11 May When a Doctor Has a Substance Abuse Problem
Dr. David Stidham was a young, handsome graduate of Harvard Medical School when he moved his family to Tucson, Arizona, to become a partner in an eye surgery clinic for children. His patients and their parents adored him, and he was so successful that he planned to open a solo practice. On October 4, 2004, Dr. Stidham’s body was found in his office parking lot. He had been stabbed 16 times in what police believed was a random act of violence.
The truth turned out to be more shocking. Dr. Stidham’s partner, Dr. Bradley Schwartz, had hired a hit man to murder him. Police said that Dr. Schwartz was jealous and angry with Dr. Stidham, who was leaving their practice and taking many patients with him. Dr. Stidham had testified about Dr. Schwartz’ addiction to Vicodin after his federal indictment on drug charges.
Dr. Schwartz is one of many physicians who have harmed themselves, their families, their colleagues and their patients because of untreated drug addictions. The rate of prescription drug abuse among doctors is five times higher than the national average, and some are practicing medicine while under the influence of drugs, usually painkillers. At any given time, between 10% to 15% of all physicians have substance abuse problems.
Some of their stories are truly horrific:
Dr. Brian West, a doctor struggling with substance abuse, botched the reconstruction breast surgery of a cancer patient so badly that she had to forego chemotherapy and other treatments, which in turn contributed to her death.
In 2007, a dermatologist addicted to hydrocodone did not stitch a nose properly on to a patient’s face, leaving it dangling after surgery.
In 2006, a St. Louis surgeon operating under the influence of drugs put a hole in a patient’s colon.
A young medical professional in Denver repeatedly replaced drugs in syringes with a saline solution so she could inject herself with them. By neglecting to sterilize needles, she exposed 6,000 patients to Hepatitis C.
Another health professional, this time in Minneapolis, is facing charges of stealing painkillers from a patient undergoing kidney surgery. This addict told the patient to "man up and take on some of the pain yourself."
"The American public has accepted the idea that a physician works in their patients’ best interests," said Dr. Lucian Leape, a professor of public health at Harvard University, "but in the past 20 years, there’s more and more evidence that we have definite problems."
The main reason for physicians’ high rate of drug abuse is that they are in an extremely stressful profession is extremely stressful and have easy accessibility to drugs. As one expert put it, those two factors plus a genetic propensity toward drug abuse means a doctor with an addiction.
Another factor is that doctors have trouble identifying and diagnosing behavior-based diseases, such as obesity, alcoholism and drug addiction because medical education is slanted toward the use of procedures and medications to treat conditions. One panel of experts concluded in 1996 that primary care doctors are inadequately trained to diagnose and help people who have substance abuse problems, which makes it harder for them to identify the problem among their colleagues.
Because of their superior intellects, doctors can be extraordinarily talented and creative at hiding their addictions from their colleagues and patients. Since they know the symptoms of addiction, they also know how to mask them and how to fake urine tests. One doctor who was drinking three bottles of vodka a day actually devised a chemical concoction of drugs she took every morning to disguise her hangovers.
Only a few hospitals and organizations require medical professionals to undergo random drug testing, although such tests are routine in other professions where people’s lives depend on the competence of the person in charge. For example, pilots undergo drug tests and can be fired if they fail a test even once. The American Medical Association does not even have a drug testing policy, and relies upon each state to set up a government-supervised Physician Health Program or PHP. Doctors who have problems with drugs can be referred to a PHP and required to go through therapy and sometimes even residential treatment programs. Most continue to practice medicine while they are in treatment. However, most experts, including Dr. Leape, believe that the majority of doctors with drug problems escape detection by PHP monitoring boards, and their colleagues and patients.
"Medicine tolerates bad behavior that in any other profession would be unacceptable," he said.
The thing is that physicians who do enter treatment have a superior rate of recovery. One of the few studies performed about this issue found that of 904 doctors enrolled in PHPs, 78% were able to abstain from drugs during the five years of the study. Dr. Mark Gold concluded this study by saying, "Treatment works. It is safe, effective, and cost effective."
Doctors are often the last people to reach out for help. As Dr. Michael Wilks, an Australian doctor who struggled with substance abuse said, "Doctors are taught to be decisive and they are treated with respect. So to ask for help you have to climb off your pedestal and admit you have a problem." Doctors don’t want to reach out for that help because they don’t understand that a real addict cannot help himself."
The thing is if when doctors who abuse drugs do reach out for help, they can and do overcome the problem.
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"Beloved doctors murdered in cold blood," CBS News, and 48 Hours TV Show, Oct. 27, 2007.
Cox, Lauren. "Urine Drug Tests for Doctors?" ABC News, November 12, 2008.
Gilbert, Susan. "Doctors found to fail in diagnosing addictions," The New York Times, Feb. 14, 1996.
Guadagnino, Christopher. "Treating Physician Drug Abuse," Physicians’ News, March 1997.
Malone, Andrew. "Why are so many doctors addicted to drink or drugs?" The Daily Mail, May 13, 2010.
Markel, Howard. "Treatment for addiction meets barriers in the doctors’ office," The New York Times, Oct. 21, 2003.
McGrath, Tim. "Is your doc addicted?" Men’s Health, May 14, 2010.
McGrath, Tim. "Addicted doctors put patients in peril," Men’s Health, June 24, 2010. Also seen on msnbc.news.
McKinney, Matt. "Nurse accused of stealing pain meds in treatment," The Minneapolis Star-Tribune, Feb. 17, 2011.
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Zaroff, Larry (M.D.) "A Bout with Addiction, for the doctor who has everything," New York Times, May 9, 2006.
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