It’s estimated that approximately 6% of physicians have drug-use disorders and 14% have an alcohol use disorder—numbers that mirror addiction in the general population.
Have you ever experienced this—having to work with a physician while they’re under the influence of drugs or alcohol? It's a scenario that not only puts everyone in the room at risk, but could endanger the patient's life.
The surgeon was drunk
Here is a first-person account from J.L., an ER physician who asked to remain anonymous. They had a harrowing experience along these lines:
"When I was a young emergency room physician new to a small community hospital in California, I called in a well-known, big-shot surgeon to perform an emergency splenectomy after my patient was in a traumatic car accident.”
"The on-call surgeon arrived, and it was clear he had been drinking."
— J.L., ER physician
“I could smell the alcohol on his breath, hidden under minty mouthwash and strong cologne. There was no other available surgeon at the time, and this patient was unstable with a ruptured spleen and needed to be taken into the operating room as soon as possible. The surgeon operated, and the patient was stabilized.”
“I later found out that this surgeon had a reputation for drinking while practicing medicine, specifically during his on-call nights. I was too ashamed and nervous to report him, as I was fresh into my medical career. Although this patient survived, I regret not reporting this surgeon for operating under the influence. I wonder if any patients were harmed under this surgeon's care, and to this day, I am haunted by my ill-considered decision.”
How many physicians are impaired?
For the degree of responsibility entrusted in them, the number of physicians who abuse drugs and alcohol is a major cause for concern.
Patterns of misuse vary, but, in general, alcohol is most commonly misused, followed by opioids and cocaine. Anesthesiologists and ER physicians are three times more likely to abuse substances than general-population physicians.
Burnout, stress, anxiety, and depression all play a role in substance abuse among the healthcare community.
But treating a patient while under the influence is not only unethical and illegal, but can cost a physician their career, license, and potential criminal charges—and can kill the patient.
Warning signs of impaired physicians
It may be difficult to see the signs that you’re working with an impaired physician, as many know how to hide their substance abuse. Their work is usually the last aspect to be affected. Alcohol abuse may exist for up to 15 years before they (or their co-workers) recognize the need for treatment.
The following are potential warning signs associated with substance use disorders among healthcare professionals:
Late to appointments, increased absence, unknown whereabouts
Unusual rounding times—either very early or very late
Discord in personal relationships; increased irritability/aggression
Increase in patient complaints; poor charting, writing of prescriptions, handwriting
Increased secrecy, avoidance, and isolation
Decrease in quality of care, productivity, or efficiency; careless medical decisions
The smell of alcohol, needle marks, sloppy appearance
Erratic job history
Your duty to file a report
If you’re concerned that a physician is practicing under the influence or has a substance disorder impairing their functioning, intervene immediately. It’s our duty as physicians to protect our patients, even though we also want to protect our colleagues.
The perfect scenario would be for the impaired physician to turn themself in.
But if this isn’t happening, you must confront them.
Your best tool: State Physicians Health Program
It’s usually best to avoid confronting the impaired physician alone, as they'll probably be in denial and may respond defensively to any intervention attempt. Instead, contact your state's Physicians Health Program (PHP) or company's Employee Assistance Program about the situation.
If you're working with your someone from your state's PHP program, avoid arguing or negotiating with the impaired physician. Instead, praise their abilities and express how treatment will allow them to continue to use those skills.
When you're uncomfortable confronting the physician with your PHP’s help, report them anonymously to the PHP. It’s much better to report to the PHP than to your state's medical board, as PHPs help identify impaired physicians while staying involved in their evaluation, treatment, and long-term monitoring. The state medical board is more likely to take a disciplinary approach and would probably restrict or suspend their license.
All 50 states now have PHPs, which are usually sponsored by state medical societies. PHPs protect the public from impaired physicians and help them achieve long-term recovery so they can continue their careers.Read Next: Real Talk: When you're in the throes of addiction
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.