Transcript current topics in substance abuse - Vanderbilt University Medical

The Troubled Physician
Prevention and Intervention
Anderson Spickard, Jr., M.D.
Director
Center for Professional Health at Vanderbilt
December 20, 2002
EAP Physician Consults
1998-99

Critical Incident Stress Debriefings
» 4 MD deaths
» 2 MD terminations for misconduct

Request from Legal for Consult
» 2 MD employment application irregularities
Reasons for the Vanderbilt
Physician Wellness Program
Need for a comprehensive program for
VUMC physicians(650 residents and 750
faculty - 400 students)
 Emerging world-wide interest in physician
burnout

Physician Wellness
Development Plan
Approved by the Medical Center Medical
Board July 15, 1999
 Director, staff and space assigned
 Program directed at prevention, early
identification, treatment and relapse
prevention after reentry to work

JCAHO Intent Statement
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“The medical staff implements a process
to identify and manage matters of
individual physician health that is
separate from the medical staff
disciplinary function” - JCAHO, Medical Staff
Standards (MS.2.6)
JCAHO Process Components
Education
 Referral
 Diagnosis/Treatment
 Confidentiality
 Evaluation (Verification)
 Monitoring
 Reporting

ACGME Requirements for
Resident Support
Provide confidential counseling services
 Medical and psychological support
 Written policies about impairment
including substance abuse
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Organization of the Physician
Wellness Committee
17 members of the faculty representing
many of the clinical departments
 Section of Physician Wellness created in
the EAP
 Intense marketing of the program to house
staff and faculty through grand rounds,
brochures and e-mail

Program for Physician Wellness
All assessments free to faculty and
residents
 Physicians self referred or sent by
supervisor for assistance in the EAP

Results of the Program
Physicians with relationship problems,
addiction issues, disruptive behavior
now recognized early and sent to EAP
for assessment
 Referrals have tripled in two years and
are increasing
 A culture of wellness in the medical
center is improving

Utilization
Physician Wellness Program
Number of Physicians
Before PWP (Orange) and Since PWP (Gold)
58
47
25
7
6
4
1
92-93
93-94
14
8
94-95
95-96
96-97
Fiscal Year
98-99
99-00
00-01
01-02
Institutional Barriers to
Program Implementation
Medical Center leaders not committed
 Recovering people not used to help
 Lack of funding for implementation
 Medical leaders don’t confront
physicians with A/D issues, disruptive
behavior,etc. Need code of conduct
 Resources for referral are limited

Impairments In Physicians
Alcohol and drug dependence
 Psychiatric disorders (bipolar,
depression,schizophrenia, anxiety
disorders)
 Personality disorders
 Sexual boundary violations and sexual
harassment
 Disruptive behavior (uncontrolled anger)

Resident Impairment
Depression
 Alcohol and drugs (self medication)
 Marital problems
 Fatigue
 Psychiatric Illness other than depression
including OCD, etc.

Risk Factors of Those Who
Abuse Alcohol and Drugs
Stress
 Access to drugs; relax with alcohol
 Self medicate
 Family history of A/D addiction
 Lack of a support group

Barriers to Diagnosis
of Physician Impairment
Denial
 Rationalization
 Myth of invulnerability
 Social acceptability of alcohol and drug
use.
 Colleagues ignore behavioral problems
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Vanderbilt Resident Wellness
Support Network
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Retreat for Anesthesia Department
Marriage retreat for residents with Michael Myers
Fallibility rounds
Women physicians support group
International physicians health assessment
Balancing resident professional and private life
seminars
Personal Wellness Profiles (stress, weight,
cholesterol)