Letters to the editor

Physician Executive, Nov-Dec, 2004 by Steven P. Kouris

Dear Editor,

The recent article "Doctors Doing Drugs and Drinking" (The Physician Executive, 30(5) September/October 2004) justly highlights this extremely important yet often overlooked source of performance difficulties among physicians.

Substance abuse and dependency, in one form or another, is a highly prevalent phenomenon in the general populace, so it should come as no surprise to us that we physicians are not immune.

Intellect, knowledge, vocation, dedication offer us no reprieve from biologic forces. Heredity is now seen as the strongest predictor of addiction risk, while drug availability may influence what is to become the drug of choice. As the article illustrated, unique opportunity exists for medical personnel to misappropriate controlled substances and conceal their actions.

Disciplining, reporting, monitoring, and/or terminating impaired physicians ranks among the most onerous duties I have faced as a physician executive. It is an essential duty, nonetheless. Today, with the advent of pharmacologic agents which effectively diminish drug or alcohol craving, the prospect for successful treatment programming is quite noteworthy. Thus, detection and confrontation is the critical first step to securing a career-saving and perhaps even life-saving course of treatment for physicians with these conditions.

As noted in the case of Dr. Kevin, pathological drinking can also represent a form of self-treatment for an underlying psychiatric disorder. I have met many patients in similar straits: their lives ravaged by the effects of alcohol abuse as they desperately attempt to mask the symptoms of undiagnosed but lifelong social anxiety. Likewise for post-traumatic stress and depression.

A general reluctance to acknowledge and constructively address psychiatric illness among our own ranks no doubt fuels the occurrence of substance abuse, disruptive behaviors, interpersonal conflict, poor performance and career dissatisfaction. It's no wonder physicians are at increased risk for suicide.

Physicians, heal thy profession by resisting society's stigma toward mental illness, by facilitating an evidence-based, treatment-oriented response to addiction, and by advocating for parity in insurance coverage for all serious disorders of the brain including mental illness and addiction.

Steven P. Kouris, DO, MPH, MS, CPE, FAPA

Rockford, Ill.