15% of U.S. Surgeons Report Drinking Problems in Survey

MONDAY, Feb. 20 (HealthDay News) — Alcohol use disorders are a
significant issue among U.S. surgeons, a new national survey reveals.

The online, anonymous poll indicated that 15 percent of surgeons appear
to suffer from alcohol abuse or dependence: nearly 14 percent of male
surgeons and 26 percent of female surgeons.

Those figures exceed the 8 percent to 12 percent figure typically cited
for alcohol abuse rates among the public at large, according to background
information in the study published in the February issue of Archives of
Surgery
.

“But it should be said that a number of studies have shown that direct
patient harm associated with impairment due to chemical dependency is
very, very rare,” said survey lead author Dr. Michael Oreskovich, a
clinical associate professor of psychiatry and behavioral sciences at the
University of Washington in Seattle.

“The chance of a patient being injured by an impaired surgeon is really
very uncommon. Something like one in 10,000. So it just doesn’t happen
very much,” he noted.

“However, the findings do beg the question as to why it is that every
other safety-sensitive profession has random drug screenings, while
surgeons do not,” Oreskovich added. “Some anesthesiologists are finally
undergoing this — pre-employment drug screens, for-cause drug screens and
random drug screens — for the same reasons. And although it may not be a
popular statement, there’s no reason other interventionists involved in a
high-risk practice should not be tested. And I think eventually we’ll get
there with surgeons.”

In the study, the investigators analyzed surveys completed in 2010 by
physicians from all across the United States, who were members of the
American College of Surgeons.

All of the surveys were administered online and processed anonymously.
However, less than one-third of the more than 25,000 surgeons to whom they
were emailed actually responded.

Among the nearly 7,200 respondents (29 percent response rate), the team
focused solely on the 1,112 surgeons (15 percent) who reported drinking
behaviors that amounted to full-fledged abuse or dependence. Completed
surveys that demonstrated an unhealthy, and perhaps even risky, pattern of
drinking that did not amount to a diagnosis requiring treatment were not
included in the final tally.

Surgeons who said they had made a major medical mistake over the
previous three months were more likely to be struggling with alcohol abuse
or dependence, as were those who were either depressed, emotionally
exhausted, suicidal, “distressed” or “burned out.”

Overall, alcohol issues were less prevalent among male surgeons, as
well as among those who were older, had children, worked longer hours,
were more often “on call” or were employed by the U.S. Department of
Veterans Affairs.

“Doing this study to find out where we’re at is truly remarkable for an
organization like the American College of Surgeons,” Oreskovich said. “But
the idea is let’s shine a light on it and get on with it. Because this may
very well be an even bigger problem than the numbers now indicate, because
many surgeons may not have completed the survey or [not] completed it
honestly out of shame, guilt and fear,” he added.

“But actually publishing this survey, and showing the high percentage
of those who have a problem, we think is actually destigmatizing by its
very nature. It kind of sets a precedent that it’s OK to be ill,”
Oreskovich said. “And, hopefully, next time we do a poll more surgeons
will come forward.”

Dr. John Fromson, a co-director of postgraduate medical education at
Massachusetts General Hospital, and an assistant clinical professor of
psychiatry at Harvard Medical School, wrote a critique of the study in the
journal.

“The most important thing here is to note that physicians are not
immune from these kinds of problems. And I think it’s quite courageous on
the part of the journal to actually publish this information, because
there are not many studies that take a kind of a fearless look at this
profession,” Fromson said.

“And even if you help just one surgeon in terms of this identification,
you’ve done a good thing,” he added. “I don’t think patients and their
families need to be alarmed. But the reality is that the more we talk
about it, the greater the chances of recognizing the factors and stressors
that contribute to it among those who need help.”

In an editorial also accompanying the study, Dr. Edward Livingston, a
professor of surgery at the University of Texas Southwestern Medical
Center in Dallas, re-emphasized the reservations with survey accuracy
addressed by the study authors.

“You really can’t interpret too much from this,” Livingston said. “The
response rate was just really, really low. Most statisticians agree that
out of 100 surveys you have to have 60 or more responses for the findings
to be reliable. That’s 60 percent. And here you have a 29 percent
response. Which is understandable, since the ramifications are so great
for a physician who is found to have a drinking problem,” he pointed
out.

“In fact,” Livingston added, “one possibility is that the problem is
even greater than they’ve found. So what we might have here is really an
underreporting of the situation.”

More information

For more on alcohol abuse, visit the U.S. National Library of Medicine.

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