Berks County Medical Society Medical Record Summer 2018 - 16

m E d i C a l r E C o r d F E at u r E

The Most
Difficult Question:
How to Approach a
Fellow Physician
You Suspect
of Substance Abuse
by Larry Rotenberg, MD

G

iving advice is tough. Giving advice when it is not asked
for is tougher. And so, if you have a friend, a colleague, or
a family member who shows manifestations of substance
abuse, what do you do?
You first assess the situation by asking yourself the following:
* Is my colleague missing a lot of work for no legitimate reason?
* Is he often absent the day after a holiday and weekends?
* Is she becoming sloppy in personal appearance?
* Is he becoming careless about his clinical notes?
* Is her speech slurred?
* Does he smell of alcohol and such?
We can obviously go on to many other signs and symptoms, but
by now everyone gets the picture.
What to do? Most people do nothing, as that seems the best
way to avoid conflict. But that is a short-term gain for a long-term
loss. Once again, you have to ask yourself some hard questions
such as:
* What is my relationship to this person?
* How much do I care about him?
* How will my approach affect my relationship?
* If it is a colleague, how does his behavior affect our common
patients? How does her behavior affect our exposure to
liability?

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In other words, the cost of silence may well be greater than the
cost of speaking out. And so, the risk/benefit ratio favors speaking
out. If you agree, do the following:
* Meet your colleague in a private place
* Express your concerns directly and unequivocally
* Share all the evidence
* Spare nothing
* Express your passionate and urgent and-if possible-specific
recommendations for obtaining help
If that works, great. But often, rationalization, minimization,
and denial ensue. What next? If you are close to the colleague's
family, get them to intervene. But families themselves often act as
enablers. So a final step is to report her to the hospital or to the
state Physicians' Health Program.
While this last option sounds draconian, it is actually an act of
kindness. During my many years as Chair of the PHP at Reading
Hospital, I had to report people from time to time. While they
were initially resentful, once they got into treatment and achieved
sobriety they were extremely grateful.
There is no magic solution to this complex problem. Each
case has to be handled with delicacy and sensitivity, but also
with firmness and determination. There is too much to lose by
remaining silent.


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Berks County Medical Society Medical Record Summer 2018

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