Victorian Doctors Health Program

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Victorian Doctors Health Program
VAADA Annual Conference DOCTORS WITH PROBLEMS
WITH EVERYDAY DRUGS 2 December 2002

• Dr Naham (Jack) Warhaft
• M.B.,B.S., F.A.N.Z.C.A.
• Medical Director, VDHP

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Principal aim

• The Victorian Doctors Health Program is an
  independent legal entity that has been
  established to provide a confidential
  professional service to meet the needs of sick
  and impaired doctors and medical students. Its
  principal aim is to assist doctors whose
  condition will, or is likely to, impact adversely
  on their ability to continue to practice medicine.

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Victorian Doctors Health Program

• CONFIDENTIAL
• Compassionate
• Management of drug dependency is its biggest
  task
• Readily accessible

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Profile of cases 2001-02

• (Insert report of Level of involvement)

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Total Contacts by type of medical practice
performedfrom 1 May 2001 to 31 October 2002
(total contacts 165)
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Everyday Drugs for doctors

• ALCOHOL
• Tobacco
• Opioids Pethidine
• Fentanyl, morphine
• Codeine
• Bezodiazepines -Diazepam, oxazepam, temazepam
• Midazolam
• Others anaesthetics
• phenothiazines, tramadol

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(No Transcript)
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WHY DOCTOR ADDICTS ARE DIFFERENT TO OTHER ADDICTS

• Highly intelligent, highly trained and
  independent individuals
• Conditioning as students and resident to assume
  authority have all the answers
• Role reversal receiver of care instead of giver
• Poor seekers of health care
• EASE OF ACCESS to drugs
• Tendency to self refer, self investigate and SELF
  MEDICATE
• Difficulty in confronting of or by another doctor
• Inability to benefit form the health system
• Very high level of guilt, shame and remorse
• BUT
• HIGHLY MOTIVATED TO RECOVER!

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Referral System

• Self Referred
• Voluntarily enter the Program. (although usually
  confronted by peers, family, etc.)
• VDHP offers individuals a CONFIDENTIAL conduit
  to access assessment and/or treatment. If they
  voluntarily engage in the program and are totally
  compliant, they will not be reported to anyone.
• Board Mandated
• Referred by Medical Practitioners Board

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Principles of case management AOD
(indicates referred out)

• (investigation)
• Intervention
• Preliminary assessment and referral
• Specialist assessment
• Primary treatment
• Aftercare, support and advocacy
• Monitoring
• Follow-up

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Case Management, Aftercare and Monitoring Program
CAMP Agreement.

• Abstinence requirements
• Treating doctor
• General practitioner
• Psychiatrist
• AOD counsellor
• Mutual support groups A.A., N.A.

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Case Management, Aftercare and Monitoring Program
CAMP Agreement.

• VDHP Support monitoring group
• Workplace monitoring
• Chemical monitoring
• Self-medication prohibited
• Prescribing restrictions
• Any other requirements

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Prognosis

• For cooperative participants in a Doctors Health
  program the prognosis is excellent US and
  Canadian stats. Show 88-92 recover.
• For untreated cases the prognosis is poor, with a
  high rate of drop-out from work, and a
  significant mortality rate.

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Example 1 Diagnostic monitoring

• 60 year old surgeon
• Reported by hospital administration for alcohol
  problem
• Subsequent medical board notification
• VDHP preliminary assessment borderline
  alcohol dependency
• Sent for expert assessment same opinion.
• MPBV placed restrictions on registration
  breathalyser, attend VDHP.
• We will monitor and provide expert counseling
• After 9 months, there has been no apparent change
  in alcohol consumption. However, there is no
  evidence of impairment.
• Time will declare more precisely the nature and
  degree of his disorder.

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• Example 2 Excellent Outcome
• 55 year old male general surgeon
• Reported by practice manager for alcohol problem
• Medical board also involved. Requested voluntary
  suspension.
• Presented to VDHP (under some duress)
  provisional Dx of alcoholism
• Referred to inpatient treatment facility
  underwent 28 days Rx
• Discharged to the care of VDHP entered into
  CAMP agreement
• Returned to work 8 weeks later
• Currently sober for 15 months making excellent
  progress in all areas

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• Example 3 Cautiously optimistic!
• 45 yrs male GP outer suburban
• Reported to me by practice partner (August 2001)
• 4/12 (admitted) history of pethidine use out of
  control
• Referred for assessment and treatment, resumed
  work under strict monitoring by VDHP
• Relapse identified early October. Asked to cease
  work and commence inpatient treatment. Medical
  Board notified (by DPU)
• Discharged November after 4/52 program
• OK until late January 02 relapsed just prior to
  return to work.
• Has since participated in an outpatient
  treatment program.
• Progress has been sporadic until August has ?
  turned corner.
• Probable return to work in early 2003.

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• Example 4 Excellent Outcome
• 51 yrs male GP, suburban
• Reported to me by practice manager (June 2001)
• Past history of pethidine use 5 yrs ago MPBV
  involved, restrictions on registration for about
  3 years
• Referred for assessment and treatment, resumed
  work under strict monitoring by VDHP.
• Entered into our CAMP Agreement
• Has been fully compliant for 15 months no
  relapse behavior
• His general mood and outlook has improved
  significantly.He is a grateful program
  participant, and excellent contributor to the
  group.

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• Example 5 Excellent Outcome
• 58 year old Anaesthetist
• Previous MPBV involvement for pethidine
  addiction. Many years of subsequent drug-free
  practice and excellent reputation.
• Suspicion of recent drug misuse reported by
  theatre nurses.
• Structured intervention arranged.
• Re-entry to structured outpatient treatment
  program including rigorous monitoring.
• Signing of CAMP agreement.
• Now over 12 months clean and likely to remain so.
• No medical board involvement necessary
  confidentiality maintained at workplace and
  elsewhere.

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VDHP can

• Assist with intervention
• Refer for treatment
• Case manage
• Assist with re-entry to work
• Design and implement appropriate aftercare and
  monitoring

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VDHP Services

• Intervention
• Assessment and referral
• Case management
• Aftercare and monitoring
• Caduceus (support and monitoring) groups
• Family support
• Advocacy Work, MPBV, Courts

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Victorian Doctors Health Program
Tel. [phone] Level 8, Aikenhead
Building 27 Victoria Parade Fitzroy 3065