S C I E N C E
O F
M E D I C I N E
Physicians Helping Physicians: A Template for Success SCOTT HAMBLETON, MD Physician Health Programs and Safety Physician Health Programs (PHPs) have a well-documented history of tremendous success in rehabilitating physicians.1,2 Outcome data reported in one longitudinal study involving 16 PHPs indicated that 78% of the 904 physicians monitored for addictive disorders were sober after 5 years, without a single relapse. In Mississippi, 89.8% of the physicians monitored by the Mississippi Physician Health Program (MPHP) for addictive illnesses involving substances were sober, without a single relapse, in the 5-year period ending December 31, 2018. (Hambleton S. Annual Report to MPHP Board of Directors. Update on MPHP participants. May 2019). With few exceptions, these documented long-term rates of recovery are unparalleled in the general population of individuals with addictive illnesses. Additionally, physicians monitored by PHPs are safe physicians. In the previously mentioned study of 904 physicians, there was only one case of documented patient harm during the period of monitoring and that case involved improper prescribing. Another study demonstrated that PHP monitoring is associated with a lowered risk of malpractice claims and that physicians constituted a 20% lower risk than the matched cohort, after monitoring.3 Considering the epidemic of fatal drug overdoses in the United States, solutions to the underlying problem of addiction are desperately needed. The PHP approach to managing physicians with addictive disorders is unequivocally effective and hopefully will one day be utilized to help all individuals suffering from addictive illnesses. Addiction, Impairment and Shame Like no other condition, addiction is an insidious and remarkably effective disease process that ravages sufferers and all those who know and love the sufferer. Many people who have recovered from addiction report a sense of unimaginable hopelessness during active addiction, in some cases believing that death is the only legitimate way out. Addiction adroitly protects itself as a disease process and without treatment will progress, ensuring that the sufferer afflicted with it will lose everything: spiritual connectedness, relationships with family and friends, health, self-respect, the ability to practice medicine and ultimately life itself. Becoming a physician is an incredibly arduous process, and successfully enduring the rigors of medical education and training requires remarkable perseverance. Not surprisingly, physicians with addiction will attempt to exert control over their substance use so that it does not impact their ability to practice medicine safely. However, even in
324 VOL. 60 • NO. 10 • 2019
physicians, control over substance use diminishes as the addiction progresses and may result in overt impairment. An important point is that untreated addiction in physicians does not always manifest with overt impairment, and illness often predates impairment by a period of years.1,2,4-7 Considering that addictive disorders are classified as mild, moderate or severe, it makes sense that earlier intervention is more efficacious than intervention in later stages of disease. Impairment is a functional classification, and an impaired physician is unable to fulfill patient care responsibilities safely and effectively. The risk of impairment is a primary reason to support early referral to a PHP to identify and treat addiction prior to its progression to functional impairment. Shame is another prominent feature of addiction that contributes to the cycle of continuous substance use. Behavior that occurs during addiction is often harmful to others, and appropriate feelings of guilt, combined with the inability to stop using substances effectively, contribute powerfully to the addicted individual’s sense of shame. Unfortunately, the stigma of addiction promotes secrecy and increases resistance to seeking or accepting treatment. Shame is especially prominent in physicians who are trained to function independently and are reluctant to ask for help. Unfortunately, during the process of training, many physicians incorporate the idea that asking for help is a sign of weakness, which fosters the need for even more secrecy and results in persistent, untreated addiction. Why are PHPs so successful? Physician Health Programs (PHPs) have been in existence since the 1970s and have continued to evolve, with increasing effectiveness.1,2,4-7 The Federation of State Physician Health Programs (FSPHP) is
