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Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
In Reply: Program directors in our study believed
that alcohol and substance abuse were underlying causes contributing to the
poor performance of their problem residents "half of the time or more frequently"
in 2% of the cases. Similarly, the program directors responded that substance
abuse rehabilitation programs were helpful "half of the time or more frequently"
for 7% of problem residents in situations in which this intervention was felt
to be applicable.
In a national survey of resident physicians, Hughes et al1
found that, compared with nonphysician age-matched peers, residents reported
a higher rate of alcohol and benzodiazepine use in the proceeding month. Aach
et al2 outlined the responsibilities of
residency training programs in dealing with alcohol and substance abuse and
impairment among physicians in training. Recommendations focused largely on
the identification of these residents (by approaches such as referral and
self-referral), as well as effective intervention strategies (eg, confrontation),
and treatment options.2 Despite the effort
of educational systems, substance abuse problems among resident physicians
likely remain underdiagnosed. In a study of residents in emergency medicine,3 only 1% of current residents were estimated by
program directors surveyed to be impaired by alcohol, but 12.5% could be diagnosed
as having alcoholism by clinical criteria.
Alcohol and substance abuse may be underlying causes contributing to
some of the more frequently seen apparent deficiencies among problem residents
including poor judgment, inappropriate interactions with colleagues, and tardiness.
It is also conceivable that problem residents with apparent deficiencies (such
as a poor knowledge base) or other underlying causes of their deficiencies
(such as stressors or depression) look to alcohol and drugs as an escape from
Our study described the diverse and complex array of deficiencies seen
among problem residents and the range of underlying causes that should be
considered when faced with a trainee who is struggling. We believe that an
individualized approach with careful attention and consideration of personal
factors, including but not limited to alcohol and substance abuse, may result
in more successful management of problem residents.
Yao DC, Wright SM. Alcohol and Substance Abuse Among Medical Residents—Reply. JAMA. 2000;284(22):2874. doi:10.1001/jama.284.22.2869
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