Physician Impairment: Substance Abuse

INTERNAL MEDICINE RESIDENCY

Faculty: Robert Healy, MD, Kirk Moberg, MD, PhD

Sites: Provena Covenant Medical Center (PCMC), Carle Foundation Hospital, Danville Veterans Administration Illiana Health Care System (DVAIHS)

Duration: Continuing 18 Month Curriculum

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Description:

Core Conference curriculum to educate residents on physician impairment secondary to substance abuse.

I. GOALS

Demonstrate comprehensive knowledge of the effects of substance abuse on physician performance.

II. OBJECTIVES

A. PATIENT CARE

Objective 1: Describe the effect of subsance abuse of physician performance in caring for patients including, however not limited to, impaired medical decision making, patient abandonment, effects of physical withdrawal on performance.

Objective 2: Recognize the impact of substance abuse and physician impairment on patient safety.

B. MEDICAL KNOWLEDGE

Objective 1: Understand the terms abuse, dependence, and addiction as defined by the American Society of Addictive Medicine. (ASAM).

Objective 2: Understand the definition of physician impairment.

Ojbective 3: Discuss the criteria for addiction as outlined by ASAM including impaired control overuse, preoccupation with use, continued use despite know adverse consequences, distortion of thinking (denial)

Objective 4: Discuss the landmark report by the American Medical Association " The Sick Physician, " 1973.

Objective 5: Describe studies of prevalence of addiction in physicians.

Objective 6: Describe factors contributing to substance abuse by physicians, including however not limited to, access to pharmaceuticals, self-medication, stress.

Objective 7: Discuss substance use in residents in general, i.e.Journal of the American Medical Association (JAMA) 1991.

Objective 8: Describe the signs and symptoms of substance abuse (addiction) in physicians.

Objective 9: Understand the term addiction liability and be knowledgeable of drug classes that can be abused.

Objective 10: Describe the physiological effects of substances of abuse on the human body including, however not limited to, physical impairment, i.e. physical health; cognitive impairment, i.e. memory, task completion, analytical thinking; and psychological impairment, i.e.motivation, demeanor, mood, psychiatric illness.

Objective 11: Discuss treatment options for physicians with substance abuse, including primary treatment and follow-up care.

Objective 12: Discuss physician outcomes after treatment for substance abuse.

C. PRACTICE-BASED LEARNING AND IMPROVEMENT

Objective 1: Discuss methods to recognize physician impairment secondary to substance abuse.

Objective 1: Discuss the prinicples of intervention for impaired physicians.

C. INTERPERSONAL AND COMMUNICATION SKILLS

Objective 1: Discuss with residents the effect of substance abuse on interpersonal skills.

Objective 2: Discuss with residents the effect of substance abuse on communication skills.

Objective 3: Educate residents on techniques in intervention for colleagues suspected of being impaired secondary to substance abuse.

E. PROFESSIONALISM

Objective 1: Recognize the effects of substance abuse on behavior, mood, demeanor and subsequent effects upon professionalism.

Objective 2: Discuss policies in place at training site(s) that address impaired physicians.

F. SYSTEM-BASED PRACTICE

Objective 1: Discuss the effects of substance abuse on physician performance, errors, and efficiency.

Objective 2: Recognize resources of state-wide assistance programs for the impaired physician.

III. METHODS

Residents attend weekly core lectures. As part of the 18 month curriculum, there are 1 scheduled physician impairment conference of one to two hours every 12 months. Residents will role play scenarios of substance abuse and impairment of physician performance including recognition and of physician impairment secondary to substance abuse, and intervention.

IV. EVALUATION

Evaluation of resident knowledge of physician impairment related to substance abuse will be assessed by post test. Secondly, residents will evaluate the conference by survery.

V. REFERENCES

1. The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA. 1973;223:684-7.

2. Hughes PH, et al. Resident physician substance use in the United States. JAMA. 1991;265:2069-73.

4. Mansky PA. Impaired physicians. In: Galanter M, Kleber HD, eds. Textbook of Substance Abuse Treatment, 3^rd ed. Washington, DC: American Psychiatric Press, Inc. In Press.

5. Talbott GD, et al. Impairment and recovery in physicians and other health professionals. In: Graham AW, Schultz TK, eds. Principles of Addiction Medicine. 2^nd ed. Chevy Chase, MD: American Society of Addiction Medicine, Inc; 1998:1263-1279

6. Principles of Addiction Medicine, American Society of Addiction Medicine, 3rd ed. 2003.

7. www.asam.org

10/14/2005