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The Alienation Of America’s Best Doctors | Melinda Hakim MD

 Doctors are hurting and they don’t have the time to reach out.

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16-24 Segment 1: Doctor Suicide — Radio Health Journal

Experts discuss the coverup of doctor suicides, the reasons behind depression in doctors, and why doctors who are depressed are less likely than normal to get help.

via 16-24 Segment 1: Doctor Suicide — Radio Health Journal

Physician Suicide and “Physician Wellness” –Time to start talking about the elephant in the room!

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Physician Suicide and the Elephant in the Room

Michael Langan, M.D.

Although no reliable statistics exist, anecdotal reports suggest an alarming upsurge in physician suicide. This necessitates a reappraisal of known predisposing risk factors such as substance abuse and depression but also requires a critical examination of what external forces or vulnerabilities might be unique to doctors and how they might be involved in the descent from suicidal ideation to suicidal planning to completed suicide.

Depression and Substance Abuse Comparable to General Population

Depression and substance abuse are the two biggest risk factors for suicide. The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria suggest that physicians have the same rates (8-14%) of substance abuse and dependence as the rest of the population 3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 found a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

State Physician Health Programs

Perhaps it is how physicians are treated differently when they develop a substance abuse or mental health problem.

Physician Health Programs (PHP) may be considered the equivalent to Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems. Originally developed as “impaired physician” programs, the PHPs were created to help doctors who developed problems with substance abuse or addiction as an alternative to disciplinary action by State Medical Boards. These programs existed in almost every state by 1980. Often staffed by volunteer physicians and funded by State Medical Societies, “impaired physician” programs served the dual purpose of both helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation (so long as the public was protected from imminent danger)  most medical boards accepted the concept with support and referral.   However, most EAPs were developed with the collaboration of workers unions or some other group supporting the rights and interests of the workers.  Not so with PHPs  as there is no such organization representing doctors.   PHPs developed in the absence of regulation or oversight.    As a consequence there is no meaningful accountability.   

In Ethical and Managerial Considerations Regarding State Physician Health Programs published in the Journal of Addiction Medicine in 2012, John Knight, M.D. and J. Wesley Boyd, M.D., PhD who collectively have more than 20 years experience with the Massachusetts PHP state that:

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”8

Noting that “for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine,” Knight and Boyd raise serious ethical and managerial questions about current PHP policies and practice including conflicts of interest in referrals for evaluation and treatment, lack of adherence to standards of care for forensic testing of substances of abuse, violations of ethical guidelines in PHP research, and conflicts of interest with state licensing boards.

Knight and Boyd recommend “that the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.” 8 They also recommend the relationship of PHP’s between the evaluation and treatment centers and licensing boards be transparent and that national organizations review PHP practices and recommend national standards “that can be debated by all physicians, not just those who work within PHPs.”8 Unfortunately this has not happened. Most physicians have no idea that the state physician health programs have been taken over by the “impaired physicians movement.”

In his Psychology Today blog,  Boyd again recommends oversight and regulation of PHPs.   He cites the North Carolina Physicians Health Program Audit released in April of 2014 that reported the below key findings:

As with Knight and Boyd’s paper outlining the ethical and managerial problems in PHPs, the NC PHP audit finding that abuse could occur and not be detected generated little interest from either the medical community or the media.

Although state PHPs present themselves as confidential caring programs of benevolence they are essentially monitoring programs for physicians who can be referred to them for issues such as being behind on chart notes. If the PHP feels a doctor is in need of PHP “services” they must then abide by any and all demands of the PHP or be reported to their medical board under threat of loss of licensure.

State PHP programs require strict adherence to 12-step doctrine9 yet many of the physicians monitored by them are neither addicts nor alcoholics. Some do not even have substance abuse issues and there are reports of “disruptive” physicians being diagnosed with “character defects” at the “PHP-approved” facilities that do these assessments.   PHPs require abstinence from drugs and alcohol yet use  non-FDA approved Laboratory Developed Tests in their monitoring programs. Many of these tests were introduced to commercial labs and promoted by ASAM/FSPHP physicians.10-12

LDTs bypass the FDA approval process and have no meaningful regulatory oversight.   The LDT pathway was not designed for “forensic” tests but clinical tests with low risk.   Some are arguing for regulation and oversight of LDTs due to questionable validity and risk of patient harm.13

These same physicians are claiming a high success rate for PH programs9 and suggesting that they be used for random testing of all physicians.14

As with LDTs, the state PHPs are unregulated, and without oversight. State medical societies and departments of health have no control over state PHPs.

Their opacity is bolstered by peer-review immunity, HIPPA, HCQIA, and confidentiality agreements. The monitored physician is forced to abide by any and all demands of the PHP no matter how unreasonable-all under the coloration of medical utility and without any evidentiary standard or right to appeal.

The ASAM has a certification process for physicians and claim to be “addiction” specialists. This“board certification” is not recognized by the American Board of Medical Specialties and is not a recognized medical specialty. The goal of the ASAM is to be recognized as the experts in addiction medicine with the consensus expert opinion based on the 12-step prohibitionist brain disease model. The ASAM has aligned itself with a number of inpatient drug treatment centers  (Hazelden, Talbott, Marworth, Bradford,etc) and are heavily funded by the drug testing industry.   It is in fact a “rigged game.”

State PHPs are non-profit non-governmental organizations and have been granted quasi-governmental immunity by most State legislatures from legal liability.

By infiltrating “impaired physician” programs they have established themselves in almost every state by joining, gaining power, and removing dissenters. Groupthink and 12-step indoctrination are the goals. By advertising as advocates for doctors who are “caring,” “confidential resources,” “giving help,” and advocating for “colleagues in need” the outward appearance is one of benevolence.

The biggest obstacle is that this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration. Those outside of programs either defend or ignore the reports of ethical and criminal violations, complacent in their trust of these “experts” claiming they are just helping sick doctors and protecting the public.

With no oversight or regulatory body involved this is all done with impunity, immunity, and undercover. They use the accusation of substance abuse as an indication to disregard the claims of the accused. The physician is left without rights, depersonalized, and dehumanized. The imposition of confinement, stigmatization, lack of oversight of the organizations, peer-review protected confidentiality, and lack of procedural protection is a one-way train to hopelessness and despair.

By establishing a system that of coercion, control, secrecy, and misinformation, the FSPHP is claiming an “80% success rate” 15and deeming the “PHP-blueprint” as “the new paradigm in addiction medicine treatment.

The ASAM/FSPHP had a major influence on the DSM-V where drug abuse and dependence are no longer separate entities. They are also working behind the scenes to get legislation to randomly drug test all physicians.

They are now after the “disruptive physician” and the evidentiary criteria are fairly low and red flags include “deviating from workplace norm in dress or conduct” and being tardy for meetings.

They have identified “the aging physician” as a potential problem because “as the population of physicians ages,””cognitive functioning” becomes “a more common threat to the quality of medical care.”

The majority of physicians are unaware that the Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment in 2011 that uses addiction as an example of a “potentially impairing illness.”  According to the Federation of State Physician Health Programs …”physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.”

“Process addiction” was added as a potentially impairing illness including compulsive gambling, compulsive spending, compulsive video gaming, and “workaholism.” According to the FSPHP “the presence of a process addiction can be problematic or even impairing in itself, and it can contribute to relapse of a physician in recovery. As such, process addictions should be identified and treated.” They define three levels of relapse including the novel “relapse without use.”

Bullying, Helplessness, Hopelessness and Despair

Perceived helplessness is significantly associated with suicide.16 So too is hopelessness, and the feeling that no matter what you do there is simply no way out17,18 Bullying is known to be a predominant trigger for adolescent suicide19-21 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.22

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.23,24 The “Cry of Pain” model 25,26 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life.

There is also evidence that rescue factors such as social supports may play a role in preventing suicide. These rescue factors act buffers to protect against suicide in the face of varying degrees of life stress.27,28 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 29 and support at work when difficulties arose appeared to be a protective factor for the male physicians.30   Research involving Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.31,32 Organizational justice is related to fairness and refers to an individuals perception of an organizations behaviors, decisions, and actions and how these influence one’s own attitudes and behaviors and has been identified as a psychosocial predictor of health and wellbeing33 34Low organizational justice has been identified as a notable risk factor for psychological distress and depression.35,36

A recent report indicates that job stress, coupled with inadequate treatment for mental illness may play a role in physician suicide..

Using data from the National Violent Death Reporting System the investigators compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.1

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians.

They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity.

We have heard of numerous suicides due to these institutionally unjust programs.   Three doctors died by suicide in Oklahoma in a one month period alone (August 2014).   All three were being monitored by the Oklahoma PHP.   I went to an all boys high-school of less than 350 students yet a classmate a couple years ahead of me died by suicide a few months ago. He was being monitored by the Washington PHP. His crime?  A DUI in 2009–a one-off situational mistake that in all likelihood would never have recurred.  But as is often the case with those ensnared by state PHPs he was forced to have a “re-assessment” as his five-year monitoring contract was coming to an end.  These re-assessments are often precipitated by a positive Laboratory Developed Test (LDT) and state medical boards mandate these assessments can only be done at an out-of-state “PHP-approved” facility.    Told he could no longer operate and was unsafe to practice medicine by the PHP and assessment center he then hanged himself.  And at the conclusion of Dr. Pamela Wible’s haunting video below are listed just the known suicides of  doctors; many were being monitored by their state PHPs–including the first name on the list– Dr. Gregory Miday.

None of these deaths were investigated. None were covered in the mainstream media.   These are red flags that need to be acknowledged and addressed!    This anecdotal evidence suggests the oft-used estimate of 400 suicides per year (an entire medical school class) is a vast underestimation of reality—extrapolating just the five deaths above to the entire population of US doctors suggests we are losing at least an entire medical school per year.

As physicians we need to demand transparency, oversight, regulation and auditing by outside groups. This is a public health emergency.

To wit:

They first came after the substance abusers and I did not speak out because I was not a substance abuser.

They then came for those with psychiatric diagnoses and I did not speak out because I was not diagnosed with a psychiatric disorder.

They then came after the “disruptive physician” and I did not speak out because I was not disruptive.

They then came after the aging physician and I did not speak out because I was young.

They then came after me and there was no one else to speak out for me.

  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
  2. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. The American journal of psychiatry. Dec 1999;156(12):1887-1894.
  3. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA : the journal of the American Medical Association. Apr 11 1986;255(14):1913-1920.
  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res.1992;1:148-186.
  5. Stinson F, DeBakely S, Steffens R. Prevalence of DSM-III-R Alcohol abuse and/or dependence among selected occupations. Alchohol Health Research World. 1992;16:165-172.
  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.Archives of general psychiatry.Jun 2005;62(6):593-602.
  8. Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.
  9. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  10. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol and alcoholism.Sep-Oct 2004;39(5):445-449.
  11. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results.Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  12. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study.European addiction research.2014;20(3):137-142.
  13. Sharfstein J. FDA Regulation of Laboratory-Developed Diagnostic Tests: Protect the Public, Advance the Science. JAMA : the journal of the American Medical Association. Jan 5 2015.
  14. Pham JC, Pronovost PJ, Skipper GE. Identification of physician impairment.JAMA : the journal of the American Medical Association. May 22 2013;309(20):2101-2102.
  15. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.
  16. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school.The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S32-36.
  17. Lester D, Walker RL. Hopelessness, helplessness, and haplessness as predictors of suicidal ideation. Omega. 2007;55(4):321-324.
  18. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  19. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
  20. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  21. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  22. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody.Crisis.2008;29(4):216-218.
  23. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  24. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  25. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  26. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  27. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors.Pediatrics. 2001;107(485).
  28. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample.Journal of Psychopathology and Behavioral Assessment. 1994;16:37-46.
  29. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  30. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  31. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica. Aug 2007;51(7):815-822.
  32. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  33. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  34. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  35. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  36. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.

 

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Michael Langan, M.D.

Physician Suicide, Organizational Injustice and the Urgent Need for Open Discourse

They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride


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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved in the descent from suicidal ideation to suicidal planning to completed suicide.  What are the cumulative situational and psychosocial factors in physicians that make suicide a potential option and what acute events precipitate the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population 1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician. Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

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Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9 Hopelessness10,11 Bullying is known to be a predominant trigger for adolescent suicide12-14 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17 The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20 Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing26 27 Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

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Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?   They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott. Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.31   The constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35 In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

ByQiW11IYAI2Cit

Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.”31According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37 The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39

Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“these special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

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Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42 The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure. However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43  He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

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Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced. A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition the PHPs have no oversight by the medical boards, departments of health or medical societies. They police themselves. The PHPs have convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.” The “swift and certain consequences” of this are an effective means of keeping the rest of the inmates silent.   Likewise doctors have been going to the media only to have the door slammed in their faces because the media has generally bought in to the “impaired” and “disruptive” physician construct these same people developed through propaganda, misinformation and moral panics and crusades.

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Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect. Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves. And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.  With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair. Locus of control is  lost.  Organizational justice is absent.

The temporal relationship is clear.

Why is this still the elephant in the room?

This needs to be named, defined and openly discussed and debated.  How many more must die before we speak up?

Please help me get the conversation going.

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  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
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  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res. 1992;1:148-186.
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  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.Archives of general psychiatry. Jun 2005;62(6):593-602.
  8. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. General hospital psychiatry. Jan-Feb 2013;35(1):45-49.
  9. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school.The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S32-36.
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  11. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  12. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
  13. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  14. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  15. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody. Crisis.2008;29(4):216-218.
  16. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  17. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  18. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  19. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  20. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  21. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  22. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors.Pediatrics. 2001;107(485).
  23. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample. Journal of Psychopathology and Behavioral Assessment. 1994;16:37-46.
  24. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica. Aug 2007;51(7):815-822.
  25. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  26. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  27. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  28. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  29. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.
  30. Gonzales L. When Doctors are Addicts: For physicians getting Molly Kellogg is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.
  31. King M, Durcanin C. The suicides at Ridgeview Institute: A Doctor’s treatment program may be too tough, some say. Atlanta Journal and Constitution. December 18, 1987a, 1987: A12.
  32. Durcanin C, King M. The suicides at Ridgeview Institute: Suicides mar success at Ridgeview with troubled professionals. Atlanta Journal and Constitution. December 18, 1987, 1987: A13.
  33. Bissell L, Royce JE. Ethics for Addiction Professionals. Center City, Minnesota: Hazelden; 1987.
  34. Addiction Scientists from the USA: LeClair Bissell. In: Edwards G, ed. Addiction: Evolution of a Specialist Field. 1 ed: Wiley, John & Sons, Incorporated; 2002:408.
  35. Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
  36. Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
  37. King M, Durcanin C. The suicides at Ridgeview Institute: Many drug-using doctors driven to Ridgeview by fear of losing licenses. Atlanta Journal and Constitution. December 18, 1987b, 1987: A1.
  38. Bissell L, Haberman PW. Alcoholism in the Professions. Oxford University Press; 1984.
  39. White W. Reflections of an addiction treatment pioneer. An Interview with LeClair Bissell, MD (1928-2008), conducted January 22, 1997. Posted at http://www.williamwhitepapers.com. 2011.
  40. Williams c. Health care field chemical dependency threat cited. The Tuscaloosa News. January 16, 1988, 1988: 16.
  41. Peele S. In the Belly of the American Society of Addiction Medicine Beast. The Stanton Peele Addiction Website (accessed March 28, 2014)http://web.archive.org/web/20080514153437/http://www.peele.net/debate/talbott.html.
  42. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report. May 12, 1999b 1999.
  43. Ursery S. I was wrongly held in alcohol center, doctor charges. Fulton Count y Daily Report. April 27, 1999a 1999.
  44. Parker J. George Talbott’s Abuse of Dr. Leon Masters MD (http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters ).Medical Whistelblower Advocacy Network.
  45. images-10

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The Federation of State Physician Health Programs and the Dead Doctors at Ridgeview-A Harbinger of the Medical Profession’s Current Suicide Epidemic

“There is enormous inertia—a tyranny of the status quo—in private and especially governmental arrangements. Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes politically inevitable.” –Milton Friedman

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“Gentlemen, it is a disagreeable custom to which one is too easily led by the harshness of the discussions, to assume evil intentions. It is necessary to be gracious as to intentions; one should believe them good, and apparently they are; but we do not have to be gracious at all to inconsistent logic or to absurd reasoning. Bad logicians have committed more involuntary crimes than bad men have done intentionally.”–Pierre S. du Pont (September 25, 1790)

 “It is easier to believe a lie one has heard a hundred times than a truth one has never heard before.” –Robert S. Lynd

Ridgeview Institute was a drug and alcohol treatment program for “impaired physicians” in Georgia created by G. Douglas Talbott, a former cardiologist who lost control of his drinking and recovered through the 12-steps of Alcoholics Anonymous.

Up until his death on October 18, 2014 at the age of 90, Talbott  owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus  in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards today.

G. Douglas Talbott is a prototypical example of an “impaired physician movement” physician–in fact in many ways he may be considered the”godfather” of the current organization.  He helped organize and serve as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program.

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G. Douglas Talbott (center), with sons Mark (left) and Dave (right). (image: Ham Biggar)

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.1

In 1975 after creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program for the assessment and treatment of physicians. Founded in part because “traditional one-month treatment programs are inadequate for disabled doctors,” and they required longer treatment to recover from addiction and substance abuse.   According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike any other of the inhabitants of our society. Physicians are unique. Unique because of their incredibly high denial”, and he includes this in what he calls the “Four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”2   And these factors set doctors apart from the rest.

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves.

“M-Deity” refers to doctors “being trained to think they’re God;”3 blinded by an overblown sense of self-importance and thinking that they are invincible-an unfounded generalization considering the vast diversity of individuals that make up our profession.   Although this type of personality does exist in medicine,  it is a small minority -just one of many opinions with little probative value offered as factual expertise by the impaired physician movement and now sealed in stone.

Former Assistant Surgeon General (Ret) Admiral (Ret) John C. Duffy

Former Assistant Surgeon General (Ret) Admiral (Ret) John C. Duffy

This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”1

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LeClair Bissell

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals4 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”5

“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.3

The constitution did a series of reports after five inpatients died by suicide during a four-year period at Ridgeview.6 In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.1

Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.”3

According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”3

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,7 and other lawsuits initiated on behalf of suicides were settled out of court.6

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 8 The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”8

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after her death in 2008 per her request.   Noting that her book Alcoholism in the Professions9 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population; to which she replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”10

Talbott claimed a “92.3 percent recovery rate according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”11 A 1995 issue of The Federal Bulletin: The Journal of Medical Licensure and Discipline, published by the Federation of State Medical Boards, contains articles outlining impaired physician programs in 8 separate states. Although these articles were little more than descriptive puff-pieces written by the state PHP program directors and included no described study-design or methodology the Editor notes a success rate of about 90% in these programs and others like them 12 and concludes:

“cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” 12

No one bothered to examine the methodology to discern the validity of these claims and it is this acceptance of faith without objective assessment that has allowed the impaired physician movement through the ASAM and FSPH to advance their agenda;  confusing ideological opinions with professional knowledge.

“There is nothing special about a doctor’s alcoholism,” said Bissel

“These special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”10
“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”10

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.13  Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”13

The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.14

The fraud finding required a finding that errors in the diagnosis were intentional. Masters, who was accused of overprescribing narcotics to his patients was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation.

Masters agreed to the latter, thinking he would have an objective and fair evaluation. He was instead diagnosed as “alcohol dependent” and coerced into “treatment under threat of loss of his medical license. Staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice,”14  the equivalent of professional suicide.

Masters, however, was not an alcoholic.

According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 15

He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license.

Talbott faced no professional repercussions and no changes in their treatment philosophy or actions were made. They still haven’t.  They have simply tightened the noose and taken steps to remove accountability.

Up until his recent death, Talbott continued to present himself and ASAM as the most qualified advocates for the assessment and treatment of medical professionals for substance abuse and addiction.16

ASAM and like-minds still do.

In most states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview.

There is no choice.   In mechanics and mentality, this same system of coercion, control, and indoctrination has metastasized to almost every state only more powerful and opaque in an unregulated gauntlet protected from public scrutiny, answerable and accountable to no one.  Laissez faire Machiavellian egocentricity unleashed.    For what they have done is taken the Ridgeview model and replicated it over time state by state and tightened the noose.  By subverting the established Physician Health Programs (PHPs) started by state medical societies and staffed by volunteer physicians they eliminated those not believing in the mentality of the groupthink.   They then mandated assessment and treatment of all doctors be done at a “PHP-approved” facility which means a facility identical to Ridgeview.  This was done  under the scaffold of the Federation of State Physician Health Programs (FSPHP).  They are now in charge of all things related to physician wellness in doctors.

  1. Durcanin C, King M. The suicides at Ridgeview Institute: Suicides mar success at Ridgeview with troubled professionals. Atlanta Journal and Constitution. December 18, 1987, 1987: A13.
  2. Gonzales L. When Doctors are Addicts: For physicians getting Drugs is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.
  3. King M, Durcanin C. The suicides at Ridgeview Institute: A Doctor’s treatment program may be too tough, some say. Atlanta Journal and Constitution. December 18, 1987a, 1987: A12.
  4. Bissell L, Royce JE. Ethics for Addiction Professionals. Center City, Minnesota: Hazelden; 1987.
  5. Addiction Scientists from the USA: LeClair Bissell. In: Edwards G, ed. Addiction: Evolution of a Specialist Field. 1 ed: Wiley, John & Sons, Incorporated; 2002:408.
  6. Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
  7. Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
  8. King M, Durcanin C. The suicides at Ridgeview Institute: Many drug-using doctors driven to Ridgeview by fear of losing licenses. Atlanta Journal and Constitution. December 18, 1987b, 1987: A1.
  9. Bissell L, Haberman PW. Alcoholism in the Professions. Oxford University Press; 1984.
  10. White W. Reflections of an addiction treatment pioneer. An Interview with LeClair Bissell, MD (1928-2008), conducted January 22, 1997. Posted at http://www.williamwhitepapers.com. 2011.
  11. Williams c. Health care field chemical dependency threat cited. The Tuscaloosa News. January 16, 1988, 1988: 16.
  12. Schneidman B. The Philosophy of Rehabilitation for Impaired Physicians. The Federal Bulletin: The Journal of Medical Licensure and Discipline. 1995;82(3):125-127.
  13. Peele S. In the Belly of the American Society of Addiction Medicine Beast. The Stanton Peele Addiction Website (accessed March 28, 2014) http://web.archive.org/web/20080514153437/http://www.peele.net/debate/talbott.html.
  14. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report. May 12, 1999b 1999.
  15. Ursery S. I was wrongly held in alcohol center, doctor charges. Fulton Count y Daily Report. April 27, 1999a 1999.
  16. Parker J. George Talbott’s Abuse of Dr. Leon Masters MD ( http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters ). Medical Whistelblower Advocacy Network.

Hopelessness, Helplessness and Defeat: Organizational Justice and Physician Suicide

They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride


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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved in the descent from suicidal ideation to suicidal planning to completed suicide.  What are the cumulative situational and psychosocial factors in physicians that make suicide a potential option and what acute events precipitate the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population 1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician. Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

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Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9 Hopelessness10,11 Bullying is known to be a predominant trigger for adolescent suicide12-14 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17 The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20 Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing26 27 Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

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Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?   They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott. Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.31   The constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35 In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

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Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.”31 According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37 The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39

Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“these special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

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From a talk given by FSPHP

Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42 The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure. However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43  He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

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Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced. A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition the PHPs have no oversight by the medical boards, departments of health or medical societies. They police themselves. The PHPs have convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.” The “swift and certain consequences” of this are an effective means of keeping the rest of the inmates silent.   Likewise doctors have been going to the media only to have the door slammed in their faces because the media has generally bought in to the “impaired” and “disruptive” physician construct these same people developed through propaganda, misinformation and moral panics and crusades.

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Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect. Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves. And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.  With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair. Locus of control is  lost.  Organizational justice is absent.

The temporal relationship is clear.

Why is this still the elephant in the room?

This needs to be named, defined and openly discussed and debated.  How many more must die before we speak up?

Please help me get the conversation going.

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Do physician health programs increase physician suicides? —Pamela Wible, MD

Do physician health programs increase physician suicides?

How do we care for the people who care for us? As doctors, we’re immersed in pain and suffering — as a career. We cry when our patients die. We feel grief anxiety, depression — even suicidal — all occupational hazards of our profession.

A recent Medscape article on physician health programs suggests the people who are here to help us may actually be doing more harm than good. And they may even be increasing physician suicides.

 Both doctors I dated during medical school died by suicide. Eight physicians killed themselves in my town alone. I’ve become a specialist in physician suicide. My cell phone has turned into a suicide hotline. And I have a stack of physician suicide notes that I keep at home.

Here’s one of them:

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Dear Some, My family, I love you. To others who have been good friends, I love you too. This is just the end of the line for my particular train. Earth wasn’t a great place for me. We’ll see what else is out there. Will miss you all. I’m sorry for what it’s worth. Love Greg.

On June 22, 2012. Dr. Greg Miday killed himself — 12 hours after being told not to follow his psychiatrist’s safety plan by the physician health program that controlled his medical license.  Sober for years, he relapsed just before his death. A brilliant clinician, never impaired at work, Greg drank to cope with anxiety.

Afterwards, two interns jumped to their deaths from New York hospitals the same week (within three days of each other, I believe). Greg’s mother, a psychiatrist, sent this letter to the editor of the New York Times:

An unacknowledged predicament for physicians who identify their struggle with substance abuse and/or depression is that they are often placed under the supervision of their state medical board’s physician health program. My son, Greg, was being monitored by such a program. He took his own life at age 29, one week before he was to enter an esteemed oncology fellowship. His final phone calls were to the physician health program notifying them of his use of alcohol while on vacation, a disclosure he had previously described as a ‘career killer.’ These programs, which often offer no psychiatric oversight, serve as both treating and policing agencies, a serious conflict of interest. Threatened loss of licensure deters vulnerable physicians from seeking help and may even trigger a suicidal crisis. Medical Boards have the duty to safeguard the public, but the assumption that mental illness equals medical incompetence is an archaic notion. Medical Boards must stop participating in the stigmatization of mental illness. We cannot afford to lose another physician to shame.

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Greg Miday and his mother, Karen Miday

The facts: Our medical schools, hospitals, and clinics actually cause or exacerbate mental health conditions in physicians, then they blame us and force us to release our confidential medical records. And in the end, they take our license ..

Maybe that’s why my friend, an excellent psychiatrist, drives 200 miles out of town, pays cash, and uses a fake name to get mental health care.

And another physician friend who was deemed “too slow” (seeing patients) by her residency director, was sent to a psychiatrist who diagnosed her with mild OCD. (Don’t we all have some OCD if we are thorough physicians?) Well, she was actually then sent to medical board who referred her to a physician health program that mandated an AA-style substance abuse program — which makes no sense at all since she does not do substances, She doesn’t drink or smoke.

So who the hell is protecting us from being misdiagnosed, mistreated, and abused?

There are many who prey upon physicians. So who cares for doctors?

And how in the world can we give patients the care we’ve never received?

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor. She hosts the physician retreat, Live Your Dream, to help her colleagues heal from grief and reclaim their lives and careers.


“Do Physician Health Programs Increase Physician Suicides?” by Dr. Pamela Wible was published on Medscape August 28, 2015 and was subsequently posted on KevinMD on September 7, 2015 where it quickly became the #1 most popular article of the week and the #3 most popular article of the past six months. 323 comments have been left on Medscape thus far and 258 on KevinMD where comments are now closed.

Pauline Anderson’s article Physician Health Programs: More harm Than Good?” published August 19, 2015 on Medscape currently has 200 comments and the response from the President of their national organization the Federation of State Physician Health Programs (FSPHP) Doris Gunderson “FSPHP Response to ‘Physician Health Programs: More Harm than Good? published September 8, 2015 on Medscape has generated 172 comments.  

What is the consensus so far regarding the questions raised by Anderson and Wible?    Judging by the comments the consensus is that Physician Health Programs are not only causing harm but serious, far-reaching and grave harm on a large scale.  This is by a landslide.   Of the over 950 collective comments all but a few have been extremely negative toward PHPs. They raise specific and serious questions that are not being answered by the FSPHP, their sympathizers or apologists.  Gunderson’s response to Anderson’s article deserves a point-by-point analysis which will be done at a later date.  To summarize, her rebuttal attempts to summarily dismiss the serious criticisms raised in Anderson’s article by questioning the integrity and quality of the both the report itself and the sources used for the report.     Calling it a “biased and unbalanced view of Physician Health Programs (PHPs)” Gunderson implies the piece falls short of the “journalistic excellence” expected of Medscape and that almost all of the information relied primarily on “hearsay, including information from anonymous sources, allegations rather than facts, and a handful of anecdotes.”  This is in contrast to the “six pages of factual information and references to several peer-reviewed articles” that were ignored by Medscape.    Quality of that information aside, the point of Anderson’s article is to express the concerns of tangential dissident voices that often go unheard (or are silenced) by perceived authority not a research based comparison of the literature. The criticisms involve  lack of due process, accountability and oversight in a secretive and unregulated system of coercion, disempowerment and control.   Most victims of this system lack resources to mount effective challenges, much less undertake their own counter research.   She goes on to present the usual appeals to authority, special knowledge and consequences and brandishes the “overwhelming success” of PHPs and references her own study showing that PHPs reduce malpractice stating: 

“…research demonstrates that physicians who participate in PHP monitoring for any health issue have a lower malpractice risk compared to the physician population at large, underscoring the relationship between physician health and effective patient care.”

The “overwhelming success” is of course based on Setting the Standard for Recovery: Physicians’ Health Programs, a  poorly designed non-randomized non-blinded retrospective analysis of a single data set with multiple flaws in both reasoning (type I and type II errors) and statistical analysis that render its conclusions invalid. In addition the impact of undeclared but substantial financial conflicts-of-interest (including funding by drug testing and addiction treatment industries) and personal ideological biases (including personal 12-step recovery from addictions) in the authors make it nothing more than authoritative opinion.   Adding the alleged misdiagnosis and over-diagnosis of addiction in physicians by this group incentivized by lucrative self-referral dollars for expensive 90-day treatment programs renders it less than authoritative opinion.  As with the “PHP-blueprint” the claims of lower malpractice risk are based on a single retrospective cohort study (with Gunderson being one of the authors ) that compares malpractice risk prior to and after being enrolled in the Colorado PHP and showed a reduction in malpractice in those who participated in the PHP program.  The 20% reduction they speculate:   

“It could be that participants learned skills during their treatment and recovery — skills to communicate better with colleagues, staff, and patients. It may be that experience with the PHP led participants to make use of other professional supports — that is, maybe to seek consultation earlier in their work. Or maybe they were more motivated to practice conservatively and adhere to standards of practice, given what they learned in the PHP program.”

This sounds great until you consider what impact being monitored by a PHP might have on the number of patient encounters a doctor might have before and after being enrolled in a PHP.

How many had practice restrictions, reduced hours, retired or were working in non-clinical positions. For a study looking at malpractice risk I would venture to guess that matching the NUMBER OF HOURS SEEING PATIENTS AND NUMBER OF PATIENT ENCOUNTERS  would be an essential part of the study design.    In addition the average age enrolled in the PHP was 50 and the chances of reducing hours obviously increases with time as we age.   

This is like a pre-school claiming that participation in their program leads to a 20% reduction in wet diapers for children because of the skills those little fellers learned at the school.

Unfortunately this combination of logical fallacy and misrepresentation of seriously flawed studies usually sways the audience.  Criticisms are dismissed with everyone complacent in the belief that these are just good people helping doctors and protecting the public.  But that is not what has happened here.    The comments have made it abundantly clear that not only is there a  problem but a very serious problem and  allegations included fabricated diagnoses, “diagnosis rigging”, “treatment rigging,” total denial of due process, lab fraud and many other serious concerns.  Faced with these specific and serious criticisms and critical reason the FSPHP has become tongue-tied as the individual horror stories mount.

Now  silence from authority is an acceptable stance when the criticisms are unreasoned and unfounded ad hominem attacks and generalizations based on bias and prejudice but that is not the case here.   The testimonials and criticisms are articulate, specific and remarkably similar.

Patterns are appearing that involve abuse of power and control of information in a system that manages all aspects of testing, assessment and treatment without oversight or regulation; an opaque and rigged game that dismisses all outside opinion with no transparency or apparent accountability (including the provision of information and justification for actions).  Due process has been removed and the  coercion, control and abuse of power are seen in these comments that are not only believable but plausible.  This is crystal clear.

These comments can be seen here:  FSPHP Response to ‘Physician Health Programs_ More Harm Than Good_’ and I urge others to read them, form their own opinions. investigate this area and help expose these issues.

Comments (258)

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    Thanks, Pam.

    Now in my fourth decade, I can tell you that if I had mental illness, chemical dependency, or practically anything that could threaten my medical practice I would not tell anyone, including my one good physician friend who is my primary care doc. I don’t have any of those conditions mentioned, but I am very sensitive to those who do. In my mind, the most untrustworthy physicians are the ones on the state medical boards. They seem to have one and only one goal… protect the public at all costs and toss physicians who show any weakness. I never get any communications from them when they want me to shell out my yearly fee or remind me that I need to have a certain amount of CME hours.

    Our privacy is invaded by them even before we have a chance to declare it. Why is it that everyone in the world can know most everything about us as physicians from where we live to, but patient’s information is rabidly protected with the HIPPA maul?

    Thanks for your caring. Perhaps it is because a physician’s story would be safe with you? Ours is truly one of the lonliest professions. I don’t think we can trust anyone much, and am extremely careful about sharing myself as a person with anyone even though I have no mental illness or substance abuse issues.

    Now I’m in my 33rd year…my goal is maybe 45 years and I’m done.

    Warmest regards,

    Ron

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      I don’t tell m doctor that I’m a doctor or even in healthcare. I make a point of going further out of town to get any major treatment. The only time my doctor knew who I was is when I had to have some orhto surgery.

      I don’t trust any of them. Actually I don’t trust most doctors when it comes to these type of things. They will sell you out. They sell their own out for less.

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        Doctors have gone into hiding, Cruel “health care” system.

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        That is just so overwhelmingly sad — a doctor not being able to trust most other doctors. As a patient, I continue to struggle to try to understand why the same people who become doctors to help people can be so heartless and untrustworthy to each other. And yet, at the same time, a lot of doctors marry other doctors.

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          We are beaten up. We came into this profession with compassion and a desire to serve. Instead we have been bullied, hazed, victimized, and if we ask for mental health help . . . (just read the stories here to see what happens then). I couldn’t make this stuff up. Truth is stranger than fiction.

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      This is terrible. We need to bring more public awareness to these issues!

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        You’re absolutely right. Many very talented and compassionate physicians’ and nurses’ and PA’s careers are being destroyed by these self-righteous state-protected psychopaths. And this malignancy is soon to move to broader professional horizons – lawyers, counselors, teachers … just about anybody who needs a license to practice. All done under the virtuous banner of “protecting the public,” all the while depriving the professional of due process and operating without any oversight or accountability! And … all the while, these programs turn a handy profit by using their state-sanctioned authority to refer to their friends running “preferred programs.

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          Is there a way to protect due process by contract as well as by law? Web sites such as this can offer model contracts for doctors

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            Due process is in the NC law, and in the contract that NCPHP had with the NC Medical Board.
            It made no difference, as they just did not respect the law and offered no due process.

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            We are held to an inhuman standard and we have no safe accessible mental health care. It’s insane. No wonder we have such high rates of suicide. Again, I will ask, who is helping us?

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              Pamela,

              No one is helping us. No one will. We are the overpaid evil doctors who are just in it for the money. Didn’t you know that?

              The guy selling vitamins makes millions and he is a good businessman.

              The lawyer makes millions on BS lawsuits and he is a brilliant attorney.

              The doctor makes millions serving patients, doing a good job and saving lives or improving peoples live and he must be a crook or doing something wrong.

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                You must be referring to the specialist. No primary care docs making millions (that I know of).

                The media has certainly portrayed us poorly. And doctor bashing stories somehow get much more traction than others.

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                People don’t know or care about the difference. To them we are all the rich doctor. And so what if we make a good living.

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                  I’m a patient and part of the public and I don’t think doctors are all just rich and overpaid. I think you’re seriously underestimating how many of us patients do sincerely care about our doctors. You need to stop obsessing about the patients who do hate doctors and start building a coalition with those of us patients who do care about our docs. Just like in a political election, forget about trying to change the minds of people who will never vote for you and concentrate on engaging with and activating the patients who are on your side. I’ve said this many times here but I’ll say it again — We really need to start building a strong doctor-patient coalition.

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                  Divide and conquer. Us vs. them mentality. Really keeps us locked down in the status quo. Patients and docs should be on the same team. Weren’t we once?

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                Doctors don’t feel that way about other docs, do they? I don’t either, for what it’s worth. But even if that is the dominant image that the public has of doctors (and I’m not agreeing that it is), how does that explain how ruthless docs can be toward other docs?

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                  The PHP system is a funnel for psychopathy. Many of these doctors had a history of manipulating the system, got caught and had their licenses revoked. By claiming the salvation card, blaming their bad behavior on drugs and alcohol, and claiming they were redeemed through 12-step they got their licenses back. Unlike the doctors telling their stories here, many of these doctors were criminals who got caught doing something very bad. Many of these doctors joined their state PHPs and others found work in the drug and alcohol assessment, treatment and testing industry. It is these doctors who are involved in the culture of harm you see here. In my opinion what we are seeing is the result of corporate psychopathy and this system makes Enron look like a preschool picnic.

                  The final common pathway for many sociopaths is jail. This depends on them getting caught. The final common pathway for a sociopathic doctor who gets caught would likely be a PHP. And what do you think might happen when a group of these doctors find each other? Some of these individuals should never have had their licenses returned. Giving them power without any oversight or accountability probably wasn’t such a bright idea.

                  One of the common themes reported is the complete lack of empathy these people exhibit.

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                    The PHP system is the physician’s rabbit hole into the twilight zone. Don’t go near one. Voluntarily or otherwise.

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                      If a doc with a substance abuse and/or mental health problem opts to seek help from a direct pay private practice psychiatrist or other doc with no insurance records, are the helping docs required to report the docs with problems to anyone (medical board, doc’s employer, etc). Or are they both protected by doctor/patient confidentiality?

                        
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                          Speaking of MB position statements in re: reporting impairment, it is also important to note that MBs also have position statements re: reporting of unethical behavior. A number of physicians have reported the profoundly unethical behavior of the PHP clinician to the MB as unprofessional (and illegal) behavior (e.g. the violation of due process; coercive referral to preferred programs etc.). The MB has repeatedly declined to even consider the complaint. Appears they get to choose what is “unethical.” And apparently anything involving the illegal and abusive behavior of MBs and PHPs is immune from being considered “unethical.” Seems like they like a rigged game.

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                            Have most of the docs who have filed complaints with the MB about unethical behavior by the PHP been docs who were treated — or mistreated — at the PHP? I’m guessing that the MBs find it easy to blow off the opinions of docs who have a substance abuse problem as disgruntled resistant participants. Have any docs with no personal substance abuse problem and no need for a PHP filed any complaints about PHPs? Or are they reluctant to get involved with that can of snakes?

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                              MGH tried to remove me from PHS and the MGH attorneys, my Chief and his Chief had a conference with them to attempt this. When things got confrontational with one of the Chiefs they asked him how much he drank in a not so thinly veiled threat. The Boards have agreed not to second guess the PHPs and they are free to do what they want. Boards do not investigate PHP members–at least here in Massachusetts.

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                                Wow! to the way they threatened the Chief who tried to support you. I imagine there’s a certain amount of CYA going on here by everyone in case a patient gets hurt badly by a doctor down the line. Nobody wants to share the blame if that happens.. But, at heart, it sounds like PHPs are far too lucrative and that money train is what they’re protecting at all costs. Aren’t they supposed to be nonprofit organizations with the dual mission of protecting patients and helping doctors? How easy would it be to follow and document the money being made by PHPs and those who run them? Expose how lucrative they really are and you expose the motive. I’m really sorry that you’re having to go through this but I love how you’re fighting back!

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                            Wow.

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                            However, that said, it is also important to note that some / most states’ medicals boards have “position statements” that say that you must report an impaired colleague. My guess is that this pertains when you a) know an impairment exists; and b) have tried other means of intervention such as you or another colleague talking with the doc. Otherwise, this “duty to report” turns colleagues into undercover secret Stasi and creates distrust and further isolates and disrupts the necessary existence of a collegial community.
                            Now, if a physician with a run-of-the-mill illness like anxiety or depression or excessive use of alcohol or similar is in treatment with a private doc, my personal belief is that the private treating clinician’s 1st duty is to one’s patient. If there is a question about potential impact of that patient’s illness on others (e.g. their own patients) then I think it’s incumbent on the treating clinician to seek wise and confidential consultation with knowledgeable (non-PHP) colleagues.

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                        There is no duty to report anyone (i.e. mandated reporter) unless there is child abuse, elder abuse or intended harm. There is no duty to hospitalize unless the patient is a danger to oneself or others or incapable of self care. I would argue that if a therapist reported confidential information to anyone without explicit consent of the patient, they have violated their professional ethics and should a) be reported to their board and b) should be put on a “do not use” list.

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                        I’d like to know the answer to that too! Anyone know? Michael?

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                  As with most groups of people 95 + percent of doctors are honest and sincere individuals with moral compass and kind heart. They inherently “do the right thing.” The doctors who have erected this scaffold predominantly come from the same pool of like-minded addiction specialists.

                  In the 1980s some of these physicians realized they could make money by holding a doctors medical license hostage. The first step was the specialized facilities for doctors. It makes no sense on any level for doctors to spend 3-4 months in rehab. There is no difference between doctors and anyone else other than the specific education, training and experience they have. To claim doctors are “unique” and require different treatment is ludicrous. It is a dicto simpliciter argument that can be refuted just by pointing it out. It is an urban legend that exists to this day and one of many that must be addressed with critical reasoning, common sense and evidence-base.

                  And believe it or not it is this same group that has created the moral panics that has tarnished the image of doctors.

                  https://disruptedphysician.com/…

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                    Wow. This whole discussion about state PHPs has been a real eye opener to me, especially, assuming it’s true, that many of the people who run PHPs are doctors who lost their licenses for criminal reasons. it sounds like, to justify their jobs and maybe to retaliate for what happened to them, they go after other docs.

                    Even if 95% of docs are good people, I can see how the fact that any doc could be one of the 5% who might turn on you creates an atmosphere of threat and mistrust among doctors. This truly dark side of the healing profession is extremely disheartening. As a patient, I want there to be a way to keep dangerous doctors from practicing but there has to be a better way.

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                      Exactly why we are conversing publicly. There must be a better way. Curious what reform you would suggest?

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                        One more thought: Are there any countries that are handling the issue of treating doctors’ mental illness and substance abuse better? Or is this a worldwide issue for docs? If there are places that are handling it in a better, more fair/humane, less corrupt way, how are they doing it?

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                          Other Countries have PHPs but this model originated here and is also in Canada and has been put in place in the UK and some other countries facilitated by the countries equivalent of ASAM. Other countries PHPs are the same as the EAPs used by the rest of society. After all that’s how it should be. Specialized programs for doctors is not needed and there is no evidence for 3 months of treatment . This same group just made it up as a way to make money and bamboozled others into believing the lie. And they are still at it.

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                          What a great question! Just off the phone with a female doc in Canada with similar horror stories.

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                        Heh. I’ll let you know if/when I come up with any replacement ideas. To be honest, your OP and the comments here and on Medscape are making me aware of and educating me for the first time about PHPs. I knew nothing about them before this. But what I’m reading now is outrageous. You need to make more patients like me aware of this.

                        Clearly, replacing the current system is not going to happen overnight. But I would start with exposing the corruption of individual doctors in positions of power in these things. Systematically start to discredit the whole system, thereby creating a need for something new.. Find the docs who weren’t broken by the PHPs but instead emerged stronger, even if they are no longer practicing medicine. They are some of your potential leaders. I sure don’t have any instant solution. Just thinking out loud here. Brainstorming strategy was part of my former work.

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                      It is indeed the “dark side.” It’s eerily akin to “Shutter Island.” Once you go there, you’ll never escape. An if you try to visit just to investigate, whoa boy – they just don’t like snoops crashing their game.

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                        I didn’t think of Lehane’s (or Scorceses’s) Shutter Island while reading this thread. But now that you mention it. I did think of Kesey’s One Flew Over the Cukoo’s Nest while reading through this thread.

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                  It doesn’t. competition does. the threat of losing your practice or license due to a malpractice suit because some other as hole doctor said negative things about you does. Happens all the time.

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                    Fear really cause some strange behavior in humans.

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                      I agree.

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                      I agree. Living in a constant state of fear is a horrible way to live. I’ve lived that way a few times briefly but couldn’t take it so I had to just say “FU fear”, shake it off and refuse to live in fear of things that may never happen or that I have no way of stopping them if they do. I did this living in NYC after 9/11 as the smoke from the WTC blew by my apartment windows. I did this after my ovarian cancer dx. I did this after I had to be my own lawyer in housing court to keep a roof over my head. I still do this on a daily basis, living paycheck to paycheck when there is a paycheck, not being able to afford food everyday and still pay my bills. Maybe it’s easier for me than it is for docs to choose not to live in fear because I don’t have much to lose anymore except for my life. But still, docs should try to remember that they can’t use fear as a tactic against you if you refuse to live in fear.

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                        As an independent doc. let me tell you my fears.

                        malpractice
                        board certification
                        constant state of am I going to have enough cases and patient to keep clinic going and for how much longer
                        Can I do this for the rest of my career
                        I’m so stressed today and don’t know if I can continue this any longer
                        How am I going to pay the bills
                        Is there going to be some doc. my competition that is going to bad mouth me today. They have before.
                        The list is longer but I’ll spare you.

                        I know it’s like the refugees but it a different kind of fear.

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                          I’m truly sorry that you’re living with all of that. I certainly didn’t mean to minimize your fears. I really don’t believe in competitive pain or fear (as in whose is worse). I do think life is stressful for most of us, each in our own ways, and that we can’t really avoid stress in this world, only manage it. For me, swimming and laughing regularly are two of my best stress busters. I hope you find a way to manage yours and be happy. I guess there really is a kind of freedom in nothin’ left to lose. But let me tell you, even though I lost everything material and financial, in the past two years I did fight hard in deep uncharted waters (like our healthcare system) to live since my cancer dx. And now that I’m alive and kicking, I get to start over in my late fifties. I probably should be terrified. But I’m just happy to still be here.

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                      And doctors are human.

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                  People who are injured and afraid may act as irrational as an injured raccoon or squirrel. Have you ever tried to help an injured animal? They’ll bite you. Furthermore, a cycle of abuse perpetuates itself. Those who have been abused often become the abusers.

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                    Yes, I actually have helped and been bitten and clawed by injured animals. And I certainly understand, from the perspective of families with domestic violence and abuse, how some of the abused become abusers themselves. I also know several guys who I know were abused by their fathers as boys and who broke that cycle and, instead of becoming abusers themselves, grew into the least violent men I know — basically, they became the opposite of their fathers instead of becoming their fathers. This abusive dark side of medical culture is truly disturbing. Doctors are supposed to be healing and nurturing (as are families), not viscous and vindictive and sadistic.

                    Any time we try to change anything bad in this world, the first step is always awareness, shedding light on the darkness and spreading that awareness. Because of the nature of the problem, clearly, docs can’t fix this on their own. You’ll need to get others to work with you to change this. But you also need good activist leaders like you, Dr Wible. Keep kicking those doors down and shedding that light.

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      See whether any articles at www.aapsonline.org are useful.

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      Sad, as mental illnesses are biological as much as “physical” ones…actually, the term should be brain illnesses, but we are not to that point in our civilization yet to consider the brain (mind) an organ…though that makes no sense, logically.

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      Please don’t go. We need you to help bring our professional back to life. What are your plans for retirement? Don’t just hang out on the golf course Ron. Help heal our profession. I’m begging you.

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        Hi, Pam.

        Just recently I’ve dropped to three full days a week from four. Its nice in one way, but I think I get the hardest patients. Because I answer email, I get a fair amount of that, but the practice only fields about 6 or 7 phone calls a month and we see around 9 to 10 thousand patients visits a year. I have four nurse practitioners who work for me and we are a good team and the office has a very good community reputation.

        But I find myself getting tired more. I’m just 57 but I’ve been at this a long time and the intensity level is at the maximum throughout the day. My forty minute drive to and from work is relaxing because I don’t have to talk to anyone.

        After 200,000 to 250,000 patients visits in my career, I still find myself thinking mostly about my staff who need the work, my patients who need a graying doctor, and my grandchildren who remind me of all the other grandchildren. If I keep up this pace I could see another 40,000 visits or more. I get physicially tired.

        My wife Stacy and I have been married 38 years and we are stuck together for sure. But I can’t remember the last real good friend since undergrad in premed. I’m sure other docs feel isolated as well.

        I wish I could make a different with all these issues, but I don’t think the powers that be can listen because of their powers that are. I’ve never struggled with depression or addictions or any medical conditions, but there are a few doctors that I know who have. I don’t think they are bad people, but one strike in this game and you’re out according to those in power.

        I’ll keep going as long as I can.

        Warmest regards,

        Ron Smith, MD

        see more

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          Ron, You’re a real trooper and I bet it’d be a gift to have you as my doc. Hope you’ll stay involved with this PHP issue.

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          Medicine is all encompassing. It can be isolating for sure. So you never answered my question about your post-retirement activities. Have you given any thought to that?

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            Well, I haven’t gotten that far. We’ve just got our small, 115 yo farmhouse paid off, and I’ve talked to Stacy about maybe hiring a Pediatrician at the office and keeping it going so that my staff will continue to have jobs, and my patients/parents have the care they are used to. I thought too about doing some clinical teaching maybe at Mercer or one of the other schools in their resident’s clinic, since I like teaching.

            I don’t play golf, but I’ve got two grandsons and two granddaughters ages 2 to 6 that I want to spend as much time with as possible.

            I don’t know what to do about the PHP mess. Maybe if we physicians could spearhead a non-profit to compete with current PHPs where we could set the rules, more or less, and keep the physician’s confidences. Maybe it could be a membership thing…maybe there is already something like that.

            I have no confidence in state medical boards. They have a conflict of interest between their public image of patient protectors and what appears only at face value to be a friend to physicians. Maybe a physician advocate organization could wield some muscle in our behalf?

            Heck, that’s a steep climb…the public at large doesn’t have much sympathy I don’t think, even when they say their doctor is the best. Everybody else is questionably in their minds I think.

            I think I’m living out the end of medicines best years. No one starts solo much. That was really fun. I really liked the cutting edge of making critical primary care decisions…still do and I get my share of “I’ve never that before” patients.

            Ron Smith, MD

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              Solo docs are coming back! http://www.idealmedicalcare.or…

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                Looked at that link and its encouraging. But what I want to see it solo practice have at least an equal footing with freshly certified Pediatricians coming out of residency. Heck, I never ever considered working for a corporation or even a group when I started. Now, residents shy away from solo like it was the plague. I would really like to teach the business of solo practice to residents…they are missing out on the best that medicine has to offer I think.

                Ron Smith, MD

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                  Yes. You should teach because many students do not find suitable mentors during training. Need more inspired community docs teaching in med schools:

                  Is medical school an anti-mentorship program?

                  http://www.idealmedicalcare.or…

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                    The problem in the era of ACO’s is Indy’s can’t survive. Insurance company’s pay them peanuts compared with large university and private systems with their market share and army of administrators to feed. Frankly, I have found most university systems being “anti-mentor ship”, if those mentors are outside of the university system. Dr Sieberts thread about us being “whiners” is exactly what is wrong with an academic medicine today. There is a complete disconnect from those who are part time clinicians and the rest of us.

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    Pam in your own state the PHP program has been contracted out to a private company who have very little knowledge or caring about the job of physicians. It is 12 step based and frighteningly incompetent, but gee whiz, they got the contract. They treat physicians like street people and make demands on their time that are unrealistic. The medical board argued with me that care by a licensed board certified addictionologist was inappropriate so they sent a physician patient to Rush Medical Center. The result? Gee whiz, I actually knew what I was doing! I had been threatened qwith losing my own license for treating a fellow physician for his addiction. A system run by “Investigators” who again in your state are former police with no training in medicine.

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    Physician Health Programs are not the problem. The problem is the Frankenstein PHP’s have become over time. With no oversigjht, regulation or accountability the usual checks and balances that self-govern any group of individuals are not in place and Power without restraint follows an inevitable course. That is what we are seeing here. The historical precedents are many and we still fail to learn. Groupthink has poisoned the well and a Lord of the Flies free-for-all has evolved. Original intentions are lost. Those of decency and conscience are removed. Evidence-based science and critical reasoning are replaced with ideology and dogma. Empathy and moral compass give way to intolerance, injustice and fear to increase the grand scale of the hunt under the banner of “protecting the public'”

    Be it the “impaired,” “disruptive” or “aging” physician these witches are real, these witches are dangerous and we know how to find them.

    Wha remains in many state PHPs is a mix of self-appointed experts with personality disorders ((narcissism, sociopathy), bullies collectively mobbing ( previously insecure doctors of low to mediocre reputations fueled by first time Power who derive pleasure at wielding it – this ranges from bystander indifference to outright cruelty), and lastly 12-step recovery zealots blinkered by black and white thinking who believe their ability to make authoritative pronouncements over others is a divine grant bestowed on their own “recovery” and consider any use of substances “addiction” in need of lifelong abstinence and fundamentalist devotion to their creed. From the point of view of these “like minded docs” drinking a beer is a spiritual malady commensurate with an IV heroin addiction. Any resistance to AA is deemed “relapse without use” or in AA parlance “Stinkin thinkin,”. As with standards of care, professional ethics and the law, the Establishment Clause of the 1st Amendment does not apply to them.

    The biggest problem here is that the PHPs are diagnosing doctors with problems they do not have and mandating unneeded treatment and monitoring. This is taking place because no one oversees them. They have been given carte Blanche authority and power and when the animals are running the zoo that’s a big problem.

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      Some of these self-appointed experts need to be profiled — their medical careers previous to working at a PHP, their personalities, their lavish lifestyles, their connections, their intimidation tactics, their conflicts of interest. Every bit of dirt you can dig up on them and document and expose. Heh. Is my background in investigative research showing? But seriously. Find the worst offenders and expose them. But of course document everything to CYA before going public with it.

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        Let’s take a look at a typical scenario.

        In 2000 when this doctor who had a revoked license requested it be reinstated two board members were opposed due to his long term history of manipulating the system.

        http://www.ct.gov/dph/lib/dph/…

        These include the following statements: “The twice weekly random, observed urine screens imposed upon petitioner by the 1992 and 1994 Consent Agreements were insufficient to detect his then on-going substance abuse. Petitioner WAS QUITE ADEPT AT MANIPULATING The SYSTEM TO AVOID DETECTION.” (my emphasis).

        How did he get it back?

        Advocacy of his state PHP of course.

        Many in the current abusive PHP system got their licenses back using the 12-step salvation card and reinvented themselves as specialists in “addiction medicine.” They are given a “clean slate.”

        This doctor is now running the entire Health Professionals Program in Florida–nurses, doctors, and any licensed medical practitioners from acupuncturists to veterinarians are referred to this program.

        Brilliant! Let’s not just give him his license back but how about we put him in a leadership position with no transparency, regulation or accountability and put all the medical professionals careers and lives in his hands. You can read some of the reviews on the vitals.com website for examples. They are very similar to what are being reported here. Of course the majority of the comments are probably true but in this sick system are considered the bellyaching of sick doctors and ignored.

        Here is a recent comment that tells it all:

        “Every single available website has years of overwhelmingly negative reviews, accompanied by similar stories of abuse, coercion, and damage, all for this physician. Enough. Please join us in our promotion of public awareness and help end the injustice at stopscottteitelbaum.com.”

        Even with a petition out no one is listening as they consider the whole chorus of doctors condemned here for trivial issues a bunch of bellyaching dangers to the public.

        It is this same route that felons, double-felons, Doctors who stole IV pain medication and replaced it with saline from dying cancer patients, pedophiles, and a guy who got caught selling industrial quantities of the date-rape drug to undercover cops are now practicing medicine while those who got a single DUI, borrowed their husbands ativan to help them sleep, had a little too much at the christmas party or sometimes nothing at all are losing their licenses and some are dying.

        Label the accused as deviant to disregard the claims of the accused. It is hard to wrap ones head around the thinking here.

        How about we just apply Occam’s razor or a little bit of common sense? It’s time to WTFU.

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      I agree completely

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      you have elucidated the problems very well, very succinctly. Yes, those drawn to positions of authority in PHP programs probably come from those backgrounds along with some naïve doctors who are chronic do-gooders (except in this case, they harm and kill).

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        If you want to march in front of your PHP, I will join you…that is what I want to do here in Tx.
        PHYSICIAN’S LIVES MATTER.
        PHPs=DEAD DOCs
        etc.

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          Gail, I really like the “Physicians Lives Matter” slogan.

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          I’m not a doctor but I am a veteran of political and social justice campaigns, including building coalitions. I am also a patient who is on your side on this issue. But with all due respect, if you want to start reaching out to the public for support on this, I really think it’s a bad idea at this point in time to try to co-opt the phrase “Black Lives Matter” into “Physicians Lives Matter”. Honestly, that’s bound to push some buttons and alienate some who would be on your side. Docs need their own slogan. Surely we can think of something else. If it annoys me, I can only imagine how the black community might take it as docs equating their issues with young black men who get shot in the back or strangled by police officers.

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            Ok well, I never thought of it that way. I was thinking of it very concretely. I think the black population had a great idea in bringing forth that slogan, and it is effective, to the point. Of course I borrowed it, because it was so great! I believed I was honoring the black population which has been decimated in the same way, by authorities run amuck without oversight. I completely support blacks in their marches and believe we should march, too. Want to join me?

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              but I see your point in believing I was usurping this motto, though I wasn’t sensitive to that idea…ok will not use it…will think up another. Thanks for your constructive voice.

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                It’s just my humble opinion. You’re, of course, free to use any slogan you want to use. My background is not in medicine but I have friends and familiy who work in healthcare. My professional background is decades of experience in strategic research, analysis, campaigning and coalition building. And I sincerely think that the public would not react well to the Physicians Lives Matter slogan and it’s seeming to equate racist violence with what addicted doctors go through. It’s not that I’m not sympathetic to what PHPs do to docs. I am.

                But I think this slogan might backfire on you. I wouldn’t march with you under it and I’m already with you on this issue. As for marching in the streets, I’ve been doing that for years for numerous social justice issues. I live in Brooklyn a few miles from where Eric Garner was killed by police on Staten Island.

                Please don’t take any of what I’ve said as hostile to your cause. We’re on the same side here.

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                  No, I don’t! I saw it as cautionary and something I didn’t think of. You are right about this! I would rather you tell me I have spinach between my teeth than let it keep hanging there!
                  As one who enjoys smiling…
                  I will come up with something else. Thanks.

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                    Something else I thought of to share is that I learned that we aren’t necessarily speaking of addicted physicians, though a program harming one suffering already from that illness is bad enough, but we are reading here and on other websites about any physician getting involved with PHPs for any reason, including being “reported” to them anonymously having no recourses to the draconian measures dealt to them by PHPs under the guise of providing for their “health”.

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            I agree with you Kit. I think an original slogan is better 🙂

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    “At times to be silent is to lie. You will win because you have enough brute force. But you will not convince. For to convince you need to persuade. And in order to persuade you would need what you lack: Reason and Right”
    ― Miguel de Unamuno

    The first “step into the breach” is to question and challenge authoritative opinion and that is being done here and on Medscape. The FSPHP is used to making authoritative pronouncements without opposition or scrutiny. When challenged directly with specific questions and facts they simply do not answer the questions.

    It is clear there is a big problem with PHPs as currently being managed by the FSPHP. What is being described is abuse of power not unlike the political abuse of psychiatry seen in the Soviet Union. Doctors are being diagnosed with illnesses they don’t have while those who do need help are getting improper treatment in a rigged system of friends referring to friends. Others are afraid to get help for fear of being ensnared by the PHP. How many good doctors are we losing every year unnecessarily? How many suicides?

    Although the comments here are alarming it is just the tip of the iceberg. Even under guaranteed anonymity and not having to provide any identifying information the majority of doctors I talked to who are being monitored by the MA PHP would not call the state auditor to tell their stories. They were too afraid of the PHP finding out. A 3-month stay in an out-of-state “PHP-approved” facility for “relapse prevention” keeps most doctors silent. The PHPs use the accusation of substance abuse or behavioral problems as a means to delegitimize doctors and remove their power and this is a hole hard to crawl out of when an outside facility confirms a problem. It is a rigged system and the ideological and financial conflicts-of-interest are significant. The FSPHP is both illegitimate and irrational authority.

    An evidence-based scrutiny of the literature would reveal their research to be invalid and of little probative value.

    A public policy analysis would reveal the logical fallacies involved in trumpeting their positions including exaggerated rhetoric and fear monitoring strategies designed to inspire moral panics and exploit fears to further an underlying political agenda

    A critical analysis of authoritative opinion would reveal cherry picking. proof by anecdote, deceptive propaganda, double talk, contradictory, illogical and incomprehensible jabber, unprovable and un-disprovable statements and a panoply of logical fallacy.

    These groups misrepresent, censor and suppress. They nit pick and split hairs. The concept of denial is not just used to force people into treatment and justify abuse during treatment but to suppress specific questions and deliberately avoid key facts.

    The next step needs to be exposing the Emperor has no clothes. Once this is acknowledged it would not take long to address directly the specific problems and erroneous assumptions of this paradigm through the lenses of science, critical reasoning, ethics and common sense. If this were to be done the entire Potemkin village would fall like a house of cards.

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    I’m an early career doctor. I got mixed up with a PHP due to an error. PHP tried their best to label be dependent on alcohol. It didn’t work because I don’t drink and I had strong supporters and testimonies.

    The PHP director gave me a choice: spend all my money or ruin my career. I have no reason to be involved with the PHP. I have wonderful documentation of everything. I would love to see a few PHP directors in jail.

    I had committed lawyers, great documentation, and powerful supporters, and I am lucky to be out of PHP’s reach now. I can get back to my patients now. I can easily see how another doctor in my position could be murdered by coercion from the PHP.

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      This is unusual as the PHPs have taken a Machiavellian and “stand your ground” approach to their decisions. They usually do not negotiate or back down unless they have their backs to the door. As I am sure they did not reconsider the facts or have a change of heart. Something must have threatened them. Could you tell us what it was that caused them to retreat?

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      Sad. So how did you prevail when others do not?

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      Orwellian Napoleonic law with no due process. Do you think lawyers would put up with this for one second?

      WWJDD?

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        No.

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          And what is the fundamental difference in character between lawyers and doctors?

          Lawyers FIGHT, they are not only willing to do so, some REALLY DIG IT. Doctors consider is “unprofessional” to fight. Even though lawyers are professionals too.

          Doctors are like British generals who sent columns into machine gun fire at the Battle of the Somme in WWII cause that was the honorable thing to do in the Boer War or whatever. The honor strategy is obsolete and it is getting our troops killed.

          I don’t expect this to change anytime soon. Moses waited forty years in the desert so that the servant mentality would disappear. I’m just appealing to the minority of doctors who get it or who are starting to come around.

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            Disagree. Lawyers may fight when their own ass is on the line (and they generally don’t have malignant Bars or Legal Assistance Programs), but in terms of defense of docs, most have been pretty lazy and even deferential to the Boards. After all, a lot of them are chums. Why disrupt the gravy train? I can’t get over the fact that no lawyer has ever challenged forced out of state evaluation, inappropriate extended in-pt treatment, the shaky corporate and legal basis of PHPs, the medical liability of PHPs, the use of polygraph experts, use of explicitly contraindicated lab tests, violation of confidentiality under both HIPAA and 42 CFR Part 2, violation of HCQIA …. As bad as the PHP scourge has been, the performance of legal representation has been abysmal. One can only conclude 3 causes: incompetence / laziness of counsel; deferential bias (pre-existing relationship with Boards legal staff); or “law-for-profit only,” i.e. run out of money, you done run out of justice.

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      Congratulations to you and your lawyers! Amazing what it takes to extract oneself! Care to say what strategy your lawyers used to make the predators back away? And over what period of time and at what $$ cost?

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      I am glad you escaped! I didn’t think escape possible.

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    State Physician Health Programs (PHPs) were originally developed by competent and caring physicians to both protect the public and help sick colleagues who developed problems with addiction or substance abuse. The current system does neither. These programs have been taken over by a group that does not represent the best interests of doctors or the patient public. Physician health programs are not the problem. We need PHPs. What needs to be addressed is the current management of them under the FSPHP. This group has created a culture of impunity and harm.while effectively removing due process from doctors while removing answerability and accountability from themselves. There is no oversight, regulation or accountability. They are a power unto themselves with carte blanche managerial control. The horror stories are real and mounting. They are also consistent. Egregious ethical violations, forensic-fraud, diagnosis rigging, and other crimes are being reported. It is a system of institutional injustice and organizational sham-peer review. They have also convinced medical boards to give them complete autonomy when it comes to physician assessments. There is absolutely no oversight.

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      So PHPs were well run until recently? When did the “current management” and institutional injustice begin? Do you have a timeline?

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        In 1973 the AMA Council on Mental Health published The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence in JAMA. recommending that physicians do a better job of helping colleagues impaired by mental illness, alcoholism or drug dependence. The AMA defined an “impaired physician” as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or abuse of drugs, including alcohol.” This led to the development of state “impaired physicians programs” Often staffed by volunteer physicians and funded by State Medical Societies, these programs served the dual purpose of helping sick colleagues and protecting the public. PHPs are the equivalent of Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess, and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems.

        Most EAPs, however, were developed with the collaboration of workers unions or some other group supporting the rights and best interests of the employees. PHPs were created and evolved without any oversight or regulation.

        At this same time specialized treatment centers for doctors were being developed by members of the “impaired physician movement” such as G. Douglas Talbot who claimed physicians are unique because of what he called the “four MDs.” “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.” This was used to justify the thrice lengthy stay of doctors compared to the rest of the population.

        Doctors admitted to these programs complained of false diagnoses, coercion and abuse all under threat of loss of their licenses and in 1987 the Atlanta Journal constitution did a series of reports after five inpatients died by suicide during a four-year period at one of Talbott’s facilities (Ridgeview) and at least 20 more did so after being discharged.

        Critics of these boot-camp like programs included ASAM President LeClair Bissell and former Assistant Surgeon General John C. Duffy.

        But in 1995 The Federal Bulletin: The Journal of Medical Licensure and Discipline, published by the Federation of State Medical Boards published articles reporting the 90% success rates of PHP programs directed by ASAM physicians in 8 separate states. This formed an alliance between the FSPHP and the FSMB. This is when they gained a seat at the table of power and the FSMB accepted their offer of “rehabilitation” as an alternative to “discipline.” Since that time the FSPHP has duped the FSMB (as well as others) into accepting public policy and changing medical practice law to gain power and immunity. They also pushed for changes that removed due process and rights of doctors. To see how far this has gone one only has to look at the 2011 FSMB Public Policy Statement on Physician Impairment. The FSMB accepted “potentially impairing illness: and “relapse without use” as definitions and agreed not to second guess the PHPs. Medial Boards have agreed not to question their decisions. They have also introduced non-FDA approved drug and alcohol testing (LDTs) and these are being used by the PHPs. The conflicts-of-interest are immense both financially and ideologically.

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          You are a walking encyclopedia on this topic. Amazing.

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            Thanks. If I can clarify anything for anyone I am happy to do so. And unlike the group we are talking about I can reference sources, facts and documentary evidence.

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              Just curious Michael. How long have been at this? When did you first start researching PHPs?

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                Since July 1, 2011 when I was minding my own business and the Massachusetts PHP asked me to submit a blood test for alcohol and requested I have an evaluation at a “PHP-approved” assessment center. Since that time I have obtained documentary proof that the MA PHP is colluding with both the drug testing and assessment centers to fabricate false positive tests and the assessment and treatment centers to intentionally report normal tests as abnormal to support unneeded treatment. This will eventually be recognized as political abuse of psychiatry against the medical profession and those behind it are affiliated with the drug and alcohol testing, assessment and treatment industries.

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          I agree completely.

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          EAPs especially need to be cautious about signing a contract with these “specialized programs.” They will have not only sold their souls to the devil, they will have contributed to the derailment of good physicians’ careers. It is VITAL that they understand the malignancy and profit motive of these predators.

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            I actually don’t trust EAPs. And I was represented by a union for 18 years before my layoff and was an active member, serving on the negotiating committee for our contract. Nope. I don’t trust EAPs.

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            The “PHP-blueprint” iis merely a template for the “Nrw Paradigm” and that is the plan that has been in place all along as envisioned by Robert DuPont. In fact Gunderson alludes to it in her response to Pamela’s paper. If you do an Internet search with “new paradigm” “PHP blueprint” and DuPont you will find a lot of information relating to this and see how they are laying the foundation for exanding this to as many people as he can.

            The FSPHP do not represent the best interests of doctors but serving the interests of a business plan.

            Doctors are afraid to speak out of fear and intimidation because iit serves a purpose. The “recovery racket” ASAM and FSPHP are singing the praises of PHPs with no opposition. To sell this model to other EAPs as the next best thing you can’t have a bunch of doctors telling the truth about them. Who would want them? But by creating a culture of fear and intimidation and keeping doctors silent they can continue to claim “gold standard”

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              Well, they’ve laid the groundwork pretty effectively. “Preferred programs,” “preferred labs;” “PHPs really don’t do evaluations;” state sanction authority; complete immunity; no malpractice worries; denial of due process; no pesky oversight; complete control over career if non-compliant – and even if compliant; shaming of the victim and reporting to their employer. And now, the masterpiece – congressional endorsement and guaranteed insurance parity for extended hospitalization for oh-so-necessary treatment at the facilities we’ve set up especially designed for professionals.
              Wow! Sort of like insider trading, though that, even in great magnitude, doesn’t hurt people so directly.
              Wonder how many “in-the-know” docs who are members of the medical societies which proudly proclaim ownership of these PHPs have hopped on the bandwagon to own a piece of this action!
              It’s easy! It’s franchisable!
              All you gotta do is open a shabby facility, hire questionably-recovered drunks and druggies with a high school education and with a penchant for bullying and a delusional zeal about their being God’s angel here to rescue you from your illness to do the counseling; make friends with the right people at FSPHP (a little donation can’t hurt); and get yourself designated as a “preferred program.”
              And you’re guaranteed an endless stream of high-paying referrals who dare not balk because you now are powerful like the PHP you’re in bed with and you too can take away their license – just label them as “disruptive” and “non-compliant.” What a rush!
              And who’s going to believe THEM anyway – they’re just disturbed docs, officially stamped with the PHP imprimatur of infallibility. Docs now with zero credibility. And now no money to hire a lawyer! What a dream! What a golden goose investment opportunity for economically squeezed docs and morally depraved lawyers looking for a good income stream. It’s a virtual annuity! Do you realize how much you could make on mandatory testing alone?! 5 years of guaranteed monitoring! Even if they’re not diagnosed with alcohol or drub abuse issues! Wowzer!
              Before he blueprint goes public, you really want to get in on this!

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              It sounds like a big chunk of the problem is that PHPs have apparently been allowed to become, first and foremost, a lucrative, profit-driven business when they should be nonprofit organizations with the central mission of helping and healing docs, not making as much money as possible. Frankly though, this doesn’t surprise me since I think our entire healthcare system has been allowed to become a profit-driven big business in which making money is the main goal. In the profit-driven business of healthcare in the US, why would PHPs be any different? The people who are deeply vested in, at all costs, keeping it this way are the ones who are making the money. It’s hard to attack PHPs for making tons of money off of some doctos’ misery when our entire healthcare system is making tons of money off of patients’ misery. That kind of money and corruption come hand-in-hand.

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            The grand plan of these criminals is expanding the PHP model to the rest of the population. What is happening to doctors

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      It would seem that a system that has no oversight would also have no enforceability. If the source of their power is the legislature, then we need to reverse that legislation. I recognize that’s a long-term solution (and to necessarily even accomplishable). Then next step it would seem is to make it clear that certain states are to be avoided at all costs. Effectively, a physician embargo.

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      I am in total agreement.

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    I would like to hear from supporters of PHPs please. Recent articles on Medscape are filled with tragedies from those who have been injured by PHPs: http://www.medscape.com/viewar… and http://www.medscape.com/viewar…

    It is my objective to hear from both sides. If you are a doctor, please comment if PHPs have helped you with your mental health. As a physician who is extremely concerned about all these physician suicides (just off the phone with another doc who lost her colleague) and I need to know what we are doing (or not doing) as a profession to help or harm our vulnerable colleagues.

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    This is sad, and not limited to the healing professions. Aspiring lawyers must go through a bar admission process that in many jurisdictions still requires disclosure of any past mental health issues. I’ve known cautious law students who have discontinued seeing psychiatrists and stopped taking medication so that they could honestly answer “No” to these types of invasive inquiries. Regulators might say that this is an unwarranted over-reaction, but try explaining that to risk-averse-by-nature law students who are spending more than $100,000 for a professional education that will be useless in the absence of a license to practice. These types of mental health inquiries by licensing boards (which have no particular expertise or competence in these areas) are useless and counter-productive, and should be prohibited by law, in my opinion.

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    The following is a quote from an article on physician suicide by W. Clay Jackson, MD featured on the PsychCongress Network this morning:

    “Clinicians’ risks for suicide mirror those of general society in many ways, but differ in one critical area: the
    intense sense of personal identity tied to the professional role,” said Dr. Jackson. “When that identity is threatened, physicians are at high risk of depression and self-harm.”

    Need I say more?

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    Hello all. I am so grateful for this posting. This is SUCH an important issue. I certainly felt more despairing when, due to a history of depression alone (no other significant illness, no substance abuse, no malpractice, excellent reviews by supervisors and colleagues during residency etc.) I was required to enroll in a 2-year PHP contract in order to get my license to practice following residency. The program required monthly visits with a case manager who asked me the same questions each time: had I abused substances, had I gotten in trouble with the law, had I complied with my psychiatrist’s suggestions, etc. – even though none of these had been the issue to begin with. They were asking the wrong questions. It also required reports every 3 months from a “workplace monitor” (a colleague), my therapist, my family members, and my psychiatrist, on my “behavior.” I was being treated as though I had committed a crime, when all I had done was voluntarily disclose on my licence application that I suffered from depression and had VOLUNTARILY chosen to take medical leave twice for a few months during residency, for more intensive treatment. I had an impeccable professional record and still do. This was extremely humiliating and the restrictions I had on my license (the fact that I had to comply with this monitoring program) have followed me every time I have had to apply for hospital privileges, or a license in a new place. Certainly the demoralization of this process exacerbates/exacerbated my depression, and exhaustion. I think we certainly do need programs specifically designed for physician mental health, but that these programs need to be there for the purpose of helping physicians – NOT for the purpose of policing them. I realize some physicians with mental health issues can at times be a risk to patients, but most are not. PHP’s need to match the services they provide to each individual physician based on individual issues/risks/needs.

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      Given your experience, what program would you wish that you had available to you? What would you suggest that we offer to support (rather than punish or police) med students and docs. Thanks.

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    I find it interesting that the FSPHP continues to compare doctors to pilots. Also interesting that, on the whole, it is likely that both pilots and doctors routinely perform their tasks with a serious lack of sleep. No cause for concern here? Frankly, I would rather have my surgeon or pilot drink a beer before work than reporting for work after only 2 or 3 hours sleep. Interesting that the house of medicine, at least during training years, has actually been designed to keep doctors awake all night and all day and then expect them to perform well. This is institutionalized impairment. What about protecting the public from this? Where’s the outcry?

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      They often use the nuclear power, airline and railway industry as examples of “safety sensitive” occupations that use drug testing in their push to randomly test all physicians. The big difference is that these three agencies follow strict Federal Workplace Drug Testing Guidelines and use only certified labs and FDA approved tests. These industries follow strict procedure and protocol using strict chain-of-custody procedures and MRO review. There is accountability and oversight. In addition, these industries have unions or other groups looking out for the best interests of their employees. Doctors do not. This is how non-FDA approved laboratory testing with no FDA oversight has been introduced into these programs. There are no safeguards. While government drug testing uses only certified labs the PHP system uses commercial labs using these “Laboratory Developed Tests” (LDTs) that they themselves pitched to the labs. The conflicts-of-interest are unimaginable and it is unconscionable that the medical profession has allowed their own to be tested with what is essentially junk-science. Just look at the history of the EtG introduced by Greg Skipper who was director of the Alabama PHP at the time. He claimed 100% specificity at an arbitrary cutoff level of 100, then raised it to 250, 500, 1000, 2000 to unknown as the test was shown to be unreliable and with no evidence base. Any rational authority would have taken it off the market but the PHPs just kept raising the cutoff leaving a wake of ruined lives behind them as they arbitrarily changed the cutoff and claimed it to be valid. This is not science but snake-oil carney hucksterism.

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        The Airline Pilots Association has been complicit in all of this. They are not a union, but an association, that frequently, if not always, works against the interest of the pilots they purport to serve. ALPA is a paper tiger; a political behemoth, if you will.

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    “Greg’s mother, a psychiatrist”

    This does not surprise me one bit. And while this article is about “physician health programs” doing more harm than good, I would also argue that psychiatrists are also guilty. Partly by self-selection and partly by virtue of psychiatry training, they have this desire to “fix” people. They pick up on verbal and non-verbal queues to figure out what people are “really thinking”, and they know how to influence people and change behaviors. One can not stop being a psychiatrist when they go home, it’s part of who they are. This weighs on people and may cause irreversible harm to those who spend a significant amount of time around psychiatrists. Anecdotally, out of all of my friends who I grew up with, only 1 has ever had a significant physiological problem, this actually required hospitalization during high school. Not surprisingly, one of his parents is a psychiatrist.

    On the other hand, short 15 min appointments every few months are beneficial for many people with mental health problems, I will always refer these patients to the experts if needed.

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    Please post directly to Doris Gundersen, FSPHP response, Medscape. She needs to hear from all of you.

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      One gets the sense that she and her affiliates don’t particularly want to hear critical feedback. Interrupts their firmly held notion that anyone who objected was just in denial or a defiant troublemaker who hadn’t done their 12 steps of submission. It’s very difficult for people like this who live in an insular world of magical thinking to accept information that challenges their fundamental assumptions. It literally blows their mind.
      It’s best they adapt quickly, because what truly is going to blow their mind and their pocketbook are the suits for intentional misdiagnosis, operating without a medical license, involuntary detention, denial of due process, deprivation of civil liberties, physician patient endangerment, and patient endangerment (patients of victim physicians of these gulags). Every state that has let these programs run under state authority and immunity will face incomprehensibly huge punitive damages.

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        Let’s get started! Please advise what is best to do right now…Gail

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          Assuming Dr Langan wants it, doctors could start massively supporting him in his case to highlight what the MA PHP is doing and make an example of MA as just the tip of the iceberg of what many state PHPs are doing. Get tens of thousands of docs to sign a petition in support of Dr Langan. Buttons, t-shirts, bumper stickers asking “Where is Dr Langan?” or “Free Dr Langan” or “Who is Dr Langan?” or “What have they done to Dr Langan?”. He could become the Karen Silkwood of the reform PHPs movement.

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            I’m willing to do whatever it takes to expose this. I have documentary evidence of how they are colluding with both the laboratories and the “PHP-approved” facilities. Both of these are verified by outside groups and they were forced to correct the intentionally fraudulent interpretation. In addition I have proof of the Establishment Clause violations confirmed by outside groups.

            http://americanhumanist.org/ne…

            Not sure if you are aware of the Like-minded docs and their involvement in all of this.

            Both the 2011 ASAM Policy on Coordination Between PHPs, Treatment Centers and Regulatory Agencies and the updated FSMB Policy on Physician Impairment state that assessment and treatment must be at a “PHP-approved” facility. It is assumed that FSMB “approval” is based on some sort of objective qualitative criteria and quantitative measurements but this is not the case.

            The NC PHP Audit found that no objective criteria exists in choosing the out-of-state treatment centers they used. Warren Pendergast, FSPHP President at the time could not provide the State Auditor with what criteria went into selecting the places he sent doctors to for evaluation. His best response was “reputation” and “word of mouth.”

            This would be akin to the FDA being asked what criteria went into the FDA approval process and replying “word on the street” but no one has awakened to the significance of this disparity between rhetoric and reality. The “PHP-approved” facilities have a single selection criteria–ideological. All of the medical directors of these facilities are not only all ASAM “addiction medicine” doctors but members of a conservative fundamentalist group of doctors called “Like-minded docs.”

            The list can be seen here: http://www.likemindeddocs.com/…

            PHPs mandate evaluations only at “PHP-approved” facilities and the states enforce it. We have no choice. They give a false-choice by offering 3 or 4 options but they are all on this list.

            Therefore the state is mandating treatment at 12-step ASAM facilities only and this is an Establishment Clause violation. The fact that this is a hard-core 12-step group makes it even more pronounced.

            And look at all the other conflicts of interest. Greg Skipper introduced all the junk-science tests (EtG., PEth, Soberlink) and is behind the push to randomly test all doctors with his witch-pricking non FDA approved tests, Former Drug Czar Robert Dupont who owns the 6th largest EAP and is calling PHPs the “new paradigm.” He and Skipper are also authors of the PHP blueprint for which they claim an 80% success rate. ASAM President Stuart Gitlow is on there.

            So too is Paul Earley, the Medical Director at Talbott where the neuropsychologist reported a normal MMPI as abnormal to show “denial” and shaved points off My IQ test to show “cognitive impairment”in 2008. The GA Psychological association confirmed the MMPI fraud and forced him to correct it.

            Oh and Wayne Gavryck the MRO for PHS is on the list. After Luis Sanchez and Linda Bresnahan conspired with USDTL to add my ID # and a “chain-of-custody” to an already positive sample he was the one who was supposed to reject it. Like a firefighter arsonist he did the opposite. The MRO declared not only an invalid test valid but an intentionally invalid test valid. Based on that they sent me for an evaluation and gave me 3 choices and the medical directors of all three of them are on this list.

            http://www.likemindeddocs.com/…

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    While the title of the article borders on the sensational, some states’ physician health programs (PHPs) do drive some health professionals crazy! I agree with the sentiment of the article – PHPs need to evolve. They seem to be very good when a person has an addiction problem (e.g daily reporting online and via phone) and provide major legal cover so a health practitioner can keep his/her job… they may be addicted to pain meds and be stellar ER physicians, but they still need to work.

    Like some of the comments here already mentioned – read through your state medical board’s “monthly newsletter” about whose licensed got yanked or suspended. Nearly all of them have been relapses in egregious moral (and/or criminal) behavior, such as signing pain meds like candy (with inadequate record keeping), being drunk AND causing harm (car accidents, showing up drunk to hospital).

    For mental health conditions (that can indeed drive someone to drink, use drugs, gamble, etc) such as anxiety, depression, adult ADD, I recommend getting a thoughtful mental health team and keeping your “game face” on. Do not let anyone except your boss know, and only if he has to. Your colleagues will use it against you and if you DID NOT REPORT the “impairment”, you’re dead meat. That ADHD may sound minor but he’s not gonna like it when you have 55 patients in the office and you’re getting behind, or risk being called “moody”, “chronically late”, “disorganized”, or “dysfunctional”. INVEST TIME in your kids, family, exercise and relaxation time, and tell your family (esp parents and siblings, if alive) that even the strongest need to be held and pampered. A confidant in the same profession is a godsend…just make sure to keep this private.

    I have a med license in 2 states. What did they do for me (adult with longstanding history of depression, ADD and associated anxiety)? Nothing. I asked for a psychologist referral and told me to ask “my” health provider. The PHP of one state does nothing (unless you REALLY screw up more than once) and the other does nothing, but charges an arm and a leg, and threatens the physician with license restrictions and/or an investigation, which will stay in your records.

    And for the one who asked if a psychiatrist has to report a health professional to a state’s PHP. The answer is “it depends”. From my own experience – if you are showing signs of impairment and that has, or is causing harm to patients, he does have a responsibility to do something (urge you to get help, medical and legal, speak to your boss and HR staff and maybe take a leave, etc). In other words, he should serve as an advocate for your care, especially if he/she is finally seeking care. This is usually substance use/abuse. At least two academic physicians (one a psychiatrist) have told me “depression, anxiety, ADHD – those are OK to keep private or not disclose if someone has been in treatment for a long time and is medically/mentally stable”. However, if you have schizophrenia and bipolar disease, you should probably disclose as it may affect your decision-making process if you relapse.

    Lastly, I’m sorry about Greg Miday. His psychiatrist may have been more forceful and specifically tell him to forget about the PHP – he is the mental health provider and HAS to report the admission to the state PHP. However, Greg had a history of alcoholism dating back to his college years, and at several times was “enabled” by his friends and even his family at one point or another. You all know the individual – popular at med school, good looking, high grades, well-liked by everyone and seemingly unable to get into any real trouble. The guy’s designated friend/mentor to keep him sober committed suicide – a BIG red herring. Alcoholism and depression can co-exist, but are VERY different things. I have a history of depression, but not alcoholism. “Going out for drinks” is great to “smooth things out” after a hard day’s work. This guy rarely gets reported. The one with a history of depression that is showing signs of overwork, fatigue, and emotional lability? He’s the one with the problem. I would counsel doc with a mental health problem or chemical dependency problem to take their time when going “up the ladder” academically. Literally take 6-12 months and work as locum tenems or at the max 3/4 employed. Being a resident is a lot harder than being a med student, and being a fellow even tougher than a resident. Just my two cents guys. Now, gonna ride my bike with the kiddos.

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    Thank you, Dr. Wible, for bringing awareness to this problem. It is clear that our healers are in crisis and need help. I’m surprised the media, is being so quiet. Physician suicide should be brought out into the open and addressed. I think the silence surrounding this issue is making physicians feel even more isolated. Let’s continue to discuss, tweet and share this information online–so that it gets the attention it deserves!

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    Once again, I don’t believe the working conditions for residents and med students are any worse now then they were 30 years ago. What has changed is how uncertain are the goals and potential rewards for tolerating the abuse. Military recruits are willing to undergo the rigors of boot camp if the rewards are clear. If one wants to avoid potential drug abuse, depression or even suicide while undergoing medical training then one needs to be honest with themselves about the potential risks and benefits.
    Personally if I had to do it again today given what I know and where I started I would never do it. Motivation alone is often times not enough and one has to be realistic or face the consequences.

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    Thank you Dr. Wible for your continuing efforts to care for doctors. Anecdotally, I have many close friends who have been treated for anxiety or depression throughout their medical careers, or have seen a mental health provider at some point. Luckily, it’s never gotten to the point of substance abuse in their cases.

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      Have they had involvement with PHP programs? If so, was the experience a positive or a negative one?

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      Actually, it worked out okay. I saw a psychologist briefly in medical school and just talked to my PCP. My wife and several friends have seen a psychologist for depression that was provided by the residency program (the campus mental health program i think). I don’t think that these were true physician health programs, and the medical board was never involved.

      It’s actually been a good experience for me and my wife (who’s also a doctor). If our close friends have issues we tell them about our experience and have recommended they see psychologists (sometimes the same one). I’ve never heard of any negative repercussions from them.

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        So your care was handled locally by a therapist you trusted? That makes all the difference. I think that is all many docs wish they had the opportunity to experience for themselves. A safe place to go.

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          Doc Joe’s wife and friends got the help they needed for their depression through the med school campus/residency mental health program. It’s good to hear that this is being done without repercussions to the doc who sought their help.

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          It kind of raises a different issue why there is so much anxiety and depression in the medical field, but these were positive experiences for the most part. Currently, applying for another job is doing wonders for my outlook!

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            Watching people die. Telling parents there child died in the car accident. Amputating people’s limbs. Giving a dad a cancer diagnosis. This is no cake walk. Ya think docs don’t feel this stuff? What? Just go home and play with the kids and have sex with your spouse and bury the stillborn you delivered to the devastated mother. Really? Just kinda pretend this stuff doesn’t bother you. . . .

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              It bothers me sometimes, but it comes with the territory. I think it’s a privilege to care for people when they are at their most vulnerable, and consider it an honor. Other doctors have said it far better than I can, but the loss of autonomy and individualty/creativity are what bother me the most, along with all the data entry. I’ve said it in other posts, but we have new “interdisciplinary rounds” at the bedside that consist of hearing the nurse read a script, and we are given our own script/template to follow. That part is bad enough, but having our boss follow us around to make sure we are following the script is absolutely the final straw.

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        It’s good to hear from a doc who was able to get the help you needed with depression without having a negative impact on your career. And that your wife and several friends were able to do so too. It’s also good to hear that this help was available through your university/med school/residency program. It can be done. I hope you’re all doing well now.

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      Same question as Gail. Where did they get treated?

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    I understand comments are closing soon. Hopefully this will be a stepping stone to a larger discussion as the comments seen here show that the current management of the PHP system is causiing grave, far reaching and sometimes permanent consequences. No more doctors should die from this institutional injustice and organizational fraud. Naom Chomsky said “I think it only makes sense to seek out and identify structures of authority, hierarchy, and domination in every aspect of life, and to challenge them; unless a justification for them can be given, they are illegitimate, and should be dismantled, to increase the scope of human freedom.”

    Doctors need to stand up and challenge the current paradigm. As seen here these challenges will be met with silence because they cannot justify their actions. As an illegitimate authoity it is necessary we dismantle them and replace them with a transparent, just, accountable and fair system that actually does help doctors and protect the public. If we don’t do this decisively and urgently then darker clouds lie ahead for the medical profession and all of us.

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    To be clear: I am certainly no expert on PHPs. My video raises a question based on conversations I’ve had with suicidal docs. Many developed suicidal thoughts during their PHP treatment. I had no idea about any of this until hearing about Greg Miday’s death.

    Just raising the question. I am not one to demonize anyone. I do feel medical students and physicians are not receiving the mental health care they need in training (unrelated to PHPs). My focus is humanizing medical education and preventing physician and medical student suicides.

    I thank all of you who have participated in this heated conversation. I hope this will be the first of many conversations. We certainly need to heal as a profession. And I will echo Karen Miday that “we cannot afford to lose another physician to shame.”

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    I am lucky that I am not one of these statistics! After a left knee replacement, I had severe chronic pain, which turned out to be caused by a Staph infection, requiring a repeat knee replacement and a central line for IV Vancomycin. After all these facts came to light, the BOM and my attorney required me to join the PHP, which caused me to lose my Board Certification, and eventually my medical license. I considered suicide MANY times, but due to the love of family and friends, I had the courage to live. In spite of being clean and sober for 7 yrs., I will never be a physician again!

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    One of the architects of the current system, Dr. Robert Walzer, M.D., J.D. who was instrumental in tinkering with administrative and medical practice laws to remove the due process and appeal rights of doctors surrendered his license in 2001 due to inappropriate sexual relationships with patients. He was the co-author of the current physician health program paradigm. It is important to look at some of the backgrounds of those involved in this system as a number of them have histories of manipulating the system. Many were doctors who had their licenses revoked and got them back through the support of their state PHP. Many are felons and some are even double felons who had been convicted of criminal acts. This system often returns doctors to practice who should not be practicing medicine yet ends the careers and ruins the lives of many good doctors for little reason and without justification. It is as if the animals have been put in charge of the zoo.

    http://mss.fsmb.org/FSMBJourna…

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      How did your interview go Michael? Love to know!

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        They are currently reading through all of my blogposts and looking at the more than 700 comments here and on Medscape that make it crystal clear the current system is causing damage to doctors on a large scale. The comments raise specific and serious questions that are not being answered.

        Silence from authority is an acceptable stance when the criticisms are unreasoned and unfounded ad hominem attacks and generalizations based on bias and prejudice. But that is not the case here. The testimonials and criticisms are articulate, specific and remarkably similar. I’ll let you know as soon as I hear back.

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    You know, I feel like I’m walking in the same sort of Wicked Wonderland I had to survive as a child, growing up with two brilliant but flawed parents, who had obvious personality disorders and alcoholism. Maybe that’s why I am trying to do some good…to repair the damage.
    Still, Helen Keller said that one person alone can’t do that much, but together we can do a lot! I surely hope so.

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    Misinformation and propaganda have been used to treat doctors differently. Look at this quote from Marv Sepala who has close ties to the PHP and is medical director of “PHP-approved” assessment and treatment center Hazelden.

    “Few, no matter how desperate, seek help of their own accord.” “Physicians are intelligent and skilled at hiding their addictions.”

    “They’re often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.”

    This is just another example of authoritative opinion with no substantive value. It is moral entrepreneurship at its finest; the fallacy of appeal to authority and secret knowledge.

    If Seppala were asked to provide the evidence-base and rationality of these statements he would be hard pressed to do so.

    It is this type of misinformation and propaganda that allows the “impaired physician movement” to drag away the “best worker in the hospital” and deem him “in denial.”

    “We were so surprised. We didn’t even know he had a problem” say the nurses, patients and colleagues left behind.

    Well the truth is he probably didn’t!

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      Dr. Langan,

      I love your website and your spirit…I would also direct readers of this blog to a very important photo on your website:

      https://mllangan1.files.wordpr…

      WWJDD? (What would juris doctor do?) Not put up with this for one second.

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      You say succinctly here much of the conclusions I had drawn when I had a critical look at what is happening. It is deadly and very sad.
      PHPs must undergo major revisions or be abolished, since MB’s are the disciplinary authority (and that is a whole ‘nuther issue!)…If they aren’t going to act to identify scientifically who has a problem and who does not need their “help”, then work to heal that practitioner with state of the art methodologies, then they need go.
      As in good-bye/good riddance

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        Reclaiming sanity and civility in medicine requires swift and certain action. We need allies and activists.5

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          Agreed, Dr. Langan. Here is a glimpse of some of the logic being used by this group to identify a potentially impaired pilot:

          “An alcoholic pilot grows up, sobers up, gets locked up, or covered up.”

          “Heavy use of aftershave, difficulty during a recurrent event, and talking about marital or relationship problems in cruise. (see EtG)”

          “The time that presents the greatest risk for relapse in a pilot’s recovery is ‘release from monitoring’
          (see EtG)”

          “There is speculation that pilots have massive egos”

          I have noted that the HIMS page, on the alpa.org, website is now suspiciously absent though.

          Exiting your sandbox now. Thanks for allowing me to participate.

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    I encourage all of you to also join the discussion following the FSPHPs response to Dr. Wible’s articles on Medscape. The PHPs boast a very high success rate. This success is measured by clean urines. That measure counts my now deceased son as a success. He never dropped a dirty urine. So, as the saying goes, “the treatment was a success, but the patient died.” Let’s suppose we have a treatment with a 90% success rate, but also a very high fatality rate. Wouldn’t we want to take a closer look? Unfortunately, the PHPs do not want to discuss the outcome of the remaining 10%.

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      Will get on it

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      I’m doing so, but Dr. Gaither is really getting under my skin.

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      An 80% success rate is being claimed to parade the “PHP-Blueprint” and promote the “new paradigm” One of the first orders of business needs to be critical appraisal of the validity of this study and a conflict-of-interest analysis of its authors.

      They are pitching the PHP model to other EAPs as the “gold standard” for addiction treatment. It is also used to deflect criticism ( ASAM President Stuart Gitlow responded to Knight and Boyd’s critical PHP article with an editorial “Who can argue with an 80% recovery rate?) Doris Gunderson refers to it in her response to Medscapes criticisms.

      Articles such as “What Might Have Saved Philip Seymour Hoffman,” claims PHPs “ought to be considered models for our citizenry” and the “best evidence-based addiction treatment system we have going.” The author repeats the 80% success rate for doctors and claims Philip Seymour Hoffman might still be alive if he had been treated using the PHP model.

      The basis for these claims is a 2009 study published in the Journal of Substance Abuse Treatment entitled Setting the Standard for Recovery: Physicians’ Health Programs and authored by Robert Dupont, A. Thomas McLellan, William White, Lisa Merlo and Mark Gold.

      This study is the cornerstone of the “PHP-blueprint.” It is the very foundation on which everything else is based, a Magnum opus used to lay claim to supremacy that has been endlessly repeated and rehashed in a plethora of self-promotion and treatment community blandishment.

      To date there has been no academic analysis of the “PHP-Blueprint.” There has been no Cochrane type analysis or critical review. There has been no opposition to its findings or conclusions which are paraded as fact and truth without challenge or question and there is a general lack of concern from those both within and outside the medical profession.

      The study is a poorly designed using a single data set (a sample of 904 physician patients consecutively admitted to 16 state PHP’s).

      It is non-randomized and non-blinded rendering the evidence for effectiveness of the PHP treatment model over any other treatment model (including no treatment) poor from a scientific perspective. The study contains multiple flaws in both reasoning (type I and type II errors) and statistical analysis that render its conclusions invalid.

      In addition the impact of undeclared but substantial financial conflicts-of-interest (including funding by drug testing and addiction treatment industries) and personal ideological biases (including personal 12-step recovery from addictions) in the authors of this study also needs to be considered.

      Moreover the misdiagnosis and over-diagnosis of addiction in physicians in this paradigm incentivized by lucrative self-referral dollars for expensive 90-day treatment programs is a significant factor.

      The mean age of the 904 physicians was 44.1 years. They report that 24 of 102 physicians were transferred and lost to follow “left care with no apparent referral.”

      What happened to them? These are physicians with multiple identifiers (state license, DEA, UPIN, etc) not transient drifters.

      Of the 802 left in the program they report 155 failed to complete the contract. Of these, 48 involuntarily stopped or had their license revoked and 22 died with 6 of those being suicides.
This study is looking at defined endpoints while being monitored so 6 killed themselves while being actively monitored by the program. But what about the 24 that left with no apparent referral? It is unlikely the just left on a whim. There must have been some precipitant event.

      More importantly what happened to those 48 who were reported to the Medical Board for noncompliance and had their licenses revoked–that would be the critical time when this population would be at most risk for completing a suicide. That would be when hope was lost and the coerced physician, knowing that the fight was over, would take that step.

      It does not take a Cochrane review to see that the emperor has no clothes. This is not difficult. It is straightforward and simple.

      see more

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        Thanks for presenting this and your analysis of the flawed and unscientific study…the SINGLE study that all this BS is based upon. Much of the treatment of brain problems is based upon consensus, not well-designed studies that follow scientific methodology. Our poor patients! The diagnostic nomenclature is archaic and prejudices and persists even in DSM5! the axis thing is patently silly…and I can go on. Who asserts “personality disorders”. Is this based on solid science? It is all BS. My son told me this one—“spot it and you got it”…uncover the BS and understand it for what it is—all psychobabble, which destroys many, many lives, not just the lives of physicians.

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        Wonderfully researched and written, Dr. Langen. As a physican myself, and the mother of a young physician who died of suicide while under the supervision of his state (MO) PHP, I commend your effort to effect change. After my son’s death, the clinical director told my husband that Greg was “a model patient.” Gives one some idea as to how success is measured. Even if the 80% were true, wouldn’t we want to consider adverse events? Certainly no drug with that high a completed suicide association would ever be approved without a Black Box warning. No Black Box warning here.

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          Karen Miday @GGail Hirschfield Fitzgerald Yes we would. More concerning is what is the actual mortality rate here? What happened to those doctors who left voluntarily, involuntarily, or with no apparent referral and under what circumstances does this occur?

          Due to the severity of the consequences a 20% failure rate is alarming. 20% lost their careers that’s for sure and if you look at EAPs across the country for other occupations I would bet most people who completed them are still working in those jobs and most of those people had real illness.

          The 20% failure rate is most concerning because many doctors (if not most) monitored by PHPs are not true addicts.

          The problem is no one questions these studies.

          The FSMB, hospital administrators, insurers, and everyone else has accepted them as expert authority and their authoritative opinion as fact. It is this acceptance of faith without objective assessment that has allowed them to get whatever they want by claiming it is in the interest of public safety.

          By confusing ideological opinion with professional knowledge, the medical boards and others have acted as willing gulls each step of the way. No counter-forces existed and they still don’t.

          Junk science and unvalidated neuropsychological testing is used by these groups unconstrained and willfully. There is no regulation, oversight, or accountability.

          They are using polygraph testing (despite the AMA’s previous public policy statement deeming it junk) to both condemn “disruptive” surgeons and deem convicted pedophiles fit to return to work.

          They have introduced junk-science in drug and alcohol testing and unvalidated “neuropsychological” testing to detect “character-defects.”

          Their next step is to get rid of the strict procedural protocols used for drug and alcohol testing that protect the donor. They are claiming MRO review is unnecessary.”

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            An “innovative”program like a PHP ought to be held to rigorous evaluation with thoroughly measured parameters, such as “patient entry criteria,” “double-blinded assessment” etc. It is highly unlikely that any such study has even been done on any PHP program.
            In effect, a PHP program, aka “the Program,” is really like a medical device or pharmaceutical. These of course must go through rigorous testing before being put on the market. And if they’re found to be dangerous in “post marketing surveillance,” and have untoward effects that weren’t picked up earlier, for the public’s safety, they’re immediately removed from the market, independent of how many patients they allege benefitted.
            FSPHP’s fallacious “throwing the baby out with the bathwater” argument ignores this very principle. The “Program” is dangerous – it is killing patients and harming others’ careers and upending their lives. Yes, some bona fide substance abusing / dependent physicians have benefitted. And there’s another group for whom”the Program” is working quite well and who would really prefer that we go to all this bother: the inner circle of doctors, lawyers, path labs and recovered addicts who run this scam.

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    My hope is that everyone who has posted commentary will visit the FSPHP response on Medscape and post a comment directly to Dr. Gunderson. She needs to hear from as many people as possible. Has been too easy to dismiss the PHP “dissenters” as a “vocal few.”

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    To see how they are colluding with labs to fabricate drug and alcohol tests see my post below. “”Forensic” testing is tightly controlled with strict chain-of-custody procedures and MRO review to prevent false-positives. A single positive test can result in grave consequences so need to be rare. Most EAPs use only FDA approved tests and follow the Federal Employee Drug Testing Guidelines with strict procedure and protocol.

    Physicians Health Programs on the other hand use a variety of non-FDA approved tests of unknown validity on doctors. In fact a PHP director, Greg Skipper, MD, FSPHP of the Alabama PHP, introduced the first one when he pitched it to NMS labs as a laboratory developed test and then started using it on doctors to market it. It is junk-science testing of unknown validity and it is incomprehensible that the medical profession has allowed this to happen. But they are not only using junk science they are abusing junk-science. See below how they collude with the labs marketing these tests to intentionally give positive results.

    https://disruptedphysician.com/…

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      Yes, these tests are not standard, not scientific, and you have shown us all how they are “gamed”. The Emperor Has No Clothes…

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        The Emperor really does have no clothes. This is a Potemkin village built on misinformation, moral panics, logical fallacies and outright lies. The group that has erected this scaffold has somehow been exempt from the standards of care, professional ethics and evidence-base obligations of the rest of medicine. If you look behind the door it is an accumulation of authoritative opinion, junk-science and research designed to make the data fit they hypothesis. If a doctor has a drug or alcohol problem they should be diagnosed and treated the same way as anyone else. So why are they treated for 3 months or longer?

        Because G. Douglas Talbott put forth the urban legend that doctors are unique and have have incredible denial because of what he called the “four MDs.” “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”

        He states that “Impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.”

        Now some doctors are arrogant undisciplined egotists but narcissistic personalities exist in any profession and expanding traits that may apply to a small percentage of doctors to include all doctors as a universal truth contradicts reality. Applying a stereotypical paternalistic length of treatment in doctors three times as long as non-doctors to force a “one-size” fits all treatment on them has no evidence base.

        I would guess only three “M”s are involved. Medical Licence–as leverage to extort 2.More Money

        That is why we need to call B.S. from the get-go. Had someone called B.S. on this when he said it we wouldn’t be in the mess we are in today.”

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          Michael L. Langan Most people are afraid to “call BS” – it’s just an inborn trait. And in a healthy system, the BS eventually gets exposed and flushed out. But predators and bullies know how to manipulate that trusting docility and up the ante by assaulting dissenters. You’re right, if docs and their lawyers had confronted this menace in its early stages, we wouldn’t be here. But here we are, and the menace has become a well-embedded brutal tyrant and nothing less than overpowering force and a unified voice from those adversely affected is going to drive out this tyrant.

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          Word!

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        or “Often we have heard it told,
        All that glitters is not gold”—Merchant of Venice

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    PHPs have essentially been taken over by bad people over time. Doctors with integrity and moral compass who were not part of the groupthink were removed as the bad apples organized and gained power and control. What we are now seeing is the result of “corporate psychopathy.” For example in Massachusetts the PHP, PHS, inc. removed John Knight in 2009 and Wes Boyd in 2010. In 2011 PHS became a member of the Federation of State Physician Health Programs (FSPHP). In the past month alone I have heard from both a medical student and a a resident who were referred to PHS for minor issues unrelated to substance abuse or mental health. Both were told they had a problem and were in need of an assessment at one of the “PHP-approved” assessment centers and threatened with non-advocacy if they did not do so. This is extortion. It is a criminal enterprise using medical licenses and future careers as leverage all hiding under a veil of protecting the public.

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      Let me emphasize that is both unethical and immoral for one physician to disrupt the life of another so profoundly, but since the PHP will stop at nothing, their actions are criminal.
      Both criminal AND civil action must be taken against individuals and the group in these runaway PHPs.

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      This is extortion, fraud, racketeering, exploitation and other terms I don’t know the meaning of but some good lawyer would.
      Your last sentence says it all…but how to see that we all, especially those who have died at their hands, get the justice we deserve, we “good docs”?

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    Today (9/10/15) is World Suicide Prevention Day. What are we specifically doing to prevent physician suicides? And to prevent physician suicides within PHPs? I just got another letter from a PHP doc who intends to die by suicide.

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    After reading this article and responses what came to mind was some words of advice that Q gave in one of the James Bond movies. First, never let them see you bleed and second, always have an escape plan. For physicians the first has become painfully obvious leaving the second as our only controllable option. Our drive, compassion and intelligence has unfortunately not become enough to sustain us in an increasingly hostile world but if we have a good and viable escape plan it may just give us enough strength to go on.

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    The PHPs are colluding with labs (Quest, USDTL) to fabricate positive drug and alcohol tests. To see how easily this is done take a look at my post below. The records show how Linda Bresnahan from the MA PHP faxes a request to USDTL labs requesting my ID number be added to an already positive alcohol test and the chain-of-custody be updated. USDTL complies with the request without hesitation and provides PHS with a positive test identifying me as the donor. The docs are crystal clear and show deliberate, indefensible and unconscionable fraud. This misconduct (and subsequent cover-up) involves former FSPHP President Luis Sanchez and USDTL V.P. of Lab Operations Joseph Jones and appears to be standard operating procedure.

    These documents need to be made public and the significance of what this shows needs to be recognized and addressed. Some of the suicides that have been reported to me involve purportedly falsified tests that were used to extend PHP contracts. Joseph Jones seems to have no problem giving positive tests to people by faxed request and he knows that the consequences of such tests can be grave, far reaching and permanent. How many have killed themselves over deliberate misconduct like this. If that is the case these are more murders than suicides.

    https://disruptedphysician.com/…

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      The stuff you’re documenting needs some widespread exposure. This is 20/20 or 60 Minutes material. Have you tried to approach any mainstream media? Since you’ve been through this PHP system personally, do you think you’d have a hard time being taken seriously as a credible source? It’s a tricky subject to approach the public with since we do want to be protected from dangerous doctors. But I think the truth about PHPs needs to be exposed. Since docs risk retaliation by these PHPs and are therefore controlled by fear, it seems to me that there is more safety/less risk in numbers. One possibility is a petition exposing the abuse and corruptions of these PHPs, published only with many thousands of docs signatures (as many as possible) so nobody’s neck is out there alone.

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      Criminal—contact the FBI about it. Turn in a report.

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      This is the worst thing I have ever heard in my long career in medicine.

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      Unreal.

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        But it doesn’t end there. Once a test is fabricated on a targeted doctor the PHP mandates an assessment at a “PHP-approved” assessment center where they are willing to “tailor the diagnosis to fit the PHPs impression” of that doctor. They in partdo this by falsifying MMPI and IQ tests. I have heard from multiple doctors who report the same results I received on both. The MMPI interpretation shows a “naive and unsophisticated attempt to present himself in a positive light” and “unwilling to admit to even common faults” consistent with an elevated L (Lie) scale. To show cognitive impairment they shave a handful of IQ points off specific subsets of the Wechsler IQ test.

        I noticed the diagnosis rigging immediately in my report. The assessment was a combination of confirmatory distortion, fraud and cherry picking but it is difficult ot prove because 1. Most of the assessment is non-disprovable. and 2. They withhold records.

        As the MMPI was an objective test with standardized cutoffs and the report was false I thought if I could prove this part it would invalidate the rest (fruit of the same poison tree). I asked a neuropsychologist at MGH to obtain just my MMPI under the guise of continuity of care and requested the original scoring sheet, raw data and interpretation. They sent her the records which revealed the MMPI interpretation was made up out of whole cloth. This was no close call or ambiguous interpretation but a clear deliberate act to show normal test results as abnormal. I filed a complaint with the Georgia Psychological Association Ethics Board and they agreed. They were forced to correct the test. This was done only with their backs to the wall. Attorneys should be aware that I have heard from multiple doctors who received the same interpretation (which would be unusual in doctors as the L-scale usually does not work unless the person is naive and unsophisticated). This is a template to support denial and is part of the diagnosis rigging.

        https://disruptedphysician.com/…

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          The MMPI is little more than an expensive symptom self-check list dispersing disguised individual symptom criteria for most DSM diagnoses throughout the instrument. We were forced to take it in college and I thought it was a piece of s$#* that only served to treat the slimeball psychologist administering it as the supreme know-it-all (and he was one very odd case) and then again a few years ago as a well trained mental health clinician and my attitude is unchanged. In fact, it’s worse. I now think the MMPI is not only a worthless p.o.s. as a psychological instrument, it’s actually a harmful instrument and ought to be removed from the shelf. Same for that ancient p.o.s. the Rorschach.

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            YEP!

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            My L-scale T score was 49 and as its SD measurements from the mean that define abnormal and the cutoff for an elevated L-scale is 65 this was no close call. He made it up. Once the MGH neuropsychologist got the raw data and scoring sheet she wrote a letter documenting there was no basis for his diagnosis and I requested he correct it. He ignored these requests. I then got opinion letters from Multiple neuropsychologists st MGH and Harvard as well as the inventor of the L-scale and reported him to the Georgia Psychological Board thinking he would be held accountable. The Board’s “cognizant”reviewer deemed it a “difference of opinion” and blocked it. From going to full review even though the interpretation is a result of a specific cutoff . The “cognizant” reviewer just snubbed the opinion
            Of the originator of the test.

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          I have knowledge of very similar things happening at the diagnostic/treatment facilities, such as the physical examination reported in the record not being done, according to the physician patient. The record clearly shows on the physical exam “no marks or scars” when in fact the patient has had a total hip replacement and abdominal surgery with scars. The patient maintains he was seen in a room with no examination table, that he removed no clothing, and that a NP listened to his heart and lungs thru his shirt and undershirt. That was the physical examination but the record shows abdominal examination, neurological exam, etc. Clear case of fraud in my opinion, but I am sure it would be dismissed as “the wrong computer button was pushed.” And on and on it goes.

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          Yes, they will stop at nothing. You are a number, and an income source, nothing more/nothing less. They think, “hey! don’t take this personal, uh…” these thugs!
          Please take legal action, criminal or personal…they defamed you, that much is clear. With false information. Don’t you think you would win a civil case at least? I think a jury would see to it…and make sure press are at your trial.

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    The ocd story hit home to me. I was told I was slow handwriting vitals. Program director felt maybe I had a disability. My disability was I wanted to make sure I hand wrote accurate info and computer system was slow and disorganized. Eventually I just decided to do it faster and sacrific accuracy and no one knew the difference writing vital ranges.

    It was frustrating but senseless. Of course I had no disability. I cried and was sad for weeks. The only thing they came up with was that I should work to copy my numbers faster…. This remains a skill I have not used post residency… Copying sets of numbers from a computer repository of data for an hour and half a morning. I ended up calculating how much time I spent in tasks that most hospitals have a computer do and put it in a pie chart with things like seeing patients, synthesizing plans. I showed my pd that we all spent 80 percent of our day copying numbers from the computer to notes then the notes to sign out notes etc and he was kind of appalled we spent so much time doing dumb shit he let me go. He said it would be fixed in like three years when they replaced the shirty emr.

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      How sad. Hope you weren’t sent to a PHP with a r/o dx of “slow data entry disorder.” And then sent to a “preferred program” where they teach you how to enter data faster, and then put on a 5 year monitoring program where you have to use all of your strength to call on your higher power not to go into a homicidal rage.

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    @Dr Pamela Wible

    Pamela this is a culture of harm that operates on coercion, control, fear and intimidation. As you know I have been trying to expose the criminal activity at the Massachusetts PHP for some time. I am happy to say that it looks as if state Auditor Suzanne Bump is going to proceed with an investigation.

    I have been told that they now have enough statements from doctors and are going to proceed but this took some time as doctors who reported abuse were afraid to talk to a state agent even with guaranteed anonymity. Over 50% refused to make an anonymous call to the investigator even after being told they could withhold their names, hospital and any other identifying information. They were too afraid that the PHP would find out and punish them. One doctor I have known for 20 years who was Chief of his Department told me he just could not bring himself to do it because it could be a set-up. “I only have one year to go and don’t want to blow it.” This is the type of fear they have instilled in their victims. Most have developed a learned helplessness. There is no lifeline. Many probably have PTSD. This is understandable because they are used to no one listening to their truth.

    Doctors have been reporting misconduct and obvious crimes to medical boards, departments of public health, medical societies, law enforcement, the media and the ACLU only to be turned away. These agencies don’t believe the reports once they hear they have substance use or behavioral issues.

    In addition PHPs utilize “point people’ who are “like-minded” friends positioned at state agencies, ethics committees, boards and other places. These people block, dismiss and otherwise bury complaints. Physician Health and Compliance Committees on state medical boards are simply extensions of the PHP. Although they give an appearance of legitimacy they are simply lackeys of the PHP directed by the PHP. Board proceedings are simply sham peer-review.

    The policy of many states Attorney Generals Office is to blindly support the position of he Medical Board without consideration of the facts. They also will not investigate complaints of Boards and this apparently extends to PHPs as contractors of the boards. I am unsure how this has been established but complaints to AGO’s are invariably rejected without investigation no matter how serious or obvious the accusations. Complaints are simply ignored. Reports to the DOJ have also been unsuccessful. Political abuse of psychiatry, diagnosis rigging, lab fraud and Establishment Clause violations are simply ignored.

    Those who should and should be investigating are not and we need to find out why. It is most likely not an agency issue in most cases (with the exception of some medical boards) but a bottom up blockade specifically intended to bury complaints and prevent exposure. The usual channels are simply blocked. We need to circumvent the usual channels and make those of conscience and integrity cognizant of this public health emergency.

    see more

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      I’ve been studying physician psychology for nearly 50 years (both my parents are docs) and I now believe that doctors (with the exception of a few like my mom) are the most fearful group of people I have ever met in my life. Absolutely petrified to stand out, speak out, stray from the group. I implore you all to come forward and share your stories (even anonymously) here. Silence will not save us.

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        I agree at least in the developed world.

        The therapeutic state tempts the citizen with compassion then stabs him in the back.

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        You are absolutely right. Neither conciliation nor silence worked in dealing with Hitler. The malignant Hitlerian philosophy that’s infected PHPs needs to be treated aggressively. These programs are killing our fellow physicians. Of that, there is no doubt.

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          From the number of phone calls I am receiving from suicidal docs in PHPs I am concerned.

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            I agree – I think we’re at a crisis point. And opening this dialog is obviously going to make audible the swell of pain that has been so effective silenced. All have been discounted as either disgruntled whiners who deserve whatever diagnostic designation the infallible PHP assigned, or drunks and druggies in denial and clearly not in recovery because if we were truly in recovery, we wouldn’t be so angry.
            It’s like finally confronting the horror of intrafamilial abuse and captivity.

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      It will be great if the Auditor will do an audit. In NC we found that to be a tool to get the ball rolling.

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      That’s extraordinary that MA State Auditor is investigating. It would be in every state’s best interest to conduct a comprehensive audit as these programs, operating under the power of state sanction and immunity are exposing each state to immense liability once the due process and civil rights violations are exposed. And, as seen by the widespread case reports here and on Medscape as well as on Dr. Wes Boyd’s blog, these horrendous abuses will be exposed.

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      Good for you! I hope , hope, hope, you make some substantial inroads and other PHP authority figures will quake in their boots! (well, here in Texas). Look, PHP programs should not CAUSE PTSD! which leads to suicides. That is crazy in and of itself! MBs are bad enough—hostile, cause lots of death and destruction, and they resort to lies and deceit as well, criminal activities.
      This is as bad as the Mafiosa….they have all been reading “The Prince” or even “Mein Kampf” (well, I read the former, but not the latter) or Mao’s Red Book…

      but they are behaving as badly as the KGB and other terrifying organizations, and WE MUST STOP THEM! to save lives.
      PHYSICIAN’S LIVES MATTER
      The folks at FSHPH have plenty of blood on their hands, causing mayhem and devastation in physicians’ lives.

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    Reporting for work on 2 or 3 hours is routine Dr. Miday. This very much was and still is a culture of abuse, particularly at regional airlines. I often drank to get legal rest as schedules were not aligned, in the least, with healthy circadian rhythms.

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    there was a time when a trusted my doctor with whatever. Nix, no more.

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      Could you please elaborate? I hope my patients can trust my, my complete and total confidentiality, and I trust theirs as well. I really would like to know more of your thoughts here. Gail

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        I don’t know what to say really. But let me try: 1: Doctors works for huge cooperations these days. They are under pressure to create surplus. 2: Doctors make quick assumptions about patients. Kind of “know the type” based. Instant profiling, in other words.They don’t have the time to get to know you. 3: One doctor makes a mistake profiling you, it will still be all over, and follow you for the rest of your life. I always thought whatever I tell my doc. is between me and my doc. No more. Patients have no priv. 4: Docs fire patients if the are not obedient. 5: When I grew up, Docs had special number on the plate on their cars. Like 007 or something. If you heard some hysterically beeping the horn, it was probably a Dr. bringing someone to the hospital. some kid who had broken limbs because falling from a tree or something. Doctors worked real hard. Earned good money. They never had to feel smarter than anybody else. Because they were. Readers, intellectuals, knew the world. Conclusion: Patients private info is floating is floating around for thousands of “hospitalists” to read, and it might not even be true. I few of them will be my neighbors.

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    Coming up with a newer motto:
    PHP=Physicians Harming Physicians
    so far, that’s all I got. Any ideas? that don’t involve expletives?

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    I encourage all of you to also join the discussion following the FSPHPs response to Dr. Wible’s articles on Medscape. The PHPs boast a very high success rate. This success is measured by clean urines. That measure counts my now deceased son as a success. He never dropped a dirty urine. So, as the saying goes, “the treatment was a success, but the patient died.” Let’s suppose we have a treatment with a 90% success rate, but also a very high fatality rate. Wouldn’t we want to take a closer look? Unfortunately, the PHPs do not want to discuss the outcome of the remaining 10%.

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    I came across your this article and reading it was like looking in a mirror. The only difference is that I am a nurse, not a physician. We however, have programs that are the same thing. Due to a single dumb move, I reported myself to this thing because I was under the impression that it was the right thing to do. Little did I know that it would start me on the roller coaster of horror that involves yes, ethics violations, forensic-fraud, diagnosis rigging, questionable informed consent and so forth. For a single bad choice, I was consigned to the in and outpatient treatment in a drug/alcohol recovery place that was totally inappropriate, based on nonexistent/inappropriate diagnoses, a multi year contract, with stipulations that make it near impossible to find a job. I am basically under the same obligations as a person who stole narcotics from their patients. These programs pretty much have a one size fits all template. I have had the 12 step stuff crammed at me by the aforementioned zealots, coerced into signing a contract that was/is wholly inappropriate with requirements that are laughable at best (AA meetings? I don’t drink or smoke and never have) had heinously expensive at worst. Then, in spite of the advertised confidentiality one supposedly gets by having self-reported, this is now painted all over my professional license for any and every one to see. Due to the incredible lack of the least bit of empathy and the infiltration of “groupthink, etc” stated by a commenter above, I have had the worst possible experience. In a nutshell, I will have to discuss my mental health with every potential employer for the rest of my career.
    Having experienced this nightmare, I feel I can speak accurately, when I say that this “Frankenstein’s monster” of a program that is supposed to “advocate” for me (at least that what part of their supposed mission statement) has done me no favors, been of absolutely no help and honestly feels like punishment. Were there anything besides nursing that I could both love like I do and make a livable income with, I would do. Wholesale destruction of my career and reputation as well the immense expense on unnecessary treatments is not what I call advocacy.

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      And you self-referred? Criminals who turn themselves in get better treatment than health professionals I’ve talked to who have self-referred seeking mental health care.

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        Yup! Not a day goes by, that I don’t have to do something required of this program. It could be an AA meeting (which I truly loathe), a drug test (at my personal expense), their support group (which is all people with chemical dependency issues) or the restrictions at work (amazingly I found a job) rearing their ugly head. I realize I did a dumb thing and regardless of why, there are still consequences. I understand that, but this has become so very Monty Python-esque. I have to try and keep something of a sense of humor about it, because otherwise, well, let’s just call it a coping mechanism. My mental health issue is depression. Why, if treatment was in order, was I not in a setting that focused on that? How is being treated like an alcoholic/drug addict is supposed to help this? It is truly frightening what these programs are doing to our health professionals. I certainly had no idea what I was in for and I fear it is only going to get worse.

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          Sadly, one can only conclude from your and so many others’ stories (see also Medscape) that no physician should EVER go to a PHP, whether voluntarily, sent by their hospital or group, or even ordered by the Board. We’re going to have to disempower this psychopathic predators by active resistance and demanding of the PHP and Board proof that whatever diagnosis is postulated and whatever “treatment” is recommended has been shown to be justified. And to demand a self-chosen 2nd opinion.

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    As a patient it’s very hard to read that doctors abuse other doctors. What kind of position does that put us patients in?

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      The trickle down effect of an abusive medical system is not good for patients. For the record.

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      I think you can draw your own conclusions…we lose fine docs and who takes their places? I am not sure…less fine? less competent or experienced? I imagine so. I am getting older and am more and more a patient. I wonder who will care for me in the coming years, especially when it is obvious with Obamacare that my life will become less and less valuable “to society” as time goes by. We are in a Soylent Green culture right now, so it shouldn;’t surprise us too much that abominations such as we read on this site are happening.
      Dr. Wible, I think you have more optimism about the ability for us to speak out and make solid changes in the entrenched bureaucracies which will do anything they can to remain in power.

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        I’m a perpetual optimist. Can’t help it.

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          I’m definitely optimistic about us confronting and overthrowing this band of predatory psychopaths that have infiltrated and then overthrown the PHP movement and infected medical boards with their “our way or death” philosophy.

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          Me too. Sometimes I think I’m a pathologic optimist and you sound like you could be one too, Dr Wible. But some of us have to believe “it” can be done. As I’ve gotten older, I think I’ve somehow managed to retain a big chunk of my youthful idealism. But now I can be a pretty pragmatic idealist. I’m no purist but I’m probably a hopeless romantic.

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    I was never subject to these programs, but I did get a chance as a medical student to attend a special AA meeting called the Caduceus society at the Betty Ford clinic which was designed for such health professionals. Leaving aside the arguments about incorrect greek symbols, it was pretty inspiring to see so many doctors, pharmacists, dentists, and others working to manage their addictions and get better. And many people there did seem grateful for the program, including some who kept returning for years after they achieved sobriety.

    We hear about those who were negatively affected by the programs, but we don’t hear from the ones who went through it successfully, passed the five years of monitoring, and then never got in trouble again.

    That said, the entire field of addiction medicine isn’t very evidence-based. There is a lot of reliance upon AA, which has never been proven to work more than just leaving people to their own devices, and which has a spiritual component which may be offensive to some atheist/agnostic physicians.

    There is also the reality that we as a profession have a responsibility to the public. Patients have no idea if their surgeon is secretly alcoholic or otherwise impaired. It is up to the medical boards to decide what constitutes impairment and to try to protect the public. Perhaps they should be more understanding. But suppose that Dr. Miday was a surgeon whose patient died. If it came out afterwards that he was under monitoring by the medical board which allowed him to keep practicing after he relapsed into alcoholism, and may have had alcohol in his system when he operated? Could you imagine the public feeling of betrayal? Instead of the medical board trying to monitor and treat doctors, we would have District Attorneys demanding random drug tests and pursuing murder charges for any physician with a substance abuse disorder.

    Above all else, I have no desire to be on a medical board, charged with making these decisions…

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      Well, to begin with, my son was not a surgeon. He was, however, a hospitalist who covered the entire internal medicine section of Barnes Hospital, primarily overnight, with one other “nocturnalist.” Like most doctors, and especially those in a hospital setting, he did not work alone. He worked with many nurses and other professionals. He also had contact with many attending physicians via phone during his overnight shifts.
      None of these fellow professionals ever saw him impaired in any way. He was actually admired by most of his colleagues for his medical acumen and dedication to his work. He did not drink when he was working. Substance Use Disorder occurs on a spectrum. The assumption that a heavy after-hours drinker will always progress to drink when working is absurd. There is no one size fits all prognosis. There is no one size fits all treatment. This is the mentality that is propagated by AA and twelve-steppers who have become zealots. It is not evidence-based, and, in fact, is completely irrational. Please understand that I am in no way suggesting that my son was not in need of treatment. He was. In fact, he was planning to go the Harris House, a public recovery center in St. Louis. It was his hope that he might be evaluated and treated in a less restrictive, and local setting. His PHP appeared to have other plans for him.
      But speaking of surgeons, I hope you are aware that Halsted, one of the founders of modern day surgery, was addicted to cocaine for much of his career. We should all be grateful that PHPs weren’t around when he was practicing.
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        Ma’am,
        I’m so sorry for your loss.

        I am indeed aware of Halsted. He was treated according to the best practices of the time, which converted his addiction to cocaine into one for morphine. He had many great achievements, but his failures are rarely cataloged or mentioned. One wonders just how many patients were mangled and died when he operated on them during his “off” days. I think it is a good thing that medicine is no longer quite in the old days, when a code of silence kept exposing patients to doctors like him.

        I don’t know if you’ve seen this story:
        http://www.texasobserver.org/a…

        I think it shows why I am ambivalent on the issue. Someone still needs to protect patients from impaired doctors. Have these programs gone too far? Perhaps in some states, but clearly in states like Texas, they have not gone far enough. It is a very, very nuanced and complicated issue.

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          Halsted became addicted to cocaine in 1884 and was subsequently sent to Butler Sanatorium in Providence RI where he was converted from cocaine to morphine and discharged in 1886.
          Unbeknownst to most, he remained a morphine addict until his death in 1922. Observations of Halsted during this time period are well recorded and by all counts he was careful, methodical and precise. I am unaware of any mangled or dead patients on his “off days” which surely would have been mentioned in the written observations and reflections of his colleagues, many of whom kept personal daily records as was common at that time. All observations of Halsted reveal quite the opposite. He was noted to become reserved and withdrawn after returning from Butler but nothing suggesting “off days” is recorded to my knowledge.

          You state his “failures are rarely cataloged or mentioned” implying a large number exist that you are aware of. The only failure I can think of is a poorly written manuscript he sent to a medical journal for publication while cocaine addled. I am curious if you could specify some of these failures?

          Or are you just assuming mangled and dead patients based on the fact that Halsted was addicted to morphine? There is no evidence-base to conclude Halsted mangled or killed patients. There is also no evidence-base that “impaired physicians” are contributing to patient morbidity or mortality as far as I know. Could you tell us what evidence exists to suggest “impaired physicians” are causing patient harm? Certainly we don’t want doctors under the influence seeing patients but the alarmist message that denizens of drug-addled doctors causing mayhem in our hospitals seems to have no factual basis and the “culture of silence” is based on one small study done by the ASAM/FSPHP.

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            Are you implying that a surgeon, a known opioid addict, who actively testing positive, should be allowed to keep operating while intoxicated on morphine if his colleagues think he is fine?

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              Please point out where I said that. I asked you specific questions and you respond with a “straw man” argument. This and your and your use of other logical fallacy commonly used by those promoting these programs ( “appeal to consequences,” “appeal to common practices,” etc.), proof by anecdote, and use of misinformation with no evidence base is all part of the canned spiel pathognomonic of those involved. What is your affiliation with PHPs or the drug and alcohol testing, assessment and treatment industry? I would like to redirect you back to my original questions.

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                When you spend 3/4 of your response talking about how Halsted didn’t hurt anyone despite operating while intoxicated with morphine, the implication is that you are okay with a surgeon’s friends and colleagues turning a blind eye to active substance abuse, so long as they don’t “hurt anyone”.

                Let me put it this way. Do you believe what Halsted did should be acceptable in today’s medical practice? If not, why are you defending him?

                And while we are making ad hominem arguments, what drug did you or a “friend” test positive for that has you so passionate about the issue? If you read my original post, I MENTION THE LACK OF EVIDENCE AND MY HESITANCY OVER THE PROGRAMS. I am not some rabid inquisitor. I just think this issue is complicated with arguments on both sides.

                There is no evidence. We can’t even tell what makes a good doctor, or when a complication is a surgeon’s fault. How can we possibly know what the intoxication rates in the profession are or their implications? But as anecdotes like the Texas neurosurgeon illustrate, there must be a balance between treatment/help and coercion/enforcement.

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                  Halsted’s contributions to medicine are incalculable and vast. He not only revolutionized surgery and introduced many of the procodures we use today he shaped modern medicine. Halted is credited with changing the approach of medicine and surgery from its previously unrefined reputation to a more calculated manner. He is the father of careful, slow methodological surgery. He also happened to be addicted to morphine.at the time.

                  You stated he was mutilating and killing patients and there was a catalog size list of “failures” seldom mentioned. I merely asked you to support your statements.

                  I am in no way defending Halsted’s drug use but I’m defending Halsted. You portray him as a drug addled reckless surgeon maiming and killing patients is reckless and ironic as you are accusing the man who changed the entire profession of one of the very things he changed.

                  Hallsted may have had a “potentially impairing illness” but his achievements are real and immeasurable. Linking him to patient harm is not justifiable.

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                    Dangers of black or white thinking.

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                      Yes. the “impaired physicians movement” often uses Halsted as an example of how doctors can continue practicing medicine while impaired and how the “code of silence” allows it.
                      Multiple sources document his behavior when he was addicted to cocaine including his behavior in the OR. This is what led him to treatment at Butler in Providence where Morphine replaced cocaine.and to which he was addicted to until he died. No evidence of impairment was reported during those years but his achievements are prolific and numerous.

                      In all likelihood Halsted’s morphine intake was a constant measured dose that allowed him to function on a daily basis– s maintenance dose that was consistent. Whatever the case may be it is absurd to interpret the situation a century later in our current social, cultural and intellectual context.

                      Halsted changed medicine forever and made this world a better place. His contributions to public health and aseptic infection control alone saved untold lives. He is a hero and a legend..

                      But from the point of view of some people he was just an addict with a “disease” and noting else matters.

                      Black and white thinking, false dichotomies and either or thinking abound in this groupthink.

                      Thank God this group wasn’t around when Halsted was. But the question is how many Halsted’s are we losing today—snuffed out by zealots and self-appointed experts

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                        This brings to mind Winston Churchill, who was by most accounts a raging alcoholic. He still managed to save the entire western world. And, so yes, I would agree that not every substance using person is impaired. I am not suggesting that doctors who are clearly impaired should continue to see patients. However, this idea of “preventing harm” due to “potential” future happenings seems completely irrational and more likely to place more people – patients as well as physicians – at serious risk. Doctors are under constant scrutiny by both patients and colleagues. It is not rational to remove a physician until there is at least a suggestion of impairment (generally impairment occurs over some period of time, and does not typically happen acutely). I fear that if we continue on this course, the aging physician is certain to be next, because, of course, advanced age is a “potentially impairing” condition.

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                  Well, just to add to discussion about Halsted, I suspect that had he lived in today’s world, he would be most competent to perform as a physician if he were treated with MAT (Medication Assisted Treatment) using Suboxone. I wonder how many opioid addicted surgeons are given this option. This is current state of the art in addictionology. However, since it is not 12 step based, I suspect that most PHP’s do not endorse this approach. If I am incorrect, please let me know. And, thank you for your ambivalence on this issue. We are grateful for your dialogue. And, thank you for your note of condolence.

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                    My son did have a “potentially impairing illness” but so do physicians with insomnia, or too many sequential nights on-call. “Potentially?” “Really?” 90 days to treat a “potentially impairing” illness?
                    What ever happened to reasoned medical assessment and treatment? As a psychiatrist, I am well aware of the concept of treatment in the “least restrictive” environment. Let’s save the 90 day inpatient treatment (actually 28 days would likely suffice but would be far less lucrative) for those who are actually impaired.

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                      Exactly! Let’s treat the physicians in humane ways which are the most effective and the least costly, like we do with other patient the best that we are able to. Right?

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                      Part of the failure of one-sized-fits-all thinking. Humans are complex and deserve very individual and well-thought out treatment plans by a physician they trust. The therapeutic relationship is essential to compliance and healing. Why treat patients as criminals or guilty until proven otherwise? Many docs I have spoken to have turned themselves in to get help. They are actively seeking help, yet they are met with distrust and it seems an adversarial relationship rather than a therapeutic one.

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                    Nonetheless, Suboxone IS a street drug.

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                      Yes, true, but it is typically diverted to treat withdrawal sx. In light of the huge surge in deaths by accidental heroin overdose, it is certainly the lesser of many evils. It would be very sad, and in my opinion inconscienable, if it is not considered as a treatment option for opioid addicted physicians.

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                        I am not implying that it has no proper use, but the street thugs want anything and everything. They don’t think that deeply as to what it could be used for. However, why shouldn’t it be used to treat physicians addicted to opioids? if it is effective (I am an FP so don’t really know that much about this medication and its best uses!).
                        The treatment of addicted physicians is horrible, by the PHPs, that is…it isn’t treatment, it is a death sentence.
                        PHYSICIAN’S LIVES MATTER so let’s get on with the task of BEST PRACTICES!!! in the treatment of such medically ill physicians, and it there is oversight needed, let it be SANE and RESPONSIBLE!

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                    Which raises the question – who gave PHPs the right to dictate what is the correct treatment approach? Would we allow one group to dictate the treatment of Lyme disease? Depression? angina?

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                    Also appreciate this heated dialogue. Enjoy looking at this from all angles. I’m learning a lot!

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                    That’s an interesting idea. I am not familiar with suboxone. Is it addictive in any way? Can we ethically perform an experiment taking surgeons and looking at their performance on simulated tasks before and after suboxone administration? If it is proven, that might provide some ammunition to get PHPs and Medical Boards to start offering it to physicians.

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                      Suboxone is an opioid that is a partial agonist. It stimulates opioid recepters, but has limtied analgesic effect and no euphoric effect. It does, however, bind very tightly to opioid recepters, so that once in place, it is impossible to get high using opioids of abuse. And so, yes, it is addicting, but not imparing. It is a major advancement in the treatment of opioid addiction and has saved many lives. I really do not know if physicians are allowed to take it. I do know, however, that rigid 12 steppers see it as “replacing one addiction for another,” and so I suspect that PHPs do not allow it. Would love to have some real data on this, but, again, that is what we are missing, and the PHPs, via the FSPHP, certainly seem unwilling to provide us with any.

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                  No, there is nothing to substantiate that this was an impaired physician vs being a bad and careless one.

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          Was this fellow impaired and under a PHP program? No one is arguing that ill physicians shouldn’t have treatment and medical care, as a condition of practice IF NEED BE, or certainly that bad physicians who write their names on women’s uteri that they remove don’t need to be disciplined. That is not what is at stake here.
          What IS at stake is that what is going on is as Dr. Langdon described, a bureaucracy gone way out of hand and running on its own hidden agendas, not patient welfare, much less physician welfare.

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          The article you cite is interesting. Apparently, the neurosurgeon in question did not suffer from a mental illness or substance abuse. If he had, the PHPs would have quickly removed him. He was, however, completely incompetent. Interesting that we have no real system in place to remove incompetent docs – just ones who are perfectly competent (like my son) who have “potentially impairing” illnesses. Maybe the PHPs should be going after the docs who are really doing harm.

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            Excellent point.

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            There is another article which talked about the neurosurgeon’s cocaine and alcohol abuse- as reported by a roommate. I must have linked to a different one.

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              This quote is from the article you linked about Dr Christopher Duntsch. It makes clear that impairment from drugs and alcohol was an issue:
              “….After his license was suspended, Duntsch disappeared. At his home and office, my calls rang and rang before going to voicemail boxes that were full. It’s not clear how such a well-trained surgeon could have performed so disastrously, but the June 26 Medical Board report offers a hint: “Respondent is unable to practice medicine with reasonable skill and safety due to impairment from drugs or alcohol….”

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          Did I miss it? Was this neurosurgeon signed up with a PHP program? in Tx?

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            The point is that the Medical Board in Texas wasn’t powerful enough to MAKE him go into a PHP program and place him under monitoring and restrictions.

            Some states have PHPs and Medical Boards that are apparently far too aggressive. Others (like Texas) clearly aren’t powerful enough.

            My point is that it is a complicated issue, with positives and negatives on both sides.

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              Really? No, the TMB doesn’t make physicians sign up with a PHP, but if one doesn’t then the Board takes action. This could happen quickly.
              You have made your decision concerning the weaknesses of the TxPHP from one article, even though you say here he didn’t sign up for the it. I guess. So how could you then conclude it is not powerful enough? Did he have a mental illness or substance abuse problem? because if he was just a bad actor, then he is not qualified to go into this program, as poorly run as it is.
              Your logic escapes me. And it is off the topic of whether or not PHPs are so vile as to actually cause physician suicides and other deep harms. Is that something you care at al about?
              Remember—-
              PHYSICIAN’S LIVES MATTER

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          The fact that Dr Christopher Duntsch was allowed to keep peforming surgery is horrifying and terrifying. Clearly, nobody protected patients from this doctor.

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            Yes, but it has nothing to do with this particular topic.

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              I think it’s relevant. The article that VA linked said that Dr Duntsch had an alcohol and substance abuse problem. So what happened in TX that allowed him to keep performing surgery until he killed and paralyzed numerous patients? You can’t talk about eliminating/reforming PHPs without talking about the problem they supposedly address and what happens without them and what should replace them.

              In general, I’m on docs’ side here. But if you want to just stick to your talking points about how PHPs are horrible and inhumane to docs without addressing what happens to patients when docs go untreated, you’re going to lose me. The Dr Duntsch case isn’t exactly an unrelated tangent.

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      I think that medical providers should be identified IF they are affected by their illness enough to affect their medical care, IF that is done carefully, non-punitively, and effectively by an alternate program other than the clearly punitive or disciplinary mandate of the MB’s. I doubt anyone would disagree with me, that ill doctors should get treatment and that treatment should have proper oversight to ensure effectiveness.
      But I submit that is not what is happening now. Doctor, if you are one, you would do great on one of these PHPs as one of its “Board Members”, as it is obvious that you have an agenda.
      400 doctors a year, or two medical school classes, kill themselves. Often the last straw is when they have been duped into thinking they actually might get some understanding and help.
      Look, doctor, do you believe this?
      PHYSICIAN’S LIVES MATTER!
      or would you put some sort of qualifier on that? like, “well, yes but only if…”

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        We lose an ENTIRE MED SCHOOL. Not 2 medical school classes. The average medical school is 126 per class or approx 500 per school. 400 physician suicides is considered an underestimate due to miscoded death certificates and “accidental” deaths as noted here: http://www.idealmedicalcare.or…Also nobody is tracking medical student suicides which is likely 150+ per year in USA.

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        ” IF they are affected by their illness enough to affect their medical care”

        So… how exactly would you determine this? If someone is reported to the medical board because they were observed diverting drugs, and then tested positive, are you saying that nothing should be done until there is a clear incident in which that doctor kills someone?

        Performing surgery on someone while intoxicated to any degree is a violation of the Hippocratic Oath barring an extraordinary circumstance, and I mean MacGuyvering a chest tube in somebody on a plane extraordinary. Outpatient medicine, I’ve heard of some concierge doctors who have one and only one beer at lunch before going back to work, but they are few and far between. Most don’t think it’s okay to drink or do anything before that kind of work either.

        You can’t attribute 400 suicides a year to Physician Health Programs. Yes, some can be. How many? I have no idea- but neither do you. I’m not saying some of these programs aren’t behaving badly- but this is not a straightforward issue.

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          No one here would say that it is ok for impaired physicians to be able to harm their patients. However, the remedies in place are lethal.
          Did you even read the lead article? Doctors already dealing with mental illness including substance abuse are not helped, as the name suggests. They are put in a robotic system which feeds various organizations, are dehumanized and crippled by the process til they get out of it or are released in a few years, or are crushed and killed. THAT, my friend, is what is happening.
          If you, as a physician, think this inhumanity is ok, then I simply shake my head and hope never to meet you.
          Where is the AMA, the TMA? Why haven’t we physicians unionized? Who wants to join me in a letter to the ADA ?
          PHYSICIAN LIVES MATTER.

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          Of course one cannot attribute 400 suicides annually to PHPs. I don’t believe anyone is suggesting that. Regarding this concept of “potentially impairing illness,” I suspect that lack of sleep is the condition that impairs physicians most often. It is very interesting that this “potentially impairing” condition is not only overlooked by the medical establishment, but is actually seen as a way to prove oneself as a physician.

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          I don’t think she is suggesting all 400 are related to PHPs.

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      Docs who I have spoken with have told me they do not have a family history of alcoholism and began to drink to deal with occupationally-induced mental health distress. Where does a doctor turn for mental health support without repercussion? Physician Health Programs would imply by name that physicians could seek help with mental health, but their focus is substance abuse (which may be the end result of unmanaged mental health issues of our profession). My questions:

      1) Why wait for physicians to be in such a state of chronic mental distress before intervening? Why not help folks as a normal part of their workday? We are immersed in pain and suffering as a career. We need a place to go for support rather than drinking at night to numb the pain.

      2) Where do docs go for help with OCD, anxiety, and other distress (unrelated to substance use) that would not go on their record and negatively impact their ability to get credentialed and licensed?

      3) For those who are involved in PHPs are we certain that they are getting the care they need? Who runs these programs? What kind of education is required? What does prayer and giving up a medical condition to a higher power have to do with evidence-based medicine and science?

      I have more questions. I would like to hear from others. I find the ins and outs of PHPs and what happens to my colleagues a bit baffling and hard to understand. Is there a standard algorithm used for those who are in PHPs?

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        I’m a nurse practitioner who crashed and burned after 10 1/2 years in family practice. My last few years in family practice were a slow nose dive into hell. The grind was soul crushing.

        I loved my patients and they loved and appreciated me but the dysfunctional medical system did me in.
        As a sensitive soul called to a career to help people, I was doomed to fail in the current medical system that is focused on production while giving lip service to quality and patient centered care.

        I have no experience with PHPs but the concept alone raises warning bells. Just thinking about having to participate in a PHP back when I was struggling, depressed, unable to sleep, and having terrible anxiety is enough to give me a panic attack. We need a better way.

        We need to continue bringing our concerns up. We need to talk to each other. We need to refuse to be abused.

        I currently do short locums assignments and as I travel and meet other providers I find a great deal of stress and discontent in the medical profession everywhere I go. I love to take a moment out of my day and ask another provider how they’re doing. Unfortunately, many are too busy to even lift their head up for even a moment to talk. It’s a sad and tragic situation.

        Lets keep talking. Lets be compassionate to each other and to ourselves. We’ll figure this out someday.

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        It’s basically Soviet psychiatry for physicians with problems.

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        I think you will find another, positive perspective in Atul Gawande’s writings:
        http://www.newyorker.com/magaz…
        I don’t have access to the archive, but a version of it also appears in his second book, “Better”, if I recall correctly.

        It describes how a physician health program intervened in the career of a “Dr. Goodman”, an orthopaedic surgeon who suffered from gross depression and harmed dozens of patients. He almost committed suicide, until a program diagnosed him with depression, and saved his career (and possibly his life).

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          There is nothing wrong with a physician program as such. A program which helps physicians get better is great! Who would argue? But this doesn’t refer to a state program, and it is now somehow defunct—don’t you wonder why? I certainly do! I think that can bolster my argument, as I see graft and corruption, coercion implied here. Don’t you? At any rate, as this is referring to a private healing program, it is off-topic.
          but the state programs are not that…they are killers, not healers.
          PHYSICIAN’S LIVES MATTER

        • Avatar

          That is very reassuring. Thank you for sharing that.

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Robin Williams Melancholy Suicide–Hopelessness, Helplessness and Defeat

 
Published one year ago on DisruptedPhysician.com/blog.  Although more details have been revealed the premise of the post remains the same. Depression, as with any mental illness, needs to be diagnosed, monitored and treated by educated, trained and experienced experts in depression. Not self-proclaimed experts.  
 
There’s something in his soul
O’er which his melancholy sits on brood,
And I do doubt the hatch and the disclose
Will be some danger—which for to prevent,
I have in quick determination……..
It shall be so.    Madness in great ones must not unwatched go.
—Hamlet Act III, Scene 1
According to Radar Online Robin Williams is looking “grim and focused.”  Grim? Yes. Focused? No.  His visage is one of entrapment, despair, and dread.
In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”   This is not focus but melancholia–hopelessness, helplessness, and defeat.
In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract.”  Williams’ face  is weighted with melancholy. Not focus.

Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life  experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

As in all suicidal tragedies, the role of addiction and mental illness has been posited as the cause. Although depression and substance abuse are the two biggest risk factors for suicide, neither explains  completion of the act–the descent from ideation and planning to finality and oblivion.  Saying suicide is caused by depression and drugs is like claiming marijuana is a “gateway drug” to heroin.  It may be a a common related  pre-conditional occurrence but it is not the cause.  It is a non sequitur.   And just as most marijuana users never develop an inclination to stick an opiate filled needle into their veins, the majority of depressed individuals and substance abusers do not kill themselves.   One does not lead to the other.

And as we have seen in the reports of bullied teenagers who have died by suicide, it is all too often the bullies themselves who are quickest to pronounce this conclusion.   Attributing suicide to mental illness and substance abuse deflects culpability.  It negates the need for further inquiry.  It creates an absence of the need to change.   The rationalization diffuses both individual and collective blame.   It scatters  responsibility and guilt.  It is both an individual and community defense mechanism.  Incessantly and chronically shaming, humiliating, and degrading another person because of race, body type, sexual preference or whatever perceived eccentricity or non-conformity threatened the community herd was irrelevant.  It played no role.  It was drink, drugs, or depression–the unspoken understanding is  they would have done it anyway.   And no one stops to ponder that said depression or desire to alter ones mental state just might in actual fact be a symptom of the humiliation and shame they themselves created.   And it works.  The bullies are never held accountable. But it is nevertheless they who figuratively loaded the gun, placed it in the victims mouth, and pulled the trigger.

The  link between bullying and suicide is well known,  especially when combined with entrapment and the feeling there is no way out.  “They would have done it anyway.” No, they would not have and a modicum of perceived support, concern, kindness and understanding  from others may have prevented it.

Dr. Drew Pinsky seemed omnipresent in discussing Williams suicide; delivering authoritative pronouncements with seeming omniscience and certainty.     “The death of Robin Williams has led me to this plea — let’s loudly and seriously address something that’s still hidden, stigmatized and even ignored in this country: Mental illness,” Pinsky writes on his blog.  I don’t see the logic here.  How is exposing mental illness a product of Williams suicide.  He was  open, unashamed, and forthright about his prior addictions and depression.  He was not hiding it.  Neither is the 21st century for that matter.

The more important issue that I see needs pleading, is that mental illness be properly, accurately, and thoughtfully diagnosed and treated.

Depression, as with any mental illness, needs to be diagnosed, monitored, and treated by educated, trained, and experienced experts in depression.   Not self-proclaimed experts.     Pinsky’s specialty is “addiction medicine” and he is “board certified” by the American Board of Addiction Medicine (ABAM).

The American Society of Addiction Medicine can trace its roots to the 1954 founding of the New York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D.,  whose husband died from alcoholism. This  group promoted the concept of alcoholism as a chronic relapsing brain disease requiring lifelong spiritual recovery through the 12-steps of AA. And the primary goal of the ASAM is and always has been the acceptance of 12-step doctrine, lifelong abstinence, and spiritual recovery as the one and only treatment for addiction.  It always will be.

This philosophy and guiding doctrine stems from the “impaired physician movement”, a group that,  according to British sociologist G.V. Stimson: ” is characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”  This group grew in numbers, organized, and eventually became the ASAM.

The American Board of Medical Specialties (ABMS)  recognizes 24 medical specialties and subspecialties. Addiction Medicine is not one of them. The only ABMS recognized subspecialty is Addiction Psychiatry and it requires a four-year psychiatric-residency program followed by a 1-year Fellowship focusing on addiction in an accredited training program.

In contrast, ABAM certification requires only a medical degree, a valid license to practice medicine, and completion of residency training in ANY specialty.

Hazelden, the facility where Williams was admitted in July is an ASAM facility.  And the  Medical Director, Marvin Seppala is a Like-Minded Doc.   Unlike most ASAM physicians, however, Seppala is a psychiatrist. But he is a psychiatrist brought up in the folds of ASAM ideology. He was, in fact, the first adolescent graduate of Hazelden in the 1970s when he completed the program at the age of 19.

Pinsky, predictably goes on to state that “Williams had a brain disease, ” He posits it against demons or devils as if it is either/or.  This concrete splitting of complex subjects into two separate entities to claim only one correct is just one of many simplistic and misleading “false dichotomies” used by the ASAM.     Of course addiction is a brain disease.    But in reality the definition is unhelpful unless we are living in the Victorian era. It’s like saying Gonorrhea is a genital disease  not  venereal (from Latin venereus “of sexual love”).  In reality it involves a number of factors including both psychosocial and medical.  Cornering a definition does nothing to advance knowledge and care.

Addiction is multifactorial and diverse. Simplifying it into binary options does little to advance understanding.   And it too involves a variety of issues including the situational, the psychosocial, the genetic and the biochemical.   Like every other medical issue there are a number of factors to be taken into consideration.  And imposing the 12-steps to salvation on all-comers is not only illogical, but anti-science, and downright improper.    It can also be deadly.  Especially when the the person it is imposed on is not a full-blown addict but a substance abuser. an experimenter, a dabbler, or someone who has simply had a “lapse.”

The ASAM emphasizes that addiction is a “brain disease” and not a “moral failing” in a mutually exclusive construct that allows either one or the other but not both.  It is presented as a dichotomy in which the promotion of one both precludes and dismisses the other.  It is either black or white. Period.

But substance use, abuse, and addiction comes in every color, saturation, hue and shade.   Psychosocial, behavioral, and social factors play a role in the actions and deeds of everyone including those addicted to alcohol and drugs.  The disease concept neglects this multifactorial confluence of factors that ultimately produce a given behavior by viewing all behavior a product of the “disease.”   Any and all behavior is simply a product of a “brain disease” in the addicted individual who cannot be trusted to make decisions on his own but has to be told what to do as part of the treatment.   A danger to himself and others  the addict cannot be trusted to make his own decisions, so we must make them for him.

The chronic brain disease model is an oversimplification of the complex and a false dichotomy–so too is bifurcating  “recovery” and “relapse,” treatment” and  “discipline,”  and “confession”and “denial.”  Anything less than total abstinence constitutes an illness.

One true dichotomy  that exists among the proponents of the chronic brain disease model of addiction with  lifelong abstinence and spiritual recovery is  a  person is either “with them” or “against them.”

Dr. Drew Pinsky notes “there were a number of factors” that contributed to William’s condition.  He states “alcoholism is certainly one. He may have had a genetic potential for depression. Addiction and depression can be an easily fatal combination.”    Non-sequitur.

images-3 copy

Depression needs to be treated by thoughtful, educated, competent and trained experts in depression not self-declared experts.    ASAM doctors are not “real” experts.  They are pretend experts trumpeting one frozen paradigm while dismissing or ignoring others.  It is expert opinion where the goal is not new knowledge and and new discovery. The die  is cast.  And most of the “research” put out by this group consists of methodologically unsound studies published in their journals in which an attempt is made to make the data fit an already determined hypothesis.

Point being that depression needs to be evaluated and treated by trained professionals who understand depression. Psychiatrists, psychopharmacologists, neuropsychologists, and psychologists schooled in a broad spectrum of treatment modalities.   Numerous depression treatments are available.  If one treatment fails or is ineffective then others must be tried.    Most depression is treatable, especially subacute or acute depression.  SSRIs, SNRIs SNDRIs, tricyclics, MAOs, and atypical antidepressants are available. Different types of psychotherapy are available–cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, mindfulness therapy, and Jungian psychoanalysis can be beneficial for people suffering from depression.  And ECT and TMS can also play a role in depression refractory to medications and psychotherapy.

Depression is extremely common in Parkinson’s disease but due to the dopamine loss it requires special consideration of what drugs to use and not use.  SSRI’s can sometimes worsen the condition.   Consultation with a knowledgable and experienced neurologist is critical.

I do not know what assessments or treatments were being tried in Robin Williams.   But the treatment modalities offered by ASAM physicians are usually few to one.

The majority of “addiction medicine” specialists are not psychiatrists.   For all you know you may find yourself being treated by an addiction  “specialist” who was a practicing proctologist just a few years prior; and perhaps not even a good one at that.

Moreover, many of the ASAM physicians are “anti-medication” and may take people off medications that have been helping them and that they need.   And the devastating results are often  seen after the patient has been discharged home.

Taken off drugs while in rehab and sent home without them, the beneficial effects may wear off gradually. And as they do mental conditions may deteriorate.   Manic episodes, paranoid psychoses, extreme anxiety, and profound depression can all occur well after someone has been discharged home.   So can suicide.

And when this happens the ASAM doctors  blame it on their fatal “disease” when, just as is seen with the suicides of bullied teens, it was actually they  who put the gun to their heads and pulled the trigger.

Depression needs to be treated by experts in depression.   Putting someone in a one-size fits all shackled and frozen mold can be fatal.  And calling them  helpless addicts with a chronic disease who have no control due to character defects adds kindling to the fire.  Depressed people need empowerment not powerlessness;  self-esteem not shame.  Shame is devastating. It goes right to the core of the person’s identity making them feel exposed, inferior, and degraded.  Dehumanized, delegitimized, and vulnerable.  The link between bullying and suicide is clear.  And this is especially true when combined with entrapment.  The feeling there is no way out.

When society gives power of diagnosis and treatment to individuals  within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.   And it can be fatal.

Under a dictatorship everything else becomes subordinated to the guiding philosophy of the dictatorship.   Corresponding doctrine replaces ethics as well as professional guidelines, standards of care, and evidence based medicine.  Ideology usurps critical thinking.  Having only a hammer, everyone is seen as a nail  A symphony with just one note.

And faith in institutions demands mass adherence to faith in that authority. Direct challenge to the status quo undermines the publics blind faith. The biggest obstacle is thimages-4at this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration.

All of medicine needs to be predicated on competence, thoughtfulness, good-faith, civility, honesty, and integrity. This is universally applicable.  All specialties of medicine are required by that specialty to practice evidence based medicine and avoid conflicts of interest except one–addiction medicine.  Due to a confluence of factors they have been given a pass.

But the validity and reliability of opinions lie in their underlying methodology.  Reliance on the personal authority of any expert or group of experts is a logical fallacy.

And in order to save American Medicine this  problem needs to be clearly recognized.  The ASAM has a monopoly on addiction medicine. Treatment of substance abuse in this country is, in fact, defined by the impaired physicians movement paradigm.

A paradigm that is in actuality rife with methodologically flawed studies, cherry picking, bias, and cognitive distortion.  A paradigm that places expert opinion, ideology, and doctrine above critical thinking and evidence base.   Coercion and control are placed above patient autonomy and individual choice because the patient has a “disease” and can’t think for himself.  So we’ll think for him.    The  conflicts of interest are many and complex. They would be unimaginable in other fields of medicine.

But  I agree with Pinsky on one point.  His  comment that addiction and depression can be a deadly combination is true. And this is especially so when treatment of the addiction is the primary focus and consists of imposed 12-step indoctrination and the depression remains untreated or ineffectively treated.    That is a deadly combination indeed–and one that can easily lead a person down the road of hopelessness, helplessness, and despair. And it is time the medical field as a whole shined some light on this.  Let’s hold addiction medicine to the same standards of conduct and care as the rest of the profession.

10341576_1433278880276338_2453654675045984951_n

Clinical Psychiatry News (Letter to the editor) PHPs: part of the problem

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I was heartened to read Doug Brunk’s recent article on the need to address the problem of physician suicide within the medical profession (“Medicine grapples with physician suicide,” February 2015, p. 1). As a physician who knows of many suicides of good doctors, I have been working with Dr. Pamela Wible to expose this phenomenon gradually (as it is difficult to get one’s head around if presented all at once) and have been making some gains.

Another issue tied to the incredible stresses endured by physicians is rooted in the groupthink within state physician health programs (PHPs).

Dr. John R. Knight and Dr. J. Wesley Boyd (who collectively have more than 25 years’ experience with the Massachusetts PHP) have been trying to expose the ethical and managerial issues tied to the “diversion” or “safe haven” programs for physicians with alcohol or drug problems (J. Addict. Med. 2012;6:243-6). My posts on disruptedphysician.com also examine these issues.

Meanwhile, a 2014 performance audit of the North Carolina Physicians Health Program found that “abuse could occur but not be detected” and revealed conflicts of interest between the state’s PHP programs and “PHP-approved” assessment centers. Another key finding is the PHP “created the appearance of conflicts of interest” by allowing treatment centers that receive referrals to fund its retreats and scholarships for physicians who could not afford treatment directly to treatment centers. The audit also uncovered other disturbing practices that lead to undue pressure on North Carolina’s physicians. For details, check out the report here.

More recently, several health professionals have filed a class action suit in the Eastern District of Michigan against several entities, including the state’s Health Professional Recovery Program. The lawsuit alleges, among other things, that the involuntary program has become a “highly punitive” one in which “health professionals are forced into extensive and unnecessary substance abuse/dependence treatment.”

Getting the word out about the impact of PHPs on physicians (and other health care professionals) has proven difficult for many reasons, but we must remain vigilant. The health of our fellow physicians and the medical profession depends on it.


Michael Lawrence Langan, M.D.

Brookline, Mass.

Citation Details

Title: PHPs: part of the problem.(Letter to the editor)
Author: Michael Lawrence Langan
Publication: Clinical Psychiatry News (Magazine/Journal)
Date: April 1, 2015
Publisher: International Medical News Group
Volume: 43    Issue: 4    Page: 14(1)

Physician Suicide: The Role of Hopelessness, Helplessness and Defeat.

stewart_1

Although no reliable statistics yet exist, anecdotal reports suggest a marked rise inphysician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved.  What acute and cumulative situational and psychosocial factors are involved in the descent from suicidal ideation to planning to completion?   What makes suicide a potential option for doctors and what acute events precipitate and trigger the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5  Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9Hopelessness10,11  Bullying is known to be a predominant trigger for adolescent suicide12-14   One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17

The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20 Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing. 26 27  Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?  They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott.

Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals 33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.31

The Constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35  In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.” 31

According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37

The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions 38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39


Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“”These special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42  The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure.

However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43   He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced.

A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition state PHPs have no oversight or regulation.  They police themselves. Medical boards, departments of public health and medical societies provide no oversight.  Accountability is absent.

Moreover they have apparently convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.”

The “swift and certain consequences” of this are an effective means of keeping the majority silent.   Likewise doctors have been going to the media only to have the door slammed in their faces because the media has generally bought in to the “impaired” and “disruptive” physician construct these same people developed through propaganda, misinformation and moral panics.

Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect.

Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves.

And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.

With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  

The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair.

Locus of control is  lost.  Organizational justice is absent. The temporal relationship is clear.

Why is this still the elephant in the room?

This needs to be named, defined and openly discussed and debated.  How many more must die before we speak up?

Please help me get the conversation going.  I need allies.

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