Physicians are people too—some respond to stress, anxiety, or pain by
drinking alcohol, while others take opiates and sedatives, including those
intended for patients.
"Cases have been reported involving anesthesiologists who stole
fentanyl for personal use. The drug is a potent analgesic and sedative used to
treat pain in patients," physician health expert Michael Myers, M.D.,
told Psychiatric News. He is and chair of the Section on Physician
Health of the Canadian Psychiatric Association and chair of the
Psychiatric News Editorial Advisory Board.
Myers has encountered many doctors who self-medicated with alcohol or drugs
to cope with sudden mood swings or extreme anxiety. "Once they were
clean and sober, it was easier to detect the mental illness that triggered the
For example, Myers recalled a surgeon who was addicted to cocaine."
When he was treated for the addiction and off cocaine, it became clear
that he had a mild form of bipolar disorder, which explained his mood
swings," Myers said.
He has learned from colleagues in internal medicine to order a drug screen
for doctors when their behavior seems out of character. "The most
unlikely people will lie, deny it, and in the end test positive."
He has encountered physicians who started drinking alcohol in the morning
before work to calm feelings of panic or extreme anxiety. "Once they
were off the alcohol, it was clear they should have been treated for an
anxiety disorder," Myers said.
Michael Gendel, M.D., a forensic and addictions psychiatrist and president
of the Federation of State Physician Health Programs (see box) told
Psychiatric News, "We have to be careful in diagnosing cases
involving addictions and mental illness. The majority of alcoholics are
depressed because large amounts of alcohol in the bloodstream inhibit
neurotransmitters including serotonin and dopamine. When the addiction is
treated, the depression usually remits."
A significant minority of people, however, remain depressed after their
addiction is treated. "It is important to treat the mood disorder since
it can trigger a relapse of alcoholism," said Gendel, who is also
president-elect of the American Academy of Addiction Psychiatry.
Other types of traits or disorders can also lead to behavioral problems.
Personality disorders are more common than mood disorders in physicians and
are more difficult to treat, he said.
Gendel observed that narcissistic traits are common among physicians and
can be addressed effectively through coaching and therapy. "There is a
subgroup of people with severe narcissistic traits—who have little
insight and take no responsibility for their actions—that may require
intensive treatment, possibly in a residential setting," he said.
Doctors who are perfectionists are often seen in certain specialties such
as surgery, anesthesiology, and intensive care that require extreme precision.
Because they hold others to their standard of perfection, anything they view
as an infraction can incur their wrath, Myers noted.
"If doctors are antisocial, it can lead to serious boundary
violations and criminal behavior," Myers commented.
Gendel wrote the chapter on personality disorders in theHandbook of Physician Health: The Essential Guide to Understanding the
Health Care Needs of Physicians, which can be ordered online at<https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod170040>.▪