A video made the rounds late last year that showed a truck running through a parking lot barrier and smashing into cars waiting at a traffic light. It just so happened that the alleged drunk driver was an emergency physician who had just finished working a morning shift. She was allegedly under the influence of alcohol. It was one single isolated incident. But it played over and over on television, making emergency physicians and emergency department staffs across the nation cringe.
Explore This IssueACEP News: Vol 32 – No 06 – June 2013
It also turned the spotlight back to a study published in 2012 in the Archives of Internal Medicine that said emergency physicians suffer from burnout and stress, much more so than their counterparts in other specialties. The research was conducted on behalf of the Mayo Clinic and the American Medical Association, and 7,288 responded by filling out a questionnaire. The results found that nearly 60 percent of emergency physicians suffered from some kind of burnout. Emergency physicians were at the top of the list, along with doctors in internal medicine and family medicine.
The study didn’t say that burnout leads to drinking and drugs and driving your car off the road.
“They aren’t necessarily related at all, though obviously there is some overlap,’’ said Dr. Louise Andrew, the chair of ACEP’s Well-Being Committee.
ACEP offers help and advice for stress relief and has kept in place a policy on physician impairment for more than 20 years. It is currently undergoing a regular revision by the Well-Being Committee. ACEP has had a Well-Being Committee for about 30 years, covering all aspects of physician health and well-being. These programs offer resources to members experiencing burnout, including peer to peer counseling. But experts say physicians are often slow to acknowledge career-threatening problems, even to themselves.
Dr. Jay Kaplan, a member of ACEP’s Board of Directors and an expert on physician wellness, said it’s no surprise that some physicians battle burnout. He said even more must be done to help.
“Emergency physicians are scheduled around the clock in workplaces more prone to violence than other doctors’ offices,” he said. “They face a continuous onslaught of new patients, who often must be treated simultaneously instead of one at a time. On any given day, physicians face a rotating cast of medical colleagues. The patients themselves can be difficult and in worse shape medically than those who seek routine care.”
Stress can be the price you pay for serving as the nation’s safety net, he said. “But doctors are not terribly good at recognizing when they’re burned out,’’ he said. “And medical colleagues are often reluctant to say, ‘You seem to be having difficulty here. What can I do to support you?’ ’’
But when that conversation does happen, Dr. Andrew said, physicians can have a huge impact on colleagues who feel isolated. “We have a peer-to-peer counseling system that can be of use to members experiencing burnout, but we have not had any requests for support relating to impairment issues,’’ she said. “We also have a Wellness Section … but again, not a great deal of interest in (substance abuse) or impairment is evident.”
There are signs that more emphasis on impairment is needed.
A study of 16 state physician health programs that examined 904 physicians who had been placed under monitoring for drug abuse found more than half of the physicians were in five medical specialties. Emergency medicine ranked fourth, after family medicine, internal medicine, and anesthesiology. Psychiatry ranked fifth. The 2009 study was conducted by researchers at the University of Florida.
Aside from their own inhibitions and pride, physicians may be reluctant to seek help for practical reasons.
“There may be a conspiracy of silence in the workplace and the home, limiting involvement by friends, family members, and colleagues,’’ according to a February 2010 article in Minnesota Medicine. If the physician is in a position of power, other employees may fear for their jobs and careers if they mention the possibility of addiction.
“Family members may know of the addiction before co-workers do but may hesitate to act for fear of financial consequences,’’ wrote the authors, Dr. Marvin D. Seppala and Dr. Keith H. Berge. “Fear of litigation can limit appropriate attention to this disease as can the misunderstanding that addiction is a choice and not an illness. Stigma and bias also come into play, as people often cannot believe a physician could have an addiction or believe addiction occurs only in the lower socioeconomic classes.’’
But the stakes are high if impaired physicians continue to practice, and not just for the doctors themselves. “Research has shown that when such behavior is permitted, the patient suffers,’’ said Marilyn Bromley, Director of ACEP’s Emergency Medicine Practice Department.
That is one reason the Joint Commission on Accreditation of Healthcare Organizations now requires accredited facilities to have a code of conduct “defining acceptable behavior and specifying which behaviors are disruptive and inappropriate, and to have a process or action plan for managing disruptive staff members,’’ Dr. Linda M. Worley said at the American Psychiatric Association’s Institute on Psychiatric Services last fall.
Physicians who come forward with problems may find that the consequences aren’t as bad as they fear. In particular, non-disciplinary physician health programs can offer a third-party solution that satisfies employers and obviates the need for action by state licensing boards, so physicians can get treatment while protecting their licenses.
“Treatment in programs designed for health care professionals addresses the issues unique to physicians and other health care personnel,’’ according to the article in Minnesota Medicine. “Physicians who get involved in appropriate treatment and monitoring programs have remarkable recovery rates.’’
A key component of the success of these programs seems to be the physician’s ability to interact with medical colleagues, who identify with the unique combination of stressors facing doctors.
The programs typically contract with recovering physicians and require adherence to specific criteria including group therapy, individual therapy, mutual help meetings such as Alcoholics and Narcotics Anonymous, monitoring and oversight, drug screening and workplace monitoring. The recovery rate for physicians, according to the article in Minnesota Medicine, is 74 percent to 90 percent.
For physicians facing stress related to litigation, including depression, Dr. Andrew hosts a website, www.mdmentor.com, that offers numerous resources. Physicians and their colleagues and families are also encouraged to visit ACEP’s website for contacts, information about physician impairment, and referrals.
ACEP is also trying to broaden the definition of physician impairment to include aging, fatigue and other issues which can influence how well physicians do their jobs.
“We feel that by broadening this, there may be more acceptance of the issue,’’ Bromley said. “As a College, we have tried to take some of the stigma out of admitting you need help.’’