DRUGGIE DOCTORS: THERE OUGHTA BE A LAW....

Of course there already are plenty of laws against drug abuse, by doctors as well as by everybody else -- but such laws contantly fail to achieve anything beneficial. There is no substitute for openness of information, a non-punitive approach and supervision by those with a financial interest in good practice

There's a joke doing the rounds of Sydney's medical fraternity following the high-profile case of Timothy Steel, the brain surgeon who appeared in court last week on cocaine possession charges. It goes like this: what do you do if you're a visiting medical officer at one of the landmark Sydney hospitals where Steel works. Answer: follow the white line.

Like many good jokes, this one has an extra edge because it touches a nerve. As the doctors who have been sharing this witticism know, and knew long before Steel's name hit the headlines, drug-taking within the medical profession is a real issue for a minority of its more stressed-out members. "I don't think you can possibly estimate (the numbers of doctors taking drugs), because the difficulty is this is happening without people knowing about it," says Narelle Shadbolt, a GP and lecturer in general practice at the University of Sydney. "Doctors have high rates of stress-related illnesses such as depression, anxiety, work-related stress, marital and work relationship problems - and the end result of that is drug addiction and suicide."

Shadbolt is in a position to know: she's president of the NSW Doctors' Health Advisory Service, a voluntary service set up some 22 years ago by doctors who saw a need for a confidential advice service for medical professionals in distress. There are similar services in every state and territory, catering for this numerically small but significant problem. The NSW one gets about 100 calls a year. "Doctors tend to be a group of people who are high achievers, perfectionist and have a very strong work ethic. Those of course place you at risk of stressrelated illness," she says.

The contrast with the general public is poignant: doctors have lower rates of lifestyle illnesses, such as smoking-related diseases and heart disease. But despite this their jobs can still exact a heavy toll. Shadbolt says rates of depression among doctors are two to three times higher than among the general population; alcohol and drug abuse is about two to three times higher; and the suicide rate is about three times higher. For those experiencing high levels of stress, the risk of substance abuse may be higher because doctors have a lot of knowledge about drugs, and also can get hold of them much more easily than most members of the public.

But having a greater knowledge about a drug's effects can leave some doctors with the dangerous and wrong idea that they can use a drug safely, Shadbolt says. "Doctors do believe they can keep it under control, and that's a very false belief." Simon Willcock, Shadbolt's predecessor as president of the Doctors' Health Advisory Service, says when a call comes in, about half of the time it's from the doctors themselves; in other cases it's a work colleague, or more rarely a spouse or relative....

Willcock gives presentations on doctors' health issues and says previous taboos on a doctor reporting another have largely disappeared. "When I talk to doctors about these sorts of things, I put it in three contexts. One is that it's a stressful environment that we work in; yes, we work under stress and that can push us towards a threshold where we behave inappropriately, such as using illicit drugs, and it can affect your relationships," he says. "But the next thing I then go on to say is that individuals need to take responsibility and know what these thresholds are, and destress and take their down time - and that's something doctors aren't good at. "The third thing is that the medical community needs to take responsibility (and identify colleagues). "That's the controversial one, because do you dob in someone you are worried about.

"I think doctors increasingly recognise that to talk to the DHAS about someonethey are worried about is in fact in that person's interests - it's more likely to help them in their career than hinder them in their career."

More -- much more -- here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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