December 19, 2007

One in six doctors is addicted or a drunk. Is yours? You'll never find out!

Buried in all the seasonal holiday cheer is this disturbing news story:
AP News: Programs Let Addicted Docs Practice

It blows the whistle on the way that the medical community protects its image by allowing doctors who are seriously impaired to continue practicing. It discusses how even when local medical associations know that a doctor is impaired and offer that doctor treatment for serious addictions or alcoholism, these organizations keep this information secret and allow the doctors to continue treating patients while undergoing rehab--even though, like so many other people in rehab, many doctors in rehab do not cure their addictions.

The article focuses on the major horror stories: obstetricians who kill babies by accident because they show up at the delivery drunk. Plastic surgeons who maim and mutilate their patients. Doctors who have a string of malpractice suits behind them along with drunk driving convictions who continue to attract new patients who have no way of finding out how dangerous they are.

There are a lot of these people. I grew up in a hospital family and I remember hearing my parents discuss the brain surgeon who operated drunk. But they liked him and it would never have occurred to them that they should have been demanding that the hospital administration for which they worked should pull this guy's license to operate. They just warned their friends not to go to him if they needed surgery. The rest of his patients? Well they were out of luck.

I remember being horrified when I heard this, but in all fairness to my parents, if they had made an issue of this man's impairment, or God forbid gone public with it, they would have been likely to have lost their jobs. That was how it was 40 years ago and that is how it is now. I later had a friend who was an M.D. who did have the courage to blow the whistle on another doctor at her hospital who had severely physically abused his wife, who was her patient. She lost her job. He kept his.

Perhaps the scariest thing in today's AP story is the statistics given about how common substance abuse is among doctors. The story cites statistics I've seen elsewhere that estimate that between 10 and 15% of ALL doctors have substance abuse problems. These statistics come from medical associations. Of those who are drunk or addicted, the estimate is that only 1% enroll in treatment programs. Meanwhile all these impaired doctors continue to treat patients who have no way of knowing how dangerous they may be.

Apparently, doctors cover for these guys out of the belief that its better to have patients die than to tarnish the reputation of the medical profession. But horror stories like these hide a much more pervasive problem. Doctors also cover for peers they know to be incompetent for reasons other than drug or alcohol abuse.

They know that colleagues may be giving outdated treatments. They know that some of the older practitioners may be in the early stages of dementia. They know that there are local endocrinologists who haven't a clue about how to prescribe insulin or thyroid medication. And they know, too, when a lot of their patients are coming down with MRSA in local hospitals. (There is no requirement that any hospital report the incidence of MRSA or other hospital borne infections to anyone.)

In short, the medical community knows a lot about the really bad medical care available in their regions. But they do nothing about it because far stronger than the Hippocratic Oath is the Physician's Code that says, "Speak No Evil of a Colleague." If the choice is your health or their profession's reputation, you're out of luck.

So ask your self this: If as many as one in six doctors may be practicing impaired, what percentage of doctors is giving substandard care?

How many prescribe expensive new drugs whose side effects are poorly understood because drug companies reimburse them for every new prescription written as part of a phony "study?"

How many ignore it when patients report severe side effects after they have been put on a new drug because they don't pay any attention to even the Black Box warnings flagging potentially deadly side effects of these drugs?

How many have set up their offices so that LPN "nurses" with a high school education and a certificate from a Junior College screen all patient calls and let these LPNS decide whose messages get passed on to doctors--in whatever garbled form the poorly educated, poorly paid clerk sets them down.

How many doctors are putting all their efforts into building up money making side line businesses like "laser hair removal" and other unregulated plastic surgery procedures instead of worrying about their patients' health?

When you read about the prevalence of impaired or incompetent doctors, you probably think that it this is someone else's problem. Your doctor is such a nice guy. Well, so was that brain surgeon who operated drunk. The fact is, you aren't likely to learn who the incompetent or dangerous doctors in your area are until you become their victim. Even if every doctor in your community knows who these people are.


The Old Man & His Dog said...

Bravo!!! Many years ago my primary care physician drove drunk and killed a pedestrian. This was in the papers. I read the article and followed what happened to my Dr.. Well, many months later he was not only still practicing medicine(and still is to this day), but he also kept his driver's license and was not punished in any way, thanks to the lawyers that a Dr's income can buy, but mine can't. Within a month of the incident, I actually made an appointment to see him just to tell him I would no longer be his patient because of this and I would make everyone I knew aware of what he'd done. Well that man followed me all the way out to the parking lot begging me to come back in and talk to him. I didn't. The Dr's should be ashamed and the lawyers should go to hell if there is one. PS: My father still goes to him for his diabetes.

talesofmy30s said...

I think there are two kinds of doctors with substance abuse issues - those whose work is affected and those whose work is not affected. (Just like everyone else, I might add!)

For those who get early intervention and do no harm to a patient (or the public), I think it is important to provide a second chance. Being threatened with loss of a medical license (and family) does straighten people out - just as would a lawyer or teacher. I don't necessarily believe in third, fourth, etc chances, mind you.

I do believe in a person's right to privacy about an addiction for which they have been seeking help (and have been fighting successfully).

Jenny said...

Tales of my 30s,

There's a balance between private rights and public responsibility.

Commercial pilots with known substance abuse problems are grounded. That's because the public understands that no one has a right to fly drunk and that the pilot's need for privacy is overridden by the public's need to have competent people behind the controls. Would you really want to fly with a guy who was trying to get control of his drinking problem but not there yet?

No one has a right privacy if that "right" means he is allowed to do surgery drunk or to treat children while under the influence of a substance that destroys their ability to make good decisions.

Because they ARE impaired, these doctors are NOT able to distinguish whether their impairment is dangerous to others or not. We all know drunks who deny the severity of their impairment. These doctors do the same thing.

And as the news story makes very clear, the organizations providing the rehab don't make any call as to the severity of the impairment--or denial--either.

Scott said...

Isn't this sad? I read this, almost in disbelief except that knowing the medical profession, its easy to see how this could happen. Short story, I once had a primary care physician who for reasons never disclosed was unable to write Rx's. What happened when he couldn't write me a script for insulin, he was able to have a close doctor friend write my script knowing I'd die without insulin. Really makes you wonder!

FormerRPh said...

Similar statistics hold true for pharmacists. Twenty five years ago, as a pharmacist, I was extremely impaired.

One night I ended up in an emergency room in a paralyzed condition. The paramedics are brought my tackle box of medication along with me. However, since there were so many medications, they were unable to determine what I had taken.

What should have happened is that I should have been stablized and then sent the psychiatric unit. Instead, because I was a pharmacist, they stablized me and let me walk out the door.

The legal problems that ensued afterwards forced me to abandon my pharmacy career temporarily. However, I decided I was in the wrong profession, went back to school for another degree and turned my life around.

If someone is seriously impaired, letting the crap hit the fan is sometimes the best thing for them. Letting them off the hook not only does a disservice to others, but also to them.