In Reply.—Dr Rockwell notes that abuse of alcohol and other drugs accounts for an unfortunate number of reports of observing others working in an impaired condition and argues that these reported rates are unacceptable. We certainly agree that substance abuse accounts for a distressing number of cases of physician impairment and that any substance abuse by physicians is unacceptable. Our intent was not to downplay the impact of substance abuse but to broaden the discussion about impairment to include sleep deprivation, working too hurriedly, and incompetence, the issues most often cited by the residents in our study. We fear that substance abuse is too often written off as a problem for individuals. We meant to emphasize that the structural features of the residency training program also can conspire to produce a broad range of impairments in medical personnel.
Daugherty SR, Baldwin DC. Placebos. JAMA. 1998;280(8):699-700. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-8-jbk0826