Programs for treating addiction in doctors pose ethical issues
State physician health programs (PHPs) play a key role in helping doctors with substance abuse problems. But the current PHP system is inconsistent and prone to potential conflicts of interest and ethical issues, according to a review available as publish ahead of print content from the December 2012 issue of Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine.
In the article, Drs J. Wesley Boyd and John R. Knight of Harvard Medical School point out "substantial variability in states' PHP policies and practices, often raising serious ethical and managerial questions." Collectively the authors served as PHP associate directors for more than 20 years; based on that experience they write, "We recommend that the broader medical community begin to reassess PHPs as a whole in an objective and thoughtful manner."
'Coercive' Nature of PHP System Raises Ethical and Managerial Issues
Most states currently have PHPs, which help physicians with substance abuse disorders. State PHPs meet with, assess, and monitor doctors referred for substance abuse or other mental and behavioral health problems. hey also make provisions for follow-up and monitoring of treated physicians, including random drug testing.
The PHP system achieves good results in treating substance abuse disorders in physicians, with much higher success than reported for other groups of patients. However, Drs Boyd and Knight identify several ethical concerns related to the "coercive" nature of the system. They write, "Once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine."
One issue is the high cost of evaluation and treatment. Insurance sometimes does not reimburse physicians for evaluations recommended by PHPs—a cost sometimes exceeding $4,500. If treatment is recommended, the cost may be prohibitive: as high as $39,000 for a "standard" 90-day length of treatment. That's much longer than the 20- to 28-day stay typical for other patients undergoing substance abuse treatment—despite a lack of evidence that health care professionals need longer treatment.
Many centers who provide PHP-recommended evaluations also provide treatment, thus raising the potential for financial incentives for treatment recommendations. Drs Boyd and Knight note that close relationships between treatment centers and state PHPs are "replete with potential conflicts of interest."
The authors also point out problems related to the practice of some PHPs that "any and all" positive test results be reported to the state licensing board—even if they don't indicate substance abuse or relapse. Today's highly sensitive tests can give a positive result even in a person who has used alcohol-based hand sanitizer, as well as some types of asthma inhalers and pain medications. PHPs may instruct doctors to avoid these exposures to simplify interpretation of test results, "rather than what might be in the best interests of the physician."
Use of information about physicians in research by PHPs and their closely intertwined relationships with state licensing boards raise concerns as well. Because most doctors know little about them, PHPs "operate outside the scrutiny of the medical community at large," the authors write. "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."
Drs Boyd and Knight outline recommendations to address the perceived problems. They believe that some form of independent ethical oversight of PHPs should be considered, along with a formal appeals process and a nationwide system for licensing and periodic auditing. They also call on specialty organizations such as the American Society of Addiction Medicine "to review PHP practices and recommend national standards that can be debated by all physicians, not just those who work within PHPs."
Provided by Wolters Kluwer Health
- HCPs in pharmacotherapeutic treatment for opioid addiction should not return to clinical practice Mar 02, 2012 | not rated yet | 0
- Treating drug-addicted doctors is good medicine Feb 24, 2009 | not rated yet | 0
- State policies influence drug treatment programs Jun 25, 2008 | not rated yet | 0
- Most med schools offer students poor mental health coverage, imperiling students, patients Sep 06, 2011 | not rated yet | 0
- Substance abuse adds millions to Medicaid's total health care costs Jan 05, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Bubbles in a Pre-Boiling/Boiling pot of water
51 minutes ago How is it that bubbles form on the bottom of a surface of a pot of boiling water? I think that there is probably an elementary answer to this...
Assumptions of Griffith's fracture theory
11 hours ago Any experts on Griffith's fracture theory? I am studying the subject and I am having hard time finding out if the theory is valid for all possible...
Current leading voltage or vice versa concept
12 hours ago Hello, I was wondering if there is a conceptual explanation for when current leads voltage or vice versa for capacitors or inductors with AC...
Angular Frequency of AC voltage
16 hours ago Hello, I am wondering, what is the physical interpretation of the angular frequency of AC voltage? I don't see the physicality of what the angle...
Modeling Rigid Body - Unsure about Euler angles and angular velocity
16 hours ago I'm modeling a single 3D rigid body in preparation for some more complicated modeling in order to gain a better understanding of Euler angles, the...
Function for a bullet's path
17 hours ago I've been mulling this over all weekend, and I've decided to get some help on this. The problem is writing a function to describe a bullet's path....
- More from Physics Forums - Classical Physics
More news stories
In order to avoid exposing vulnerable groups such as children and young adults to alcohol advertising, industry groups have developed their own self-regulation guidelines. However, these guidelines have been criticized for ...
Addiction May 17, 2013 | not rated yet | 0
In order to avoid harms associated with alcohol consumption, in 2009 the National Institute on Alcohol Abuse and Alcoholism issued guidelines that define low-risk drinking. These guidelines differ for men and women: no more ...
Addiction May 17, 2013 | not rated yet | 0 |
Treatment for alcohol use disorders works best if the patient actively understands and incorporates the interventions provided in the clinic. Multiple factors can influence both the type and degree of neurocognitive abnormalities ...
Addiction May 17, 2013 | not rated yet | 0 |
Researchers from Moffitt Cancer Center and the University of South Florida have evaluated how Florida health care and social service agencies distribute "Libres para Siempre", a Spanish smoking relapse prevention booklet ...
Addiction May 17, 2013 | not rated yet | 0
Tobacco use remains the leading preventable cause of death and disease in the United States. Declines in smoking among youths were observed from the late 1990s. "However, limited information exists on trends in smokeless ...
Addiction May 14, 2013 | not rated yet | 0
You're standing near an airport luggage carousel and your bag emerges on the conveyor belt, prompting you to spring into action. How does your brain make the shift from passively waiting to taking action when ...
34 minutes ago | not rated yet | 0 |
Widely available in pharmacies and health stores, phosphatidylserine is a natural food supplement produced from beef, oysters, and soy. Proven to improve cognition and slow memory loss, it's a popular treatment for older ...
58 minutes ago | 5 / 5 (1) | 0 |
Children who are exposed to secondhand smoke in early childhood are more likely to grow up to physically aggressive and antisocial, regardless of whether they were exposed during pregnancy or their parents have a history ...
18 minutes ago | 1 / 5 (1) | 0
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
2 hours ago | 3.5 / 5 (2) | 0 |
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
1 hour ago | 4.5 / 5 (2) | 0 |
Researchers at Emory University have identified a protein that stimulates a pair of "orphan receptors" found in the brain, solving a long-standing biological puzzle and possibly leading to future treatments for neurological ...
1 hour ago | not rated yet | 0 |