Abstract
BACKGROUND: Anesthesiologists have a higher rate of substance use disorders than other physicians, and their prognoses and advisability to return to anesthesiology practice after treatment remain controversial. Over the past 25 yr, physician health programs (PHPs), created under authority of state medical regulatory boards, have become primary resources for management and monitoring of physicians with substance abuse and other mental health disorders.
METHODS: We conducted a 5-yr, longitudinal, cohort study involving 904 physicians consecutively admitted to 1 of 16 state PHPs between 1995 and 2001. This report analyzed a subset of the data involving the 102 anesthesiologists among the subjects and compared them with other physicians. The main outcome measures included relapse (defined as any unauthorized addictive substance use, including alcohol), return to anesthesiology practice, disciplinary actions, physician death, and patient harm.
RESULTS: Anesthesiologists were significantly less likely to enroll in a PHP because of alcohol abuse (odds ratio [OR] 0.4 [confidence interval {CI}: 0.2–0.6], P < 0.001) and much more likely to enroll because of opioid abuse (OR 2.8 [CI: 1.7–4.4], P < 0.001). Anesthesiologists had a higher rate of IV drug use, 41% vs 10% (OR 6.3 [CI: 3.8–10.7], P < 0.001). During similar periods of monitoring, anesthesiologists received more drug tests, 101 vs 82 (mean difference = 19 [CI: 3–35], P = 0.02); however, anesthesiologists were less likely to fail at least one drug test during monitoring, 11% vs 23% (OR 0.4 [CI: 0.2–0.9], P = 0.02). There was no statistical difference among rates of program completion, disciplinary actions, return to practice, or deaths, and there was no report of significant patient harm from relapse in any record.
CONCLUSIONS: Anesthesiologists in our sample treated and monitored for substance disorders under supervision of PHPs had excellent outcomes similar to other physicians, with no higher mortality, relapse rate, or disciplinary rate and no evidence in their records of patient harm. It is postulated that differences of study design account for contradictory conclusions from other reports.
Technorati Tags: research, physicians, treatment
2 comments:
This is a nice piece of work and follows hard on the heels of the recent paper published in the Mayo Clinic journal showing that anesthesiologists (called anaesthetists back here in the UK) generally can safely return to their work in recovery.
I agree that the quality of treatment must be important here. The expectation for all physicians is that recovery is not only possible, but likely. Recovering physicians have many role models, good recovery communities and the quality of treatment they can access is high.
The counter argument, of course, is that physicians have high recovery capital to start with, so that's the main outcome predictor, not treatment.
I buy this to some degree, but not wholly; I believe that treatment is important too, as are the supportive networks (including monitoring and supervision in health programmes) that doctors plug into after treatment.
If we could aspire to this type of approach (expectant, supported, quality treatment of sufficient intensity and duration, follow up and managed aftercare) for all, how might outcomes improve?
I agree completely.
Recovery capital is part of the picture. So are the contingencies of PHP programs, though it's important to note that those contingencies are natural, real world contingencies rather than manufactured punishments and rewards.
The recovery capital and contingencies arguments write off the following: starting off in high intensity treatment that is gradually stepped down over the course of a year or more (rather than days or weeks); up to 5 years of case management and monitoring; coordination with employers; hope and high expectations from employers, families, our culture; etc.
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