Physician Health

Doctors experience a range of extraordinary personal and professional stresses from the
beginning of medical training until the end of their careers. They may also suffer from
the same emotional and psychiatric disorders that affect anyone else. These include
addictive disorders of all kinds, conditions that can predispose to drug and alcohol
problems such as burnout, and psychiatric problems such as mood or anxiety disorders
that frequently occur co-morbidly with substance use disorders.

There is some evidence that those predisposed to suffering problems like these may,
in fact, choose medicine as a career. This may result in even greater risk that a doctor
will experience addictive disorders or other mental or emotional illnesses in his or her
professional lifetime. Medical education, in and of itself, tends not to teach or support
appropriate self-care skills amongst its trainees.

Unlike others in the general population, doctors are often less able to access the
health care system for their own use for a variety of reasons. Doctors suffering from
substance use disorders still often feel ashamed. Fearful of stigma and loss of reputation,
they are reluctant to ask for help. Trainees fear that their careers in medicine will not
advance if their personal problems become known. Those already in practice are afraid
of loss of licence and livelihood. Medical training, so far, has done little to reduce the
stigma associated with these disorders.

Denial of the presence of an addictive disorder at the personal, family, collegial,
institutional and societal levels is also frequent and widespread. For these reasons
and others, a doctor's illness can advance into its later stages
before it is addressed in some way.

Progress towards addressing these problems has been made in a number of
countries including the United States, Canada and Australia. Beginning in the 1970s,
the particular needs of doctors and treatment strategies designed to meet those needs
have been developed and refined. In recognition of the need for aftercare, monitoring and
advocacy for doctors in recovery, physician health programs were developed in a variety
of jurisdictions. These programs also represent a safe place for a suffering doctor to seek
help on a confidential basis. Physician health programs have been able to demonstrate
high success rates, most reporting sustained abstinence rates amongst monitored
participants exceeding 90%.

Comprehensive physician health programs also engage in prevention and health promotion
activities in the medical profession, as well as research into physician health concerns.
Vital physician health programs not only seek to improve the health of doctors and their families,
but, working collaboratively with regulatory agencies, medical societies and others,
simultaneously preserve and enhance public protection.

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ISAM Position

1. The medical profession worldwide accept a duty to identify and assist doctors
suffering from addictive disorders of all kinds including drug and alcohol dependence,
behavioural addictions and other mental or emotional illnesses.

2. Medical training should include education about disorders that can cause impairment
|in doctors and how to recognize, respond and even prevent them.

3. Specialized, confidential evaluation and treatment services should be made promptly
accessible to doctors in every country.

4. Doctor's health programs should be studied and developed worldwide in concert with
appropriate professional bodies, medical societies and relevant regulatory agencies.
These programs might offer services such as advice, education, personal/family support,
intervention, continuing case management after treatment, recovery monitoring and advocacy.

5. Support services such as these should be made available to doctors from the
beginning of medical education through retirement.

6. A doctor's addictive disorder has a unique impact upon the health of his
or her marriage and family. Expert clinical services designed to facilitate family
recovery should also be made available.

7. There is a need for continuing research into the field of doctor's health.

8. It is important for individual clinicians and programs everywhere to network effectively for
the benefit of recovering health care providers, the patients they serve and society as a whole.

9. Sustained effort should be made to reduce the stigma associated with these problems,
normalize the doctor's experience of mental and emotional illness, including addictive disorders,
that will result in a positive impact on the culture of medicine throughout the world.

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