Dr. John Walker described what he would do to feed his opiate addiction. He would steal medication from his patients, sometimes filling out prescriptions under another person's name. He would then have that person pick up the prescription on his behalf and deliver them to him.
"Just saying that out loud humiliates me to this day," he said.
John (a pseudonym) is only one of a thousands of surgeons who suffer from substance addiction in America. In fact, he considers himself one of the "lucky" ones. He volunteered knowledge of his addiction and abuse to the Tennessee Medical Board, and each of his co-conspirators cooperated with the subsequent police investigation. Because he confessed, he was able to avoid prison time for his charges. He was fired, but was eventually given a chance to restart his practice after prolonged treatment.
Part of John's treatment was learning how to process emotions. Surgeons, a group of notoriously self-disciplined and hard-working professionals, often compartmentalize their emotions for the sake of their work. The stresses and pressures of surgery can drive many surgeons to cope with their emotions in destructive channels.
"Medical professionals, in my opinion, are at a higher risk for developing an addiction in some ways," John asserted.
The Roots of Substance Abuse
Dr. Marc Myers offers a very similar story. He had been given painkillers for a routine wisdom tooth removal, but the pressures of his job are why he got hooked. He and John both believed that taking medication was necessary for him to cope with the rigors of surgical work.
One study found that he and Dr. Walker are not alone—studies show that surgeons don't take drugs recreationally. They take drugs to manage stress, believing that such measures are actually helpful to them and their patients.
Dr. Myers has now devoted his practice to helping other doctors cope with their addictions and recover long term. After seeking treatment for his painkiller addiction, Dr. Myers realizes how widespread addiction is as an issue—both in the general populace and among surgeons. Few addicts ever seek help, and thanks to their hyper-competent personalities, surgeons are especially skilled at hiding addictions.
Some feel that they need to overcompensate for their failures—taking on extra rounds or working longer hours to "make up" for stolen prescriptions. Relapse rates are also a problem, as 1 in 2 addicts relapse within a year of receiving treatment. Thankfully, long-term monitoring programs have kept addicts (surgeons or otherwise) from falling into abuse again.
Myers actually relapsed several times after his initial treatment. Because he failed the monitoring program repeatedly, he was terminated and his medical license revoked. This gave him the opportunity to seek long-term treatment, where he finally learned how to cope with the stresses and emotions of his life without resorting to substance abuse.
He has since regained his license and uses his experience to help doctors in the same situation.
Rates of Substance Abuse Among Physicians
One survey conducted by the American College of Surgeons questioned 7,000 surgeons about their history of substance abuse. A little less than 14 percent of male doctors reported being addicted to alcohol, and over 25% of female surgeons reported a prevalence for alcohol abuse. Think about that—nearly 1 in 5 of all surgeons abuse alcohol according to the survey.
In July 2010, another survey of 1,900 physicians revealed that 17% of doctors knew or knew of a colleague who was impaired or incompetent in the last 3 years. Over a third of this group never reported the offending doctor. They offered various reasons explaining why, but the survey conductors felt that surgeons from large or multi-site hospitals were less likely to report abuse.
The reasons for not reporting impairment among physicians included:
- Fear of retaliation
- It wouldn't "solve" anything
- Someone else would report it
- "It's not my responsibility"
- Fear of excessive punishment for the physician
Some surgeons considered it a "professional courtesy." Even when a surgeon might not be abusing drugs or alcohol themselves, almost all of them understand the factors that lead to abuse. "There but for the grace of God go I" is the phrase Dr. Rebecca Hafner-Fogarty used, a doctor who helps healthcare organizations manage physician performance. She notes that every surgeon on some level feels like they're only a few missteps from substance abuse themselves—so they don't report.
"There's also a sense of wanting to respect a colleague's privacy," she added.
The problem with this sort of professional courtesy is that it leaves patients at risk. Critics accuse doctors of covering for each other, allowing surgeons to continue feeding their addictions until someone gets hurt or killed, including themselves. Sixty percent of overdoses in the United States are with pharmaceuticals.
The other problem is lack of awareness. Medical schools usually devote a single lecture to addiction—which is a far more ubiquitous medical issue than, say, pregnancy. As one doctor observed, not every doctor will need to deliver a baby, but every doctor will need to treat an addict.
Striking a Balance Between Punishment & Treatment
Drs. Myers and Walker both sought treatment, experienced the loss of their practice, and then rebuilt from the ground up. They were rightfully barred from practicing medicine, but they were also given the opportunity to start again. Stories like theirs might make the prospect of confession easier to swallow for surgeons currently suffering alone in the dark room of addiction.
At the same time, there are real dangers posed to patients when a surgeon abandons sobriety in the course of their duties. That danger demands discipline (and on some level, public accountability). We have the right to know if our doctor has a history of abuse—and it's a right that other doctors have to fight for, as they're often the only ones who know about it.
We believe that there's a way to encourage doctors to safely disclose their addictions while keeping patients safe. But the treatment, as it often does, begins with the doctors themselves.