While drug and alcohol testing as a condition of employment is common among physicians applying for hospital-based positions, there are increasing calls for expanding hospital quality-control programs to include screening for substance abuse impairment through random testing and following sentinel events leading to a patient’s death. Expanding substance abuse testing of physicians will bring the medical profession better in line with other high-risk industries like the airlines, railways, and nuclear power, according to an article published online ahead of print April 29 in the Journal of the American Medical Association (JAMA). Data do not exist showing impaired physicians are actually harming patients. But there is recognition that alcohol, narcotic, and sedative addiction is as common among physicians as the general population and that medical errors are common in hospitals. “In states without proactive [physician health] programs, it seems, by default, that patient harm has to occur before a review process occurs,” write the authors, led by Julius Pham, M.D., Ph.D., from Johns Hopkins University in Baltimore. Self-monitoring, rather than external regulation, has been the norm in ensuring physician professionalism. But the authors of the JAMA article say that expansion of physician health program oversight coupled with hospital-level implementation might provide […]
While drug and alcohol testing as a condition of employment is common among physicians applying for hospital-based positions, there are increasing calls for expanding hospital quality-control programs to include screening for substance abuse impairment through random testing and following sentinel events leading to a patient’s death.
Expanding substance abuse testing of physicians will bring the medical profession better in line with other high-risk industries like the airlines, railways, and nuclear power, according to an article published online ahead of print April 29 in the Journal of the American Medical Association (JAMA). Data do not exist showing impaired physicians are actually harming patients. But there is recognition that alcohol, narcotic, and sedative addiction is as common among physicians as the general population and that medical errors are common in hospitals.
“In states without proactive [physician health] programs, it seems, by default, that patient harm has to occur before a review process occurs,” write the authors, led by Julius Pham, M.D., Ph.D., from Johns Hopkins University in Baltimore.
Self-monitoring, rather than external regulation, has been the norm in ensuring physician professionalism. But the authors of the JAMA article say that expansion of physician health program oversight coupled with hospital-level implementation might provide a foundation for physician impairment regulation. Components of such a model, they say, might include mandatory physical examination or drug testing or both before a hospital medical staff appointment, random alcohol and drug testing as is done for federal employees and the military, routine drug and alcohol testing for all physicians involved with a sentinel event leading to patient death, and potential expansion of the Joint Commission’s current physician health standards so that a national regulatory or accrediting body could maintain consistent standards across states including protections such as confirmatory testing and confidentiality, as implemented by the Federal Aviation Administration program, which may aid in protecting professional reputations in the case of false negatives.
“The need to detect and prevent physician impairment must be balanced with the rights of privacy and autonomy,” writes Pham. “In other high-risk industries, this right [to be protected from impairment] is supported by regulations and surveillance. Shouldn’t medicine be the same?”
Sidebar: California Voters May Decide on Drug Testing for Physicians
A California state ballot measure that would require doctors to be randomly subjected to drug and alcohol testing is being proposed by Bob Pack, a technology executive. The San Francisco Chronicle reports the campaign already has $2 million as supporters ramp up efforts this summer for a potential November 2014 ballot initiative. The California Medical Association calls the effort an “ill-fated publicity stunt” as the measure may also call for lifting the cap on damages in medical malpractice cases.
