3.1.3 Physicians and Substance Abuse
Barbara J. Russell, PhD, MBA, Bioethicist
- To understand a physician's legal and ethical responsibilities when another physician is impaired due to substance abuse (alcohol and/or drugs).
- To understand how these responsibilities can change depending on situational details.
For over six years, Dr. Smith and Dr. Jones have been colleagues in the general medicine department of the town's main hospital. Although Dr. Jones doesn't count Dr. Smith as a close friend, she does consider him to be competent and committed. Generally they work the same schedule, attend many of the same meetings and have chatted informally at departmental and hospital social events. Over the past few months, however, Dr. Jones has heard various staff members remark how stressed and disorganized Dr. Smith seems to be, and how often his patient appointments are rescheduled at the last minute.
Today, Dr. Jones is in early and opens up the department's office area. Passing Dr. Smith's office she sees him asleep at his desk, an almost empty liquor bottle beside him. She wakes him up. He is disoriented and looks awful. "What are you doing here?" he asks her. Dr. Jones tells him it's 7 am, to which he replies, "Oh boy, I gotta get home … get a shower and some coffee." Clumsily standing up and reaching for his suit jacket, he continues, "Tell Marge [the receptionist] I'll be back at 9, okay?" Seeing Dr. Jones' concerned expression, Dr. Smith says, "Hey, there's nothing to worry about."
- What is so worrisome about substance abuse?
- Must Dr. Jones confront Dr. Smith?
- What steps should Dr. Jones take?
- What should Dr. Jones do if she decides to talk with Dr. Smith, but he does not acknowledge any problem?
- (a) What if Dr. Jones is a third-year resident and Dr. Smith is her preceptor?
(b) Or if Dr. Smith is a well-known fundraiser or researcher?
(c) Or if Dr. Smith himself is worried about his alcohol use?
- What should Dr. Jones do if Dr. Smith is going to drive home?
The good news is that, with treatment, physician recovery rates range from 30% to 90%, which are higher than those for the general public.1,2,4 Physician recovery rates with treatment are high because of physicians' personal commitment combined with support from health care facilities, the Physicians' Health Network, the CMA, provincial regulatory colleges and/or provincial RCPSC offices.
While there is no legal obligation in Canada for a physician to report an impaired colleague, there may be institutional requirements. Moreover, there are ethical reasons to address signs that a physician may have a substance-use problem and to carefully determine an effective and respectful way to help an impaired colleague. Every physician has legal and ethical duties to practice unimpaired. If a physician develops a substance-use problem, he/she must seek out and participate in therapy and subsequent monitoring so as to resume high-quality and safe treatment of his/her patients.
- Baldisseri MR. Impaired healthcare professional. Critical Care Medicine 2007; 35(2 Suppl.): S106–16.
- Boisaubin EV, Levine RE. Identifying and assisting the impaired physician. The American Journal of the Medical Sciences 2001; 322(1): 31–6.
- Myers M. Treatment of the mentally ill physician. Canadian Journal of Psychiatry 1997; 42(6): 12.
- Weir E. Substance abuse among physicians. Canadian Medical Association Journal 2000; 162(12): 1730.
- Taub S, Morin K, Goldrich MS, Ray P, Benjamin R; Council on Ethical and Judicial Affairs of the American Medical Association. Physician health and wellness. Occupational Medicine 2006; 56(2): 77–82.
- Canadian Medical Association (CMA). CMA code of ethics. Ottawa: CMA; 2004. Available from: http://policybase.cma.ca/PolicyPDF/PD04-06.pdf. Accessed May 21, 2007.
- Myers MF. Treatment of the mentally ill physician, CPA position paper, Canadian Journal of Psychiatry 1997; 42(6) insert. http://www.cpa-apc.org/wp-content/uploads/TreatmentoftheMentallyIllPhysician_1997_36.pdf.
Further Reading and Resources
- Canadian Physician Health Network: http://www.cma.ca/index.cfm/ci_id/25567/la_id/1.htm. Myers MF, editor. CMA guide to physician health and well-being. Ottawa: Canadian Medical Association; 2003.