Recurrent nonspecific health problems; flu-like symptoms

■ Changes in sleep or eating patterns; weight loss or gain

■ Appearance of oversedation; bloodshot or watery eyes

■ Lack of coordination; hand tremors; stumbling

■ Alcohol detectable on breath; long sleeves in hot climate (to hide injection sites)

■ Changes in appearance; decreased hygiene

Social

■ Decreased social interaction with colleagues; isolation

■ Conflicts with staff, patients, peers

■ Excessive drinking/intoxication at social events; embarrassing or inappropriate behavior

Emotional

■ Depression; pessimism; hopelessness; suicidal ideation

■ Irritability; mood swings

■ Over-emotional; appearing overwhelmed

■ Blunted affect

Any warning signs listed in the above Tipsheet should be considered sufficient evidence to warrant an immediate intervention. For intervention techniques, please see the next Tipsheet.

Typically, the first step in the successful treatment of a physician with a substance use disorder is diagnosis and referral to a Physician Health Program (PHP). Cooperation with the PHP generally prevents the physician from experiencing punitive measures. In addition, many states protect the confidentiality of physicians who willingly participate in the PHP and do not require that a report be made to the Board of Medicine.

Guidelines for making such a referral are outlined in the following Tipsheet. The physician with a substance use disorder is most likely to be successful in a treatment program in which the staff members are familiar with treating health care professionals.

TIPSHEET: INTERVENTION STEPS IN THE CASE OF SUSPECTED PHYSICIAN ADDICTION

Job related

■ Contact the state physician health program (PHP)

■ Avoid confronting the physician alone; recruit others to assist you

■ Acknowledge the physician's abilities and demonstrate your respect for the individual

■ Describe specific, observable problem behaviors of concern; consider using a script to assist with this step

■ Avoid accusation or blame; be kind and empathic

■ Avoid negotiating, arguing, or bargaining

■ Do not engage the individual in attempts to avoid the intervention

■ Present a specific plan of action for assessment and treatment; consider working with the state PHP to develop a plan first

■ Indicate clearly the consequences of not following through with the plan

■ Do not be afraid to use coercion. It works!

■ Insist on immediate action. Do not consider requests for "one more chance"

■ Provide for safe transition and transportation to the next step in the plan

■ Typically, assist the physician in attending a professional assessment

For details, please see "Successful Treatment of Physicians With Addictions," by Lisa J. Merlo, PhD, and Mark S. Gold, MD, from which this Tipsheet was adapted.

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