Medical practitioners with drug and alcohol problems

Doctors are not immune to problems with drugs or alcohol. Apart from the general risk factors they share with the rest of the community, doctors may be exposed to particular risks relating to:

  • The demands, responsibilities and stress of their professional life
  • Conflict between their professional and personal lives
  • Easy access to prescription drugs
  • Self-treatment
  • Reluctance of colleagues to confront or deal with early warning signs.

The stakes are high in the case of doctors with drug or alcohol problems where the well being, and even the lives of patients under their care may potentially be at risk. There are real and tragic examples of patients dying as a direct result of their treating doctor's addiction and of doctors whose own lives are devastated by drug or alcohol problems.

All doctors should have a GP with whom they can develop a professional relationship.

Self-treatment and corridor or tearoom consultations with colleagues are not appropriate or effective health care.

This site deals with the issues of doctors with drug or alcohol problems from three points of view.

  1. Treating a doctor with drug or alcohol problems.
  2. Dealing with a medical colleague with drug or alcohol problems.
  3. Being a doctor with drug or alcohol problems.

TREATING A DOCTOR WITH DRUG OR ALCOHOL PROBLEMS

If you are treating a doctor with drug or alcohol problems you should:

  • Recognise that it has taken a great deal of courage (and perhaps some not-so-gentle persuasion) for a doctor to present to you for treatment.
  • Treat them as a patient, not a colleague. This may be self evident, but you should not assume anything about their knowledge of their problem, or expect them to take more responsibility for their management than you would expect from any other patient.
  • Assess them in the same way that you would assess any other patient. A detailed history and appropriate physical examination are crucial and should never be circumvented.
  • Treat them in the same way that you would treat any other patient. In these circumstances, they are your patient first and a doctor second.
  • Provide them with the same information that you give to other patients. Assume nothing.
  • Never allow them to prescribe or procure their own medications, no matter how convenient it may be.
  • Be directive about their follow up. Do not leave it up to them.
  • Consider the impact of their problem upon their work. If you believe that patient safety may be at risk, you should advise the doctor accordingly. If they are not receptive to your advice, you should seek the advice of the Medical Council.


DEALING WITH A MEDICAL COLLEAGUE WITH DRUG OR ALCOHOL PROBLEMS

You should:

  • Be alert to the possibility that a colleague may have a drug or alcohol problem. The general indicators apply equally to doctors. There are additional indicators that may alert you to a problem.
    These include:
    • Inappropriate prescribing
    • Administering patient medication in a secretive manner
    • Drug wastage, particularly in the case of narcotics
    • Poor compliance with documentation requirements, e.g. drug register
    • Patients complaining of inadequate pain relief
    • Collecting patient medications from the pharmacy
    • Unwillingness to respond to on-call responsibilities, e.g. refusing to return after-hours.
  • Take action, or make sure that someone else does! It is a regrettable truth that for a variety of reasons colleagues do not act, and the consequences can be tragic for the individual and their patients. The reasons include:
    • Not wanting to create waves
    • Hoping that someone else will take action
    • Unfounded fear of legal action
    • Not knowing what to do
    • Feeling intimidated by the person concerned.

The Steps To Take

  1. If you feel unable to deal with the matter yourself, make your supervisor, head of department or other appropriate person aware of your concerns. Do not let the matter drop until you are sure that you have been taken seriously.
  2. If you feel able to talk to the colleague yourself, do not take on a treating role, but
    • arrange to meet with them privately,
    • let them know that you are concerned and why,
    • ask them to consult with an appropriate practitioner, and provide them with contact information.
  3. Follow up to make sure that they have taken your advice. Be aware that your colleague may tell you what they think you want to hear, having taken no positive steps.
  4. Consider the impact of their problem upon their work. If you believe that patient safety may be at risk, you should advise the doctor accordingly. If they are not receptive to your advice, you should seek the advice of the Medical Council.


BEING A DOCTOR WITH A DRUG AND ALCOHOL PROBLEM

Doctors may experience drug and alcohol problems just like any other member of the community.

You may feel that with your professional knowledge and skill you should be able to control and manage your problem. Experience shows that this is rarely the case.

You may feel that asking for help is an admission or personal or professional inadequacy. Unfortunately, the consequences of failing to seek help may be far more detrimental to your personal and professional life.

Your GP is an appropriate person to help you with your problems in the first instance and you are encouraged to seek their assistance sooner rather than later.

Do not try to 'go it alone'. You will need professional support and advice.

Doctors' Health Advisory Service provide a 24-hour service to impaired doctors. They can be contacted in New South Wales on (tel) 02 9437 6552.

You should also consider contacting the Medical Council on (tel) 02 9879 2200 for advice.