William Haning, MD, DFASAM, DFAPA
The capacity to identify with the patient while maintaining a therapeutic boundary is a positive consequence for physicians who are themselves in recovery. But recovery imposes special obligations which may translate into professional risk. This week and next, in examining challenges to the clinician’s sense of identity, we begin with a Mayo Clinic Proceedings (Oct 2017) inquiry into the impact of licensure questions on the willingness of physicians to seek care [http://www.mayoclinicproceedings.org/article/S0025-6196(17)30522-0/fulltext#sec4]. The relevance is evident: estimates of our Society’s membership who are themselves in recovery, or who have faced health challenges vary, in the absence of a formal survey; but is thought to exceed 30%.
“…Changing medical licensure application questions, as well as similar items asked by hospitals and group practices in the credentialing process, so that they inquire about current functional impairment appears to be a simple but potentially meaningful step to reduce barriers to physicians seeking help for mental health conditions. Such a change, although potentially cumbersome because state medical boards may need to work with their legislators for changes to the state medical practice acts, could be implemented at minimal cost.”
Just as licensure is one source of anxiety for the physician who is reconstructing or even maintaining a career, so, too, are privileging and credentialing. And what all constitute are threats to a sense of self that most physicians have been assembling since adolescence, a sense that is captured not in the phrase, “I am a physician;” but rather, “I am only a physician.”
It is a belief amplified as other elements of one’s life are allowed to fall away. The vulnerability that this creates is apparent, as is the solution.
Editor-in-Chief: William Haning, MD, DFAPA, DFASAM
This is meant to encourage physicians with addiction issues to come clean and get into recovery with the assistance of “physician/professional recovery assistance programs” or “physician health programs”.
I’ve been the recipient of the “assistance” provided by such programs.
I’ve been very impressed with these programs.
If I ran my practice the way these programs run, I’d be out of business in a week. I’ve seen more corruption, dishonesty, unprofessional conduct, character assassination, incompetence, collusion and other problematic behaviors than I can recount. With that being said, I think that there IS a need and a place for these programs. What’s the problem?
What kind of people go into the field of addiction treatment? Addicts! Folks who have problems with ego, honesty, pride-name the 7 deadly sins and addicts (myself included) are at more risk than the average person to these character flaws–by the same genetic and environmental constitution that gave us our addiction in the first place!
We need more careful oversight, regulation & management of these programs & those that run them.
When I come across a physician with a problem related to addiction, I encourage them to get into treatment, I try to work with them, I do my best to ensure that they are not providing substandard care in any way. I’ve seen numerous state medical board disciplinary actions brought against physicians for “impairment” when there was absolutely no evidence of substandard care anywhere, yet these poor victims of the system were crucified and their professional standing assassinated. The physician may have been addicted, but what the physician went through at the hands of these (supposedly well-meaning) programs has been nothing short of criminal.