Jack D. McCue

Alcohol and Other Substance Abuse and Impairment among Physicians in Residency Training

Substance abuse and impairment are serious societal problems. Physicians have historically had high rates of substance abuse, which has been viewed as an occupational hazard. Most authorities agree that the rate of alcoholism among practicing physicians is similar to that among control populations and that the rates of other substance abuse are greater, although some studies have shown no difference. Data about substance abuse among residents in training are limited but suggest that the use of benzodiazopines is greater than that among age-matched peers, whereas the use of alcohol is similar between the two groups. Medical institutions, including those with teaching programs, have legal and ethical responsibilities concerning substance abuse among current and future physicians. Many training programs, however, do not provide educational programs on this subject, do not have faculty trained in substance abuse medicine, and do not have a formal system to address the problem of residents who are suspected or known to be substance abusers. This position paper examines the extent of substance abuse, including alcohol abuse, among physicians in residency training. It outlines approaches to the problem and delineates responsibilities of institutions and residency program directors. Recommendations are made to establish an informational program and a clearly defined, organized process to address the problems of substance abuse among residents. Careful and humane approaches can be used to identify and treat residents with substance abuse problems and thus allowing them to complete their training as competent and drug-free professionals.

Adverse Events, Stress and Litigation: A Physician's Guide

Charles SC, Frisch PR. 288 pages. New York: Oxford Univ Pr; 2005.

Stress in Medical Residency: Status Quo after a Decade of Reform?

39.95. ISBN 0195171489. Order at www.oup.com. Field of medicine: Any clinical or administrative discipline that may encounter malpractice litigation. Format: Hardcover book. Audience: Clinicians who have been sued or are at risk for malpractice lawsuits. Voyeurs, administrators, and lawyers might be interested. Nervous physicians, as the title implies, are the books main target. Purpose: To be a resource for all physicians visited by bad outcomes in patient care, events fraught with stress that is often sharpened to an almost unbearable degree for all parties by subsequent litigation. Content: The usual sequence from an adverse event to trial or settlement forms the backbone of the book. The book focuses on describing the emotional responses of physicians to the hostile, alien worlds of the malpractice attorney, litigation, and the tort system of law. The book describes the reactions of physicians to being sued for malpractice through often-engaging case histories and anecdotes. The special contribution, intended to be advice on how one can cope with self-doubt, rage, and depression, which can potentially ruin personal and professional lives, is in the middle of the book. Highlights: The book provides tired but perhaps helpful advice on how to cope with stress in general. There are useful descriptions and advice on depositions and discovery, and some tantalizing insights into the conflicting worlds of the physician and the malpractice attorney. Limitations: Depth of discourse varies from the superficial and vain to quite interesting observations on a topic of powerful emotional and practical importance to physicians. The book is oddly organized and is often stiffly written. The authors have included celebrity interviews (Saul Bellow, Norman Mailer, and Mike Wallace) that have nothing to do (remotely) with medical malpractice. These lend a silly, self-absorbed air to the discussion of a serious topic and undermine the good sections of the book. Related readings: About 10 currently available books in the popular press deal with medical malpractice, such as Andersons Medical Malpractice: A Physicians Sourcebook (Humana Pr, 2004) or Dodge and Fitzers When Good Doctors Get Sued: A Practical Guide for Physicians Involved in Malpractice Lawsuits (BookPartners, 2001). A brief skimming suggests that the latter may be a better choice than Charles and Frischs book. Reviewer: Jack D. McCue, MD, Franklin Square Hospital Center, Baltimore, Maryland.