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Jullian B, Deltour M, Franchitto N. The consumption of psychoactive substances among French physicians: how do they perceive the creation of a dedicated healthcare system? Front Psychiatry 2023; 14:1249434. [PMID: 38156325 PMCID: PMC10752955 DOI: 10.3389/fpsyt.2023.1249434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Substance use among physicians can have negative impacts on their health, quality of life, and patient care. While Physician Health Programs (PHPs) have proven effective, many physicians with substance use disorders (SUDs) still face obstacles in seeking help. Our study explores the expectations, attitudes, and experiences of French physicians regarding the implementation of a specialized healthcare system (SHS) for addiction, and their opinions on the factors that could improve the effectiveness of such a service, with a focus on substance use disorders (SUDs). Methods We conducted a web-based survey from April 15 to July 15, 2021, which included questions about sociodemographic characteristics, substance use, and attitudes toward a specialized healthcare system (SHS) for physicians with SUDs. Results Of the 1,093 respondents (62.5% female), 921 consumed alcohol (84.2%), and 336 (36.4%) were categorized as hazardous drinkers (AUDIT-C ≥ 4 for women and ≥ 5 for men). The mean AUDIT-C score was 3.5 (±1.7 SD), with a range from 1 to 12. Factors associated with hazardous alcohol consumption included coffee consumption [OR 1.53 (1.11-2.12)], psychotropic drug use [OR 1.61 (1.14-2.26)], cannabis use [OR 2.96 (1.58-5.55)], and other drug use [OR 5.25 (1.92-14.35)]. On the other hand, having children was associated with non-hazardous alcohol consumption [OR 0.62 (0.46-0.83)]. Only 27 physicians (2.9%) had consulted a specialist in addiction medicine, while 520 (56.4%) expressed interest in such a consultation. The main barriers to accessing a dedicated consultation were denial (16.3%), physician self-medication (14.3%), fear of judgment (12.8%), and confidentiality concerns (10.2%). Conclusion A specialized consultation with trained professionals in a neutral location can improve access to care for healthcare workers and maintain patient confidentiality and anonymity. Prevention and awareness can reduce addiction stigma and help peers in need. The improvement of healthcare workers' addiction culture and detection of addictive behavior in peers depends on academic addiction medicine.
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Affiliation(s)
- Bénédicte Jullian
- Centre Hospitalier de Toulouse-Purpan, Service d’Addictologie Universitaire, Toulouse, France
| | - Marine Deltour
- Centre Hospitalier de Toulouse-Purpan, Service d’Addictologie Universitaire, Toulouse, France
| | - Nicolas Franchitto
- Centre Hospitalier de Toulouse-Purpan, Service d’Addictologie Universitaire, Toulouse, France
- CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
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Zador L, Nowak K, Sitarik A, MacLean L, Han X, Kalsi M, Yeldo N, Sibai N, Penning D, Lewis M. The Burnout Epidemic Within A Viral Pandemic: Impact of a Wellness Initiative. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2022; 27:100251. [PMID: 35382030 PMCID: PMC8970611 DOI: 10.1016/j.pcorm.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
Background Anesthesiologists are at high risk of developing burnout, a condition which can lead to many deleterious effects for the physician, and far-reaching effects on their patients and hospital systems. The COVID-19 pandemic has presented new challenges that have further exacerbated the risk of burnout in anesthesiologists. It is critical to develop effective strategies to promote well-being and decrease burnout for physicians in this specialty. The purpose of this observational study was to evaluate the impact of a Physician Well-Being Initiative on distress and well-being in anesthesiologists. It was hypothesized that the wellness intervention would promote an improvement in well-being scores. Methods The Physician Well-Being Initiative was launched in August 2019 in the Department of Anesthesiology, Pain Management and Perioperative Medicine at Henry Ford Hospital in Detroit, Michigan. The Physician Well-Being Initiative was designed to address several of the key factors that improve physician wellness, including 1) a sense of autonomy; 2) positive view of leadership; and 3) flexible schedule opportunities. To assess the impact of the Physician Well-Being Initiative on the well-being and distress scores of participating anesthesiologists, the physicians were emailed the validated Well-Being Index survey at baseline and 3, 6 and 12 months. The Well-Being Index evaluates multiple items of distress in the healthcare setting. The sample size was limited to the 54 anesthesiologists at Henry Ford Hospital. Results Forty-four of the 54 anesthesiologists completed the baseline questionnaire. A total of 44 physicians answered the questionnaire at baseline, with more male than female physicians (35 males and 7 females) and the majority (17/44) in practice for 5-10 years. Thirty-two physicians completed the survey at 3 and 6 months, and 31 physicians at 12 months after the launch of the Physician Well-Being Initiative. Twenty-one physicians completed the questionnaire at all 4 time points. Although the COVID-19 pandemic started shortly after the 6-month surveys were submitted, results indicated that there was a 0.05 decrease in the Well-Being Index sum score for every 1-month of time (coefficient -0.05, 95% CI -0.01, -0.08, P = 0.013). This study shows that, with the wellness initiative in place, the department was able to maintain and potentially even reduce physician distress despite the concurrent onset of the pandemic. Conclusions Following the launch of a sustained wellness initiative, this study demonstrates that physician wellness improved with time. This suggests that it takes time for a wellness initiative to have an effect on well-being and distress in anesthesiologists.
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Affiliation(s)
- Lara Zador
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Katherine Nowak
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Alexandra Sitarik
- Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, Michigan 48202
| | - Lisa MacLean
- Department of Psychiatry, Henry Ford Health System, 1 Ford Place, Detroit, Michigan 48202
| | - Xiaoxia Han
- Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, Michigan 48202
| | - Mandip Kalsi
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York City, New York 10021
| | - Nicholas Yeldo
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Nabil Sibai
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Donald Penning
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Michael Lewis
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
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Mitigating burnout and enhancing wellness in anesthesiologists: individual interventions, wellness programs, and peer support. Int Anesthesiol Clin 2021; 59:73-80. [PMID: 34320571 DOI: 10.1097/aia.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Role of Alcohol Biomarkers in Detecting a Physician's COVID-19-Related Acute Stress Response: A Case Report. J Addict Med 2021; 16:e62-e65. [PMID: 33941756 PMCID: PMC8815638 DOI: 10.1097/adm.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Alcohol biomarkers are used to detect alcohol exposure in clinical and forensic settings. This includes professional health program (PHP) monitoring of healthcare workers in recovery from substance use disorders. Here we present the case of a physician whose positive alcohol biomarker test result was complicated by a traumatic stress response to frontline work during COVID-19. METHODS An anesthesiologist under PHP monitoring for substance use disorder and depression was interviewed extensively, urine and blood biomarkers were obtained, and longitudinal structured and semi-structured interviews related to anxiety, depression, posttraumatic stress, and cravings were used to monitor responses to the unanticipated death of a patient who succumbed to COVID-19. RESULTS After an initial positive ethylglucuronide (EtG) and ethylsulfate (EtS) toxicology test result, all subsequent testing was negative. Standardized assessments and clinical interviews provided documentation of a post-traumatic stress reaction. The physician described compulsive sanitizing of hands/arms and mask with highly concentrated ethanol-based products. CONCLUSIONS Inhalation of ethanol vapors is a possible explanation for the initial positive EtG/EtS results. To our knowledge, this case represents the highest reported levels of EtG/EtS likely due to workplace exposure. The importance of rapid intervention to thoroughly assess positive toxicology testing and its source(s) cannot be overstated, particularly as it relates to frontline healthcare workers during the pandemic. The PHP monitoring process provides an opportunity to promptly detect healthcare workers in distress, allowing for efficient connection to supportive resources and/or treatment when indicated, and possibly preventing escalation of symptoms or disease recurrence.
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Geuijen P, de Rond M, Kuppens J, Atsma F, Schene A, de Haan H, de Jong C, Schellekens A. Physicians' norms and attitudes towards substance use in colleague physicians: A cross-sectional survey in the Netherlands. PLoS One 2020; 15:e0231084. [PMID: 32243472 PMCID: PMC7122818 DOI: 10.1371/journal.pone.0231084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Substance use disorders (SUD) in physicians often remain concealed for a long time. Peer monitoring and open discussions with colleagues are essential for identifying SUD. However, physicians often feel uncomfortable discussing substance use with a colleague. We explored physicians' attitudes and norms about substance use (disorders) and their (intended) approach upon a presumption of substance use in a colleague. MATERIALS AND METHODS An online cross-sectional survey concerning "Addiction in physicians" was administered by the Royal Dutch Medical Association physician panel. Overall, 1685 physicians (47%) responded. Data were analyzed by logistic regression to explore factors associated with taking action upon a substance use presumption. RESULTS Most physicians agreed that SUD can happen to anyone (67%), is not a sign of weakness (78%) and that it is a disease that can be treated (83%). Substance use in a working context was perceived as unacceptable (alcohol at work: 99%, alcohol during a standby duty: 91%, alcohol in the eight hours before work: 77%, and illicit drugs in the eight hours before work: 97%). Almost all respondents (97%) intend to act upon a substance use presumption in a colleague. Of the 29% who ever had this presumption, 65% took actual action. Actual action was associated with male gender and older age (OR = 1.81; 95% CI = 1.20-2.74 and OR = 1.03; 95% CI = 1.01-1.05, respectively). CONCLUSIONS About one-third of physicians reported experience with a presumption of substance use in a colleague. Whilst most physicians intend to take action upon such a presumption, two-thirds actually do act upon a presumption. To bridge this intention-behavior gap continued medical education on signs and symptoms of SUD and instructions on how to enter a supportive dialogue with a colleague about personal issues, may enhance physicians' knowledge, confidence, and ethical responsibility to act upon a presumption of substance use or other concerns in a colleague.
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Affiliation(s)
- Pauline Geuijen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Physician Health Program ABS-doctors, Royal Dutch Medical Association (RDMA), Utrecht, the Netherlands
- * E-mail:
| | - Marlies de Rond
- Physician Health Program ABS-doctors, Royal Dutch Medical Association (RDMA), Utrecht, the Netherlands
| | - Joanneke Kuppens
- Physician Health Program ABS-doctors, Royal Dutch Medical Association (RDMA), Utrecht, the Netherlands
| | - Femke Atsma
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Aart Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hein de Haan
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Tactus Addiction Treatment, Deventer, the Netherlands
| | - Cornelis de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
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Bickham P, Golembiewski J, Meyer T, Murray CG, Wagner D. ASHP guidelines on perioperative pharmacy services. Am J Health Syst Pharm 2019; 76:903-820. [DOI: 10.1093/ajhp/zxz073] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Peggy Bickham
- University of Illinois Hospital and Health Sciences System, Hospital Pharmacy Services, Chicago, IL
| | - Julie Golembiewski
- University of Illinois at Chicago College of Pharmacy, Department of Pharmacy Practice, UI Health, Hospital Pharmacy and Anesthesiology, Chicago, IL
| | - Tricia Meyer
- Baylor Scott & White Medical Center–Temple, Texas A&M College of Medicine, Temple, TX
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Shafer SL. Carfentanil: a weapon of mass destruction. Can J Anaesth 2019; 66:351-355. [DOI: 10.1007/s12630-019-01295-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022] Open
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