Maybe you heard about the anesthesiologist stealing fentanyl(Drug information on fentanyl) from the drug cabinet? Or the pediatrician lacing his morning coffee with brandy to take the edge off his daily hangover? Thanks goodness nothing like that happens in your practice.
Or does it?
Experts estimate that about 6 percent of physicians have drug problems and one in seven have problems with alcohol(Drug information on alcohol). That’s about the same rate as the general population, but doctors are held by the public to a higher standard.
Of course, substance abuse isn’t the only reason some physicians may put patients, reputations, and medical licenses at risk. Personality disorders, psychiatric illnesses, and emotional problems also can lead physicians to endanger patients with substandard care. Your practice may never have to deal with these problems among its providers, but if it does, preparation and swift action can save a lot of time and a ton of trouble. You might even save a colleague’s career.
“There’s never an easy situation and they are all heartbreaking,” says Joan Roediger, a partner with the Philadelphia-based law firm Obermayer, Rebmann, Maxell & Hippel LLP. “The light at the end of the tunnel is that if you handle these things correctly, what could have been a horror story will end up with a successful outcome.”
Many recovery programs have been designed specifically for physicians. But getting to that successful outcome is a lot harder if problems aren’t detected and addressed early. Too often they are not. Physicians tell their patients how to spot the early signs of substance abuse, stress, depression, and other health issues. But as practice partners, they sometimes fail to recognize or acknowledge those signs in their colleagues. After all, it’s easier in the short run to stand back and hope the problem with a colleague will resolve itself.
“Every situation is different and there’s certainly no cookie-cutter solution, but two things are universally guaranteed: Avoiding the problem will not make it go away and the longer you wait, the more risk and pain your practice will suffer,” Roediger says.
The risks of delaying action can be high for the practice. Even if you do everything right, malpractice lawsuits frequently name the practice or practice partners.
Deny, deny, deny
Denial and secrecy aren’t just for substance abusers. Friends, families, and professional colleagues of substance abusers often refuse to acknowledge warning signs even when they are clear.
“Colleagues feel very uncomfortable confronting colleagues,” says Betsy White Williams, a psychologist and clinical program director of the Professional Renewal Center in Lawrence, Kan. “There may be obvious signs of the problem right in front of you, but it is human nature for people not to want to believe that something really bad like this is happening to them or a colleague.”
Williams says that when physicians do become patients at outpatient centers like the one where she works, it’s often because their drug or alcohol abuse was exposed involuntarily. Maybe it’s a flurry of complaints from patients or other physicians, she says. Or a payer’s chart audit turns up suspicious prescribing patterns. Sometimes, the physician is even arrested for drug possession or impaired driving.
“Smaller practices represent the best and the worst with these situations,” she says. “Physicians and staff are in close contact so they should be able to spot the signs of trouble early, but they don’t always have the experience to know what to look for or what to do.”
How to document
Williams says that changes in the physician’s behavior and appearance can give early clues that a problem exists.
