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altDear Boss,
I’ve heard rumors about one of my physicians was working with alcohol on his breath. I haven’t noticed anything but I do feel compelled to do something. What should I do?
-Paralyzed

Dear Paralyzed,
It’s estimated that 12-16% of physicians suffer from drug or alcohol abuse or an emotional or mental disorder. In my group of 20 docs and physician assistants, that means that at least 2 have had, are currently having, or will have some sort of substance abuse or mental health issue. That should be a wake-up call for any director who doesn’t have a plan in place for when this issue rears its ugly head. Here are a few tips for handling this delicate situation. 

Tread Carefully
I recall one physician whose breath smelled of alcohol who vehemently denied any abuse. Turned out it was just his breath – a lethal combo of cigarettes and a particular brand of breath mints.


Follow the Smoke
As the saying goes, where there’s smoke, there’s fire. A rumor of substance abuse should trigger a rapid, thorough investigation.

Don’t Wait
When a substance abuse rumor has reached your desk, you’d better arrange an urgent, private meeting with the physician to discuss the issues.

Prioritize
First and foremost your obligation is to the patients and their well being. Second, you are responsible for looking out for the hospital and the physician group who you, as the chairman, represent. Finally, but still a critical consideration, are the interests of the individual physician.

Use the Team (mostly)
You are not alone in this process. Utilize your human resources department (of the group or hospital) or your hospital’s chief medical officer. On the other hand, you do have an obligation to protect the physician’s integrity and reputation, and at no point should an investigation be made public to the ED staff. 

Know the Signs
Be aware of physicians who have a pattern of community withdrawal or embarrassing behaviors. From a physical status, poor personal hygiene, injuries on vacation or medication requests from colleagues should raise red flags. Clues could also include unexplained absences or tardiness, behavior changes that are inconsistent with previous behaviors and frequent visits to the bathroom. Individually, physicians could demonstrate any of these behaviors for a variety of reasons, but when suspicion exists because of alcohol or drug abuse, the whole picture needs to be viewed from that perspective.

Keep a Record
Make a documented record of the meeting and put the physician on notice of the potential issues and ramifications of the rumored behavior. The physician needs to know that they’ll be under a microscope for the foreseeable future.

Hook Them Up
Once the physician admits their problem, most hospitals and state medical societies offer programs for impaired physicians giving them the opportunity to not only take care of their addiction, but to also maintain their license. These resources should be offered to the physician at the initial meeting but also each time you discuss the problem with the doctor.

Prep for the Worst
If you get a call from the charge nurse at 11:30 PM saying that the night shift doc appears intoxicated. (By the way, why doesn’t this ever occur at 9am?)  This requires an immediate trip to the ED to privately confront the physician, ask him to take a blood alcohol or urine drug test (if appropriate) and immediately relieve him of his duties until his sobriety can be confirmed. If the physician has been using drugs or alcohol, an immediate referral to the state medical society should be made. 

Mike Silverman, MD is chairman of EM at Harbor Hospital in Baltimore and is on the faculty at the TeamHealth Leadership Academy
 

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