The Impaired Anesthesiologist: Where Do We Draw the Line? more

Journal of Clinical Anesthesia (2010) 22, 311–312 Editorial The impaired anesthesiologist: where do we draw the line? In this issue of the Journal of Clinical Anesthesia, the article, “The impaired anesthesiologist: not just about drugs and alcohol anymore, “[1] by Drs. Rose and Brown presents a thoughtful discussion of the potential for impairment of anesthesia personnel as a result of depression. This subject strikes at the very heart of our profession, for the hallmark of the anesthesiologist is vigilance, and any disease, disorder, or circumstance that reduces the capacity for vigilance deserves attention. Since depression often does not exist as an isolated entity, a more in-depth discussion of the other affective disorders alluded to in the summary statement would have broadened the applicability of this review. The authors correctly point out that it is difficult to separate substance abuse from other forms of psychiatric impairment (many patients with depression either exhibit this symptom as a result of substance abuse or they abuse substances as a form of selfmedication) and they have appropriately touched on this subject as well. The traditional approach of the medical community to the impaired physician is to remove that physician from any situation in which they could potentially harm patients or themselves. In the case of the drug-abusing anesthesiologist, there is a specific and very well defined course of action that needs to be followed [2]. This typically involves removing the physician from clinical practice during inpatient treatment, and allowing him or her to return to clinical practice in a monitored setting. Few may realize that this course of action also applies to the anesthesiologist who is impaired for some other reason, such as psychiatric illness. Each state medical society sponsors a physician health program (and each state nursing society sponsors an equivalent nursing health program) staffed with individuals trained in the diagnosis and treatment of the impaired health care provider. While it is true that the majority of medical professionals referred for treatment to these programs are treated for substance abuse, this majority is also treated for co-existing psychiatric disease, and a small number are treated for psychiatric disease without co-existing substance abuse disorder. Because referral to such organizations often results in mandated time away from clinical duties and 0952-8180/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jclinane.2010.02.004 loss of personal income for the provider, colleagues may be hesitant to report an individual whom they suspect may have a problem. I agree with the statement that the “impaired anesthesiologist” has a much broader definition than simply the “addicted anesthesiologist”, but if we are to expand the definition of impairment, then where do we draw the line? Certainly the degree of vigilance provided by the physician who is diverting anesthetic agents for personal use is less than one who is not, and perhaps the physician with untreated depression is as well, but what of the anesthesiologist who is going through a divorce, having an affair, having an argument with a colleague, or undergoing any other any life stress? There are myriad distractions in our personal lives that have the potential to interfere with our ability to remain vigilant throughout the day. Yet, as anesthesiologists, we are trained to push these thoughts and emotions into our subconscious so that we may focus on the task at hand. Anesthesia can be a very isolating specialty, especially for those in private practice where there may be only brief contact with other anesthesiologists throughout the day. Even in academic practice, where much time is devoted to teaching, and contact with residents and other attending colleagues may be greater, it is still possible for the depressed individual to remain unnoticed by others. Perhaps this isolation, magnified by the necessity that we put patient management concerns ahead of our own, contributes to the development of depression or other illnesses. This article closes with the suggestion that yearly screening for depression in anesthesia residency programs should be mandatory. While it is important to be able to identify and treat all of the possible illnesses we may suffer, I find it hard to believe that such action could be implemented when we still have not made random screening for substance abuse mandatory across all programs. The authors compare screening for, and treatment of, depression to that of coronary artery disease and diabetes. Currently, however, our society accepts the treatment of medical issues as appropriate and allows providers to continue to practice while in treatment; this is often not the case for physicians with a psychiatric 312 diagnosis. As well, the stigma attached to the diagnosis of psychiatric disorder and the need to undergo treatment presents a real barrier to referral for practicing anesthesiologists. Denial that a colleague may have a psychiatric illness or substance abuse problem, masked by concern that the referral for treatment may not be appropriate and may cause unnecessary problems for their co-worker, could potentially lead to patient or provider harm. If we are to provide for ourselves and each other the same excellent quality of care that we provide for our patients, we must move beyond this antiquated notion that psychiatric illness is somehow different and confront these issues without reservation. Editorial Ethan O. Bryson MD (Assistant Professor of Anesthesiology) Department of Anesthesiology Mount Sinai School of Medicine New York, NY 10029-6574, USA E-mail address: ethan.bryson@msnyuhealth.org References [1] Rose GL, Brown RE. The impaired anesthesiologist: not just about drugs and alcohol anymore. J Clin Anesth 2010;22:379-84. [2] Bryson EO, Silverstein JH. Addiction and substance abuse in anesthesiology. Anesthesiology 2008;109:905-17.