CONFIDENTIALITY WORKS BEST

There are sound reasons for not reporting physicians with substance-abuse
problems to the state licensing board unless they refuse to stop working,
refuse treatment or both. Eliminating the opportunity to receive
confidential assistance would discourage physicians from seeking treatment.
Delaying medical care would negatively affect not only physicians' health,
but, more importantly, the health of their patients.

Doctors who enter treatment should be able to do so confidentially under
the auspices of a well-structured physician-health program. Such programs,
which exist in most states, monitor recovery closely and act immediately to
remove a problem physician from service.

Instead of waiting until patient harm occurs, these programs best serve the
public through pre-emptive action to bring a physician's substance abuse
into remission early in the disease process.

When doctors are diagnosed with a substance-abuse disorder, some decide to
retire from medicine. Of those who want to continue in medicine and seek
treatment through New York's physician-health program, about 95% remain
abstinent. This is extraordinary compared to recovery rates for the general
population: Of those who voluntarily attend a treatment program, fewer than
50% remain abstinent.

Part of the success of doctors in New York's program can be attributed to
the fact that they sign contracts to continue treatment for five years.

Reporting all recovering physicians to licensing authorities is not the
solution. Such reporting would further stigmatize this disease and delay
physicians from receiving treatment until their disorders have progressed
to a serious stage.

Unfortunately, many state laws define physician substance abuse as
misconduct, and if a licensing board learns of the abuse, it is obliged to
discipline a physician even if there is no evidence of impaired judgment or
patient harm.

The public is best protected by encouraging confidential treatment at the
earliest possible time, without recrimination.

Terrance M. Bedient is director of the Committee for Physician Health, a
service of the Medical Society of the State of New York.