Drug testing in residents?

[ploughboy]

Besides the obvious danger, I think substance abuse in a physician speaks negatively of his/her character.

 

An oldie but a goodie:

 

Q. What's the definition of an alcoholic?

A. Somebody who drinks more than his doctor.

[NLengr]

An oldie but a goodie:

 

Q. What's the definition of an alcoholic?

A. Somebody who drinks more than his doctor.

 

I remember reading risk stratification criteria for etoh abuse as a med student:

 

"Can drink more than 5 drinks in one sitting without passing out"

 

Made me laugh. Who the hell can't drink 5 drinks without passing out?

[fred245]

Now that, I wouldn't agree with.

 

Substance abuse is often a sign of an illness that needs treatment, not a character flaw.

 

Sigh...our society tries to medicalize everything these days. People like to medicalize things, because then they have an excuse and they're no longer accountable..."It's not my fault. I have a medical condition/it is an illness!"

[shady]

As long as it doesn't impact performance and they aren't impaired at work, I don't care. People are free to make their own choices.

 

Agreed .

[epicfail]

Sigh...our society tries to medicalize everything these days. People like to medicalize things, because then they have an excuse and they're no longer accountable..."It's not my fault. I have a medical condition/it is an illness!"

 

^ That's kind of my sentiment.

 

Sure genetics may predisposed some people to substance abuse after they are exposed to it. However, the individual should also be accountable in part. A lot of the times, using the substance is a choice (unless it's something like someone injected you with a drug by force).

[ellorie]

People can have an illness AND need to take responsibility for getting it treated and under control. It can be both.

 

I've met many people who struggle with addiction, including many of my patients, and there is always a reason. Usually it's some combination of genetics and life circumstances with a helping of bad luck.

 

It's nice to think that people with mental health issues are "weak" because it means that if you are strong, you don't have to worry about developing one. Sadly, physicians are not any less vulnerable than other people - and in fact we are more vulnerable to many of them.

[osteogeek]

I remember reading risk stratification criteria for etoh abuse as a med student:

 

"Can drink more than 5 drinks in one sitting without passing out"

 

Made me laugh. Who the hell can't drink 5 drinks without passing out?

 

....me, haha. Though, the caveat there is that I'm a fairly small woman who doesn't drink very often and has no tolerance. I'm assuming that most of my class can easily drink that much without passing out.

[Silverwolf1277]

For yourself - don't do drugs. There is no testing that I am aware of.

 

This is such an overly simplistic statement. You sound like a teacher talking to middle school students. The reality is what is considered a 'drug' is a complex concept, and there many different reasons people do drugs, some innocuous and some harmful. "Don't do drugs" is a meaningless statement, especially when you're talking to adults.

 

I think what it boils down to is that if your performance is not obviously impaired or there are some clear signs of addiction (drugs missing from the OR after your cases, alcohol on your breath, etc), does it really matter?

 

I fully agree with this. I hate how this thread instantly turned into a substance abuse thread. People should NOT equate use with abuse. For most given substances (except the very highly addictive ones), only a minority of users have problems with abuse. Which is why drug testing would be overly simplistic. Plus how do you decide what to include and what not to include? Is weed not allowed even though it is way less harmful for your body than alcohol or tobacco?

 

The more important thing is to have in place supports within the healthcare professional community to identify and assist the people struggling with these issues.

[fred245]

This is such an overly simplistic statement. You sound like a teacher talking to middle school students. The reality is what is considered a 'drug' is a complex concept, and there many different reasons people do drugs, some innocuous and some harmful. "Don't do drugs" is a meaningless statement, especially when you're talking to adults.

 

 

 

I fully agree with this. I hate how this thread instantly turned into a substance abuse thread. People should NOT equate use with abuse. For most given substances (except the very highly addictive ones), only a minority of users have problems with abuse. Which is why drug testing would be overly simplistic. Plus how do you decide what to include and what not to include? Is weed not allowed even though it is way less harmful for your body than alcohol or tobacco?

 

The more important thing is to have in place supports within the healthcare professional community to identify and assist the people struggling with these issues.

 

Can you elaborate? What are the reasons to do drugs?

 

 

The ones that are legal vs the ones that are illegal.

[fred245]

People can have an illness AND need to take responsibility for getting it treated and under control. It can be both.

 

I've met many people who struggle with addiction, including many of my patients, and there is always a reason. Usually it's some combination of genetics and life circumstances with a helping of bad luck.

 

It's nice to think that people with mental health issues are "weak" because it means that if you are strong, you don't have to worry about developing one. Sadly, physicians are not any less vulnerable than other people - and in fact we are more vulnerable to many of them.

 

It's not just about mental health issues. I think a lot of illnesses are overdiagnosed. A particular one that comes to mind is ADHD.

 

Want the most bull**** medicalization example? Affluenza!

[Laika]

In Canada it's illegal for employers and schools to do random drug tests (they have to warn you ahead of time or put it in an employment contract when you get a job) because, in theory, whatever drug you did on the weekend does NOT necessarily affect your job performance today.

 

That's why the thresholds for what constitutes a positive test are different depending on the circumstance (e.g. drug testing for work vs testing in Olympics). You may have detectable metabolites floating around Monday morning from a wild Friday night that do not affect your ability to do your job.

[TheManwithNoName]

Can you elaborate? What are the reasons to do drugs?

 

 

The ones that are legal vs the ones that are illegal.

 

That is too simplistic. Alcohol is a lot worse than Marijuana. MJ stays in your system longer though even if you did it a couple of weeks ago. Likewise, I am more afraid of an alcoholic than someone that consistently uses MJ.

 

On another note, just because a person uses a drug every so often doesn't mean they are an addict or abusing it. That is a whole other matter. If someone smoked MJ once a month, I really question your sanity if you think that is dangerous.

 

People who think Legal vs Illegal is determined on science and not politics are naive.

[rogerroger]

This is such an overly simplistic statement. You sound like a teacher talking to middle school students. The reality is what is considered a 'drug' is a complex concept, and there many different reasons people do drugs, some innocuous and some harmful. "Don't do drugs" is a meaningless statement, especially when you're talking to adults.

 

Meh, oh get off it. I think you know exactly what I mean. Don't do illicit drugs. Why? Well besides these substances being illicit quality control is questionable and self medicating is never a good idea. This is just the tip of the iceberg of the multitude of reasons why indulging in these substances is not a good idea. But I'm going to end it there as I got pretty much a thousand things better to do than debate the harms/benefits of illicit substances.

[rogerroger]

That's why the thresholds for what constitutes a positive test are different depending on the circumstance (e.g. drug testing for work vs testing in Olympics). You may have detectable metabolites floating around Monday morning from a wild Friday night that do not affect your ability to do your job.

 

As an aside, the drug "screens" that are routinely ordered in the hospital are rubbish. The cross reactivity between other innocuous substances is ridiculous. The false positives are insane. For an acute care standpoint I absolutely refuse to order a urine tox for this reason. If you want a good drug screen it costs some decent coin, and even then the false positive rate is higher than many would assume.

[GrouchoMarx]

As an aside, the drug "screens" that are routinely ordered in the hospital are rubbish. The cross reactivity between other innocuous substances is ridiculous. The false positives are insane. For an acute care standpoint I absolutely refuse to order a urine tox for this reason. If you want a good drug screen it costs some decent coin, and even then the false positive rate is higher than many would assume.

 

[A-Stark]

 

I was wondering when someone would mention that.

 

Anyway, the major reason for physicians not to use illicit drugs is quite simple - they're illegal, and since we practice under licenses granted by provincially-mandated Colleges, we shouldn't use them. Remember that anyone can lodge a complaint about you with the College, and if it was to the effect that you were doing lines off a stripper's back downtown, you'd be in trouble.

 

<soapbox>

If the likes of Rob Ford were held to even the most minimal standard for physicians, he'd have since been denied the "privileges" of remaining in office.

</soapbox>

[shady]

The ones that are legal vs the ones that are illegal.

 

And that is not an arbitrary divide? Does it make sense that alcohol is legal while marijuana is not?

 

Besides, it's not the job of hospitals to enforce the country's criminal laws. The ones whose job it is to enforce those laws cannot test you for drugs without a valid reason and a valid suspicion. What gives hospitals or other employers the right to infringe on employee privacy like that?

 

I honestly don't understand the irrational fear that we have for the so called "illicit drugs".

[ellorie]

Not to be snarky or anything, but I don't really understand why everyone is so up in arms about their God given right to break the law.

 

We're doctors, or going to be doctors - is it really that hard to not do illegal things?

[rmorelan]

Not to be snarky or anything, but I don't really understand why everyone is so up in arms about their God given right to break the law.

 

We're doctors, or going to be doctors - is it really that hard to not do illegal things?

 

Plus there is some issues with the very people assigned the role in society to decide what drugs can be given to whom and when within assigned rules, actually then going about breaking rules about what and when drugs can be used for themselves. If you society cannot trust you to follow the rules personally why should they allow you to hold the responsibility of imposing them on others?

 

Medicine is a profession - that means obligations and responsibilities taken on for the return benefit of holding a unique position in society. The idea that you can have total freedom and be a professional are incompatible ideas. It is harsh of course - but that is what it means to be a professional.

[thebouque]

Not to be snarky or anything, but I don't really understand why everyone is so up in arms about their God given right to break the law.

 

We're doctors, or going to be doctors - is it really that hard to not do illegal things?

 

In the real world, yes, it really is that hard.

 

UWO Meds 2015

 

2015. Now I get it

[ellorie]

I don't really understand why my being a medical student is relevant to my opinion on this subject. I don't use substances and I never have, and I would have no problem being drug tested at any point in my professional career.

[thebouque]

I don't really understand why my being a medical student is relevant to my opinion on this subject. I don't use substances and I never have, and I would have no problem being drug tested at any point in my professional career.

 

It's really great that you don't use substances and I mean it. Neither do I by the way. However, in you previous post, you said ''We're doctors, or going to be doctors - is it really that hard to not do illegal things?''

 

Being a doctor doesn't have anything to do with doing or not doing illegal things. From my point of view, this post of yours show that you idealize the medical profession. Doctors are not super human beings. Yes, it's really that hard to not do illegal things for doctors, just like the rest of the population. Then I noticed you're still a medical students, which MIGHT explain why you idealize medicine. Indeed, med students tend to see medicine through pink goggles.

 

Your opinion may never change, but I hope it will, because you have to accept that we're all human.

[ellorie]

I suppose what I meant was more along the lines of what Rob said - that we do have to give up certain things in exchange for our career, and if one of them is a little more leeway in the use of substances, is that really so bad?

 

I really don't mind what people use or don't use in their spare time - I'm not going to be spearheading any initiatives to drug test everyone with an MD. I'm just saying that despite not being superhuman, there are ways in which we get held to higher standards than people in some other professions, and I don't have a strong objection to that.

[thebouque]

I suppose what I meant was more along the lines of what Rob said - that we do have to give up certain things in exchange for our career, and if one of them is a little more leeway in the use of substances, is that really so bad?

 

I really don't mind what people use or don't use in their spare time - I'm not going to be spearheading any initiatives to drug test everyone with an MD. I'm just saying that despite not being superhuman, there are ways in which we get held to higher standards than people in some other professions, and I don't have a strong objection to that.

 

That sounds much better.

 

Let me refer you to this article if it hasn't been quoted in the thread yet (very long and boring thread by the way I didn't bother reading everything). It states that the rate of illicit drug abuse by physicians and the general pop is the same, but the rate of prescription drug abuse by physicians is higher. CMAJ 2000

 

http://www.cmaj.ca/content/162/12/1730.full

 

Peace

[NLengr]

In the real world, yes, it really is that hard.

 

 

 

2015. Now I get it

 

Not to be snarky or anything, but I don't really understand why everyone is so up in arms about their God given right to break the law.

 

We're doctors, or going to be doctors - is it really that hard to not do illegal things?

 

People are more up in arms about not being randomly subjected to unsubstantiated searches and testing, as well as being treated like a criminal for no reason other than their job.