Doctors Advocate for Doctor Drug and Alcohol Testing

Some professions require all job candidates to pass drug tests, and some employers subject employees to random testing. Three physicians have written a medical journal article, “Identification of Physician Impairment,” advocating that hospitals also randomly test physicians for drug and alcohol use.

Writing in the Journal of the American Medical Association (JAMA), Julius Cuong Pham, an emergency medicine physician at Johns Hopkins Hospital, Peter J. Pronovost, director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality, and Gregory E. Skipper, director of professionals health services at Promises Treatment Centers in Southern California, say such routine scrutiny would improve patient safety across all medical specialties.

Unlike plane crash and nuclear accident investigations, “Mandatory alcohol-drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine,” they write. (“Sentinel” events are those resulting in death or serious physical harm.) “Yet alcohol, narcotic and sedative addiction is as common among physicians as the general population, and physicians are as susceptible to the effects of prescription and nonprescription drugs and alcohol as any other person.”

They refer to a 2006 article in the Annals of Internal Medicine that said at least 1 in 3 physicians will experience a condition that impairs their ability to practice medicine safely. Add to that the evidence that 1 in 3 patients admitted to a hospital experiences a medical error, and “physician impairment seems to be a possible contributor to patient harm.”

The doctors have five specific recommendations:

1. Mandatory physical examination, drug testing or both should be considered before a candidate receives a medical staff appointment. Some hospitals already do this.

2. Implement a program of random alcohol and drug testing. This is required of most federal employees, has been implemented successfully in several medical settings and has decreased illicit drug use in the military.

3. Test physicians who have been involved with a sentinel event leading to patient death for drug and alcohol use.

4. Establish a national hospital regulatory/accrediting body to set consistent testing standards for all states. (The authors note that the Joint Commission, a nonprofit organization that accredits and certifies medical facilities, has standards now for hospitals to identify and manage physician health that might be augmented to accommodate a drug and alcohol testing program.)

5. Limit the testing model to hospitals and their affiliated physicians. Hospitals have the infrastructure to conduct adverse event analysis and drug testing, and have bylaws for physician conduct.

If a physician is tested and found to be impaired, the hospital could suspend or revoke his or her privileges. Depending on the circumstances, the person also could be reported to the state licensing board.

But the point is not simply punitive-the writers, after all, are healers, and just as they would for any other person with addiction problems, they want to subject impaired physicians to a treatment program. Routine monitoring would be a condition of restoring or maintaining their licensure and hospital privileges.

The JAMA article is common sense and promotes basic professionalism. That its authors come directly from the community it affects boosts its credibility. As they write, “Patients and their family members have a right to be protected from impaired physicians. In other high-risk industries, this right is supported by regulations and surveillance. Shouldn’t medicine be the same? A robust system to identify impaired physicians may enhance the professionalism that peer review seeks to protect.”

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