Thursday, April 3, 2008

i went to the dr to get a prescription, i told him little fact and lots of fiction

The pool at our gym is closed for the month, and I've been back to the treadmill for a nice change of pace. I park myself in front of CNN closed caption, listen to my iPod, and page through easy-reading magazines, and the time passes pretty quickly. The result (other than sweating, which I hate) is that I've gotten much closer with Anderson Cooper. Last night, CNN featured a 27-year old, independently-living autistic woman who is tremendously well-spoken in written form but doesn't have spoken language. Really inspiring, though autism still scares the hell out of me.

Earlier this week, I came in midway through a feature on a doctor who is an alcoholic. The topic was whether patients have a right to know if their doctor is an addict/alcoholic or if he/she is in treatment for addiction. From what I could discern, the answer - based on rights to privacy - is no. Patients don't have that right, can't know about prior arrests related to substance issues, aren't told if their doctors are in treatment.

I was SO conflicted about this!

Admittedly, I have no idea what the various state medical boards permit or what privacy they afford the member physicians. I don't know whether doctors have to 'fess up to the board at any time in the licensure process if they are addicts, have ever been arrested for drug/alcohol charges, or are in treatment. Perhaps that is regulated by the board. They were discussing confidential substance abuse treatment programs, and it seemed clear doctors could attend these programs while still practicing. In fact, apparently a full 1% of US doctors are addicts, and these programs have an 80% success rate. The program representatives suggested it would be worse for doctors NOT to be allowed confidentially to enter these programs as they might completely avoid treatment.

Honestly? The first thing that came to mind was The West Wing, where we knew that Leo, the Vice President, and other high-profile government officials were all recovering addicts. And they were allowed to run a country. OK, not real life, I get that. But the point is that there are plenty of highly successful, highly functional addicts whose jobs have a direct impact on others' safety. Kind of like doctors. I fully recognize that many addicts have been sober for decades, and they still are and always will be addicts.

In this climate of surveillance, where privacy rights are being questioned and limited at a frightening rate, I'm loath to suggest that doctors should have their privacy limited any more than anyone else. And as a patient, I suppose I'm free to go to a different doctor if, like some of the people being interviewed, I think I smell alcohol on my doctor's breath. More than once. (Of course, I could also just say, "um, is that alcohol on your breath?" point blank.)

But. I think that the idea that doctors can conceal a current addiction - one for which they are actively being treated and which is clearly a problem they are still battling - is truly frightening. The doctor profiled on CNN had gotten a DUI on his way to an appointment with a patient, and it wasn't that patient's right to know.

So what is the answer? Should (or do, if you happen to know) doctors have to report addictions? treatment? arrests? to the medical board? If they are undergoing treatment, should they have to submit to random drug testing periodically until they have been sober for x amount of time? And then annually, or every other year, after that? Should they have to be tested EVERY TIME they are going to see or operate on patients? Even if the patients don't know, I feel like there's a need for some kind of oversight. And the libertarian in me feels really badly about that. I guess I am getting conservative in my old age, but since having kids, we spend a lot more time with our doctors than ever in the past. I have to wonder how patients are protected, how that protection can simultaneously grant privacy to the doctors, and how much privacy they truly deserve if their actions can have a direct impact on others' lives. Thoughts?


Leah said...

Hmm...that's a tough one, but here's my initial thought. I know of a professional, let's say a therapist, who seems like she's great at her job but can be a little wacky in her own life. I think she is a valuable addition to her community of professionals and it would be a shame if she weren't allowed to do her job because she didn't meet some external standard of sanity.

Perhaps this is too theoretical and doesn't seem related to the addiction/addict situation, but my thinking is that a person's professional strength could very well be his/her personal weakness. And that a personal weakness shouldn't necessarily ban you from doing a job you might otherwise be perfect for.

However, the idea of someone high or drunk performing surgery is definitely scary...not sure how to reconcile that.

aunt money said...

interesting. my off the cuff reaction is that i don't think there's any reason why a dr should need to tell his/her patients that he/she is going through treatment. it doesn't seem to be anyone's business. but i will think about it a bit more!