I received this question without any additional details and it’s perfectly understandable, but it would’ve helped to know a few details.
My first question would be to what?
All of us are addicted to something. Some to coffee, mobile phones, the internet, exercise, and then the usual bad guys drugs, cigarettes and alcohol. An ugly one is also prescription medication. You’ve perhaps seen this in college, especially if you lived in a hostel/dorm. Somebody gets dumped and before you know it, they’re off the road. Or they’re trying and experimenting stuff and they need intervention.
What’s unusual is to find these guys in actual practice. Because by the time we’re in practice we’ve usually sorted our own baggage so as to not let it get in the way. But there are a few that succumb.
1.What is the addiction and how does it affect your colleague’s functioning?
Now if you were answering the boards, the answer to this would be: report it to the medical board and the doctor loses his license, your job is done. In a selfish world, that would be great, but if you’re a doctor that truly cares, I suggest you do more. Why should you do more, because as leaders in society we should be able to identify and prevent another doctor like Greg Miday from taking his life due to his addictions. To know more about the wonderful Dr Miday, go here.
2. What’s the Level of impairment with addiction?
Is your colleague drunk while operating? Is he frittering away money from the till on the races? Is he putting patients or himself at harm? Is he dependent or addicted? There’s a difference. Addiction is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations. Physical dependence is where the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Dependence in and of itself does not constitute addiction, but it often accompanies addiction.
3. Talk it out with him
If you’re answer is yes to the above, then first you need to talk it out. Is there a trigger? Divorce? Family problems? Grief? Can you ask him to re-evaluate his habits and highlight the fact that he is putting patients in danger. If he shows remorse and is willing to seek help, talk to the supervisor at the hospital and do let him know first what you intend to do. Then get him help. Don’t just pass him off to the counselor or recommend meetings.
4. Create a plan
At this point, most will say why should I bother? But we owe it to one another. You’re saving a life, a talented, intelligent life, that has lost his way like most of us sometimes do. Create a plan. At this point, if the supervisor or director is included, it will result in a temporary suspension of license till he can get his act together. That’s a win for all. So create a three month plan.
5. A multi-target approach
Don’t just count on one approach. Use multiple approaches. One on one, group, family, medications, recovery plans. Do them all. You never know which one will benefit him. Don’t just be a bystander. Go with him to a meeting, ring him up and speak to him, follow up on his progress and struggles.
6. Compassion and Care
Many times you will be exasperated. Especially when he says, “Tomorrow, tomorrow I will stop.” But remember to be compassionate. It’s not easy. Walk a mile in their shoes and I don’t mean picking up a similar habit. There are going to be relapses and it’s in those times, you’re most needed as a friend. To show them to rise after a fall.
7. No shaming
Don’t allow your colleague to be bullied or shamed. Guard his privacy like a ninja and do whatever you can so that he feels comfortable being who he is. It turns out that physicians who get help, often excel at rehab. According to health service studies, they succeed at rates of 70% to 80%, which for addiction is astronomically high.
I know the easy answer to this question is report it and forget about it. But like I said before, we’re a small community. We owe it to each other. I leave you with this song. Every time I listen to it makes me cry. Its Brad Paisley and the angelic Alison Krauss singing, ‘Whisky Lullaby.’ It captures the triggers, the downward spiral and the aftermath of an addiction perfectly.