Doctors, Ethics and Drug Abuse

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imagesA new post in Medscape raises the question of whether doctors should be subject to random drug testing.

 

Facts:

  • Between 10% and 15% of doctors in the US have “a drug abuse disorder.”(2) That rate is said to be higher than in the US population overall.
  • Drug testing is not entirely accurate. Out of every 100 people tested, up to 10 will show as users who are not and up to 15 will show as clean who are not.

Given high incomes and the relatively easy access to drugs, the idea that some physicians abuse drugs shouldn’t come as a surprise.  Opportunity creates temptation.

  • 22% of doctors gave a maybe or negative response to whether they would rat on a colleague whom they knew to be abusing drugs in a 2016 survey on ethics.(3)

When your employer asked you to take a drug test, did he tell you about the measurement error issue? That’s why when a test shows positive, retesting is required.  One error could be due to a poppy seed bagel. Errors of both of two independent tests are unlikely.

The abuse isue links with the question about whether “problem doctors” should be outed. Do consumers have a right to know if a doctor is incompetent, or has a history of carelessness or abuse?

In the ethics survey, half of doctors said they might not or would not warn a patient about another doctor they considered to have “substandard capability.”

  • The question was: “Would you warn a patient if you knew they were going to have a procedure performed by a doctor with a substandard ability in that procedure?”
  • 51% said they would warn the patient, 15% said they would not, and the remainder said “It depends.”

What do consumers have a right to know?

What do you think?


Sources:

  1. Arthur L. Caplan, PhD; Cheryl Karcher, MD, MS; and Craig M. Klugman, PhD, “Should Physicians Be Subject to Random Drug Testing?” Medscape, 28 February 2017. http://www.medscape.com/viewarticle/875544?nlid=113252_1521&src=WNL_mdplsfeat_170307_mscpedit_wir&uac=153634BV&spon=17&impID=1303674&faf=1#vp_1
  2. Oreskovich MR, Kaups KL, Balch CM, et al. Prevalence of alcohol use disorders among American surgeons. Archs Surg. 2012;147:168-174.
  3. Reese S. Medscape Ethics Report 2016: Money, Romance, and Patients. December 1, 2016. http://www.medscape.com/features/slideshow/ethics2016-part1 Accessed February 5, 2017.
  4. Society for Human Resource Management. SHRM Poll: Drug Testing Efficacy. September 7, 2011. https://www.shrm.org/hr-today/trends-and-forecasting/research-and-surveys/pages/ldrugtestingefficacy.aspx Accessed February 5, 2017.
  5. Booth JV, Grossman D, Moore J et al. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesth Analg. 2002;95:1024-1030.
  6. Skipper GE, Campbell MD, DuPont RL. Anesthesiologistswith substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesth Analg. 2009;109:891-896.
  7. Oosting J. Michigan welfare drug screening program nets zero hits. The Detroit News. December 2, 2016. http://www.detroitnews.com/story/news/local/michigan/2016/12/02/welfare-drug-screening/94826672/ Accessed February 5, 2017.
  8. Covert B. Utah spent more than $30,000 to catch 12 drug users on welfare. ThinkProgress. August 27, 2013. https://thinkprogress.org/utah-spent-more-than-30-000-to-catch-12-drug-users-on-welfare-37bacc67bbbe#.icc00h1b6 Accessed February 5, 2017.
  9. Smith D, et al. An update on testing for drugs of abuse: Scientific background and practical clinical concerns. Program and abstracts of the 2010 Annual Meeting of the American Psychiatric Association; May 22-26, 2010; New Orleans, Louisiana. Abstract NR7-05.

 

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