Health care is one of the prime locations for employment for anyone drug-addicted or prone to addiction. Addictive substances in large quantities are kept either on units, on specialized delivery carts, or in locked cabinets. But there are ways around the many protections that have been put in place to secure these substances.

One of the ways is to indicate that a patient required more pain medication than was administered or to collect any containers that have medication in them and that were to be carefully discarded.

As noted in a professional journal, “Too many of us have known of a colleague with substance use disorder (SUD) whose behaviour resulted in severe consequences to the person or to others. SUD is not specific to our specialty, but doctors are at the top of the occupational risk ranking and the anesthesiologist is at the top of these….”

In fact, “Anesthesiologists experience substance use disorders at a rate reported to be 2.7 times that of other physicians.”

How do we know that any health care personnel working on a unit is or isn’t addicted? Also, how do we know that all of the physicians caring for patients are not cognitively impaired? I knew of one physician who had to be guided by the nurses on the unit whenever he was prescribing a medication.

There was no question that he should have retired, but he had a position of authority and was seen as an expert in his field, and no one wanted to step on his toes. I don’t know what happened to him, but I hope there were no serious mistakes because of his impairment.

Another physician at a nursing home, where he was the medical director, was a known alcoholic, and again the nurses always covered for him. He only left the position when the nursing home was acquired by a large corporation that cut back staff and brought in new management.

A third physician, a surgeon, was known to abuse alcohol and come into the operating room with alcohol on his breath. He was never reported. Once again, neither the nurses nor anyone else ever told anyone.

The Addicted Physician

I once worked at a hospital where a new psychiatrist came to one of the units where a colleague was working. His appearance was somewhat odd. He wore suits that were rumpled and outdated and were too flashy. We chalked it up to his not having done very well in the profession and let it go at that.

Imagine our shock when we discovered that another psychiatrist in the hospital was supervising him because he had previously been an anesthesiologist and was forced to change his specialty to psychiatry. However, the addicted physician found a way to continue his addiction, and it was simple. All he had to do was remove prescription sheets from the back of the pad of his supervisor. The supervisor had left the prescription pad in an unlocked office desk drawer.

How was his deception discovered? Foolishly, the addicted physician took the scripts, using patient names, to a local pharmacy to have them filled. In addition, the scripts were all for quaaludes. The pharmacist found this quite curious and called the director of medicine at the hospital to ask why this psychiatrist was handing in so many prescriptions. It was then that they discovered his ruse, and he was, once again, sent to an addictions rehab hospital. He had already been a patient at two prior addiction rehab facilities.

The cleverness of this deception was thwarted once the state in which he worked required all prescription pads to be printed on special paper and copies sent to a state database by pharmacists. This was not a unique instance, and other states quickly determined they needed to revise prescription pad production and recording databases to prevent misuse. But addiction isn’t the only challenge for medicine.

Setting Standards for Continued Practice

In the past few years, professional literature began discussing when a physician should retire or what types of evaluations should be put in place to maintain a license after a certain age. It doesn’t crop up often, and it is a tough call to make.

The state’s medical licensing board is one place where all physicians can be subjected to a review of their work or where complaints can be lodged. They examine both professional and consumer reports sent to them. If someone wishes to check on a specific physician’s credentials, there’s also a place for that, and it is here on Docinfo.

Unfortunately, another database, the National Practitioner Data Bank (NPBD), is accessible only to specific groups. It was created by federal law to protect consumers, and its site states, “Although these reports are not available to the general public, various entities (e.g., hospitals and other health care entities) may query the NPDB to obtain information on a specific licensee or entity.” I doubt that patients know the database exists or if it contains material on cognitively impaired physicians.

A “graying” of the physician workforce was noted before the 21st century, but there is a reluctance to report or to require evaluation of older physicians. How should this question(s) be resolved? “…the authors issue a call for an expert consensus panel to convene to make recommendations concerning aging physicians with cognitive impairment who are at risk for medical errors.”

We are awaiting such a panel and, in the meantime, let the patient be vigilant and keep good notes on their care and from whom they received it.