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All Hospitals Should Require Drug, Alcohol Tests for Physicians

Johns Hopkins experts offer recommendations (May 7)

To improve patient safety, hospitals should randomly test physicians for drug and alcohol use in much the same way other major industries in the U.S. do to protect their customers. The recommendation comes from physicians and patient safety experts at Johns Hopkins in a commentary published online in JAMA.

In addition, the experts say, medical institutions should take a cue from other high-risk industries, such as airlines, railways, and nuclear power plants, and mandate that doctors be tested for drug or alcohol impairment immediately following an unexpected patient death or other significant event.

“Patients might be better protected from preventable harm. Physicians and employers may experience reduced absenteeism, unintentional adverse events, injuries, and turnover, and early identification of a debilitating problem,” the authors write.

They note that “mandatory alcohol–drug testing for clinicians involved with unexpected deaths or sentinel events is not conducted in medicine,” even though physicians are as susceptible to alcohol, narcotic, and sedative addiction as the general public.

The authors recommend in their commentary that hospitals take a number of steps as a model to address this overlooked patient safety issue. The steps are:

  • Mandatory physical examination, drug testing, or both before a medical staff appointment to a hospital. This already occurs in some hospitals and has been successful in other industries.
  • A program of random alcohol and drug testing.
  • A policy for routine alcohol and drug testing for all physicians involved with a sentinel event leading to a patient’s death.
  • Establishment of testing standards by a national hospital regulatory or accrediting body.

In cases in which a physician is found to be impaired, a hospital could “suspend or revoke privileges and, in some cases, report this to the state licensing board,” the authors write. Impaired physicians would undergo treatment and routine monitoring as a condition for continued licensure and hospital privileges.

“Patients and their family members have a right to be protected from impaired physicians,” the authors argue. “In other high-risk industries, this right is supported by regulations and surveillance. Shouldn’t medicine be the same? A robust system to identify impaired physicians may enhance the professionalism that peer review seeks to protect.”

Sources: Johns Hopkins; May 7, 2013; and JAMA; April 29, 2013.

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