In our Journal of Addiction Medicine piece just published (which you can access here), co-author John R. Knight MD and myself discuss ethical and managerial considerations regarding state physician health programs (PHPs). These are programs that work with physicians who have various kinds of health related issues, including substance use disorders and mental health issues. As we note, “For most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine.” As we note, the fact that they have high success rates does not obviate the need for scrutiny of PHPs and does not excuse abusive practices when they exist. Such an argument is a weak utilitarian argument. Separately, to argue by analogy to airline pilots does nothing to alter the facts that some PHP practices are abusive and ethically indefensible. (See http://www.asam.org/publications/president’s-blog/asam-president’s-blog/2012/10/16/how-to-achieve-an-80-percent-recovery-rate)
What are some examples?
For one, as we point out in our essay, some PHPs report physicians for positive test results when the PHP knows that these test results do not indicate relapse or ANY problematic behavior by physicians. What’s the big deal? Well, getting reported to one’s board of medicine is almost uniformly terrifying and can require retaining legal help to address the issue, coming out of practice while the “false positive” test is being investigated, and significant psychological distress. One physician told me that one of these days a physician is going to commit suicide after one of these reports.
In addition, as we point out in our piece, PHPs often have complicated, financially intertwined relationships with the programs they send physicians to for evaluation and treatment. And these are just a couple of the problematic issues about PHPs.
As we conclude in our Journal of Addiction Medicine piece, “Since PHP practices are unknown to most physicians prior to becoming a client of the PHP, many PHPs operate outside the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are therefore not in a position to voice what might be legitimate objections to a PHP’s practices.” Because of this, to argue as some have that we can just let the legal system deal with any potential abuses of PHPs is either naïve or an attempt to allow some unethical practices to continue without scrutiny. We conclude our piece by recommending that the broader medical community begin to reassess PHPs.
The time for action is upon us.