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alcoholic med student

Arctic Char

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    what can he/she do? self-strong, no shame, determined, highly intelligent (excessively intelligent). aware of problem, but copes nonetheless, doesn't want to abstain. nor do they want to fail/drop out. has the highest marks in the class throughout, but is drunk (drinks to sleep) 4 nights a week. brilliant philosopher.

    i understand med advice on here is a no-no; but if anyone could, i'd love some input on this class dilemma. thank you
     

    Poety

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      MtMed said:
      what can he/she do? self-strong, no shame, determined, highly intelligent (excessively intelligent). aware of problem, but copes nonetheless, doesn't want to abstain. nor do they want to fail/drop out. has the highest marks in the class throughout, but is drunk (drinks to sleep) 4 nights a week. brilliant philosopher.

      i understand med advice on here is a no-no; but if anyone could, i'd love some input on this class dilemma. thank you


      we all did a class intervention with our class alcoholic during 2nd year - shes now in rads ;)
       

      OldPsychDoc

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        MtMed said:
        what can he/she do? self-strong, no shame, determined, highly intelligent (excessively intelligent). aware of problem, but copes nonetheless, doesn't want to abstain. nor do they want to fail/drop out. has the highest marks in the class throughout, but is drunk (drinks to sleep) 4 nights a week. brilliant philosopher.

        i understand med advice on here is a no-no; but if anyone could, i'd love some input on this class dilemma. thank you

        If this person doesn't fail/drop out before graduation, they will assuredly run into problems with their licensing authority SOMEDAY after graduation. I'm assuming you're still in pre-clinical phase, but he/she needs to get help NOW, before his/her impairment kills somebody (self included). By the way, once this person is seeing patients in an impaired state, if you know about it and don't report it--your ass is on the line, too.

        Not knowing the school or state involved, and how enlightened attitudes may be re: alcoholism there, you may need to explore options (probably beginning with your student assistance program/counselling center/dean of students etc.) available to this person, so you and other concerned individuals can begin to nudge them in the right direction. Let this person know that others think that this is a problem, and remind them that it is their PROFESSIONAL RESPONSIBILITY to do something about it! If they will not step forward voluntarily for help, there are probably mechanisms for anonymous reporting once patient care is involved.

        (BTW--suggest doing a google search on "impaired physicians" with name of your state, or reading through your state medical licensing board's website re: reporting requirements, and available Physician Recovery Programs which most states have.)
         
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        Museless

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          No alcoholic wants to abstain, but that's the only answer. (not says me, says AA) Until an alcoholic wants to change, and is willing to recognize his/her inability to have even one drink ever again, there's nothing anybody else can do.
           
          AA is not the accepted model for most mental health types. The harm reduction model is much more realistic, and based in science not religiosity. As a colleague you should tell them you are concerned and that they should get help, but unless they are working impaired it is up to them to make the changes. If they are compromising patient care by working impaired report them, otherwise try to help. Coming off in a holier than thou parental way will never help......
          I feel interventions are for families, not medical students.
           

          Arctic Char

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            thank you everyone for your input. because it is such a serious issue, i have to mention that this individual has not been in clinical settings as of yet - MSII -so has not treated anyone while being "impaired". but of course, the concern is the possibility of it happening in the future. thank you everyone.
             

            OldPsychDoc

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              psisci said:
              AA is not the accepted model for most mental health types. The harm reduction model is much more realistic, and based in science not religiosity. .
              Possibly true in California, but in the Midwest 12-Step based programs are still pretty much at the core of treatment models. Harm-reduction is fine for binging college students, but for people with pickled brains, I think you've got to aim at abstinence. Even so, I'd rather see this med student falling off the wagon on weekends at home than showing up hungover on rounds, or actively drinking while seeing patients, so it does have some value here. Anything that starts the process of moving this guy away from the sauce.

              psisci said:
              As a colleague you should tell them you are concerned and that they should get help, but unless they are working impaired it is up to them to make the changes. .
              Agreed. "Motivational Interviewing" rules! But this guy has got to see that his career is headed for the rocks in a big way soon, if it isn't already...

              psisci said:
              If they are compromising patient care by working impaired report them, otherwise try to help. Coming off in a holier than thou parental way will never help......
              I feel interventions are for families, not medical students.
              "Interventions" are for Lifetime Network movies. :p
              I was not suggesting a "class intervention"--but he does need people letting him know that they know...
               

              Anasazi23

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                AA is one of the most, if not the most, successful models available for alcoholics, and attendance is encouraged by mental health facilities all the time. I agree with OldPsychDoc. Many psych patients need the very structured support of AA in order to maintain sobreity. In fact, many inpatient psych units have a "traveling" AA chapter IN the hospital ward, so that patients can attend while admitted.

                There are lots of websites and you'll attend grand rounds one day on "the impaired physician." There are regulations about when/how to report, and the steps involved. Since the person in question is a med student, the distinction is blurred. The fact is, I knew lots of people (some my best friends) that drank quite a bit, and smoked marijuana, etc.

                Just yesterday in the hospital, an intern told me how they "were still drunk" at 12 noon while working on the floors, after drinking the night before. If I reported evey intern or resident that drank too much or smoked, the hospital would have to shut down. Medicine is a tough job, and this is an escape for many. Not saying it's right...just the reality. You'll have to use your discretion.

                P.S. MtMed...like your avatar. A not quite obvious but primitive throwback to organic chem!
                 

                OldPsychDoc

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                  Anasazi23 said:
                  ...Just yesterday in the hospital, an intern told me how they "were still drunk" at 12 noon while working on the floors, after drinking the night before. If I reported evey intern or resident that drank too much or smoked, the hospital would have to shut down. Medicine is a tough job, and this is an escape for many. Not saying it's right...just the reality. You'll have to use your discretion.

                  Just curious, but how did you respond to that intern?

                  I guess I would have told him to go home and to not do it again--the FIRST time--and mandated that he report himself (or I'm doing it!) if it did happen again. Once patient contact is involved the risk is just too high. Keep in mind the hospital might HAVE TO shut down if a patient is harmed and the lawyers find out about it! Bachelor parties, etc. do happen the "nights before", but again, it's time to be learning the meaning of professional responsibility.
                   

                  Anasazi23

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                    OldPsychDoc said:
                    Just curious, but how did you respond to that intern?

                    I guess I would have told him to go home and to not do it again--the FIRST time--and mandated that he report himself (or I'm doing it!) if it did happen again. Once patient contact is involved the risk is just too high. Keep in mind the hospital might HAVE TO shut down if a patient is harmed and the lawyers find out about it! Bachelor parties, etc. do happen the "nights before", but again, it's time to be learning the meaning of professional responsibility.

                    Well, I think he was sort of saying that more for effect, than actual truthfullness. You know, that sort of hungover brain drain you feel the next day after too much drinking the night before. The intern I'm speaking of is usually a responsible, competent guy. He didn't appear drunk, did not smell of alcohol or anything like that. It was more pal-ing around elevator guy talk. Besides, I was post-call when I saw him...even if he were, he'd probably be in better shape than how I felt. I guess that's why the Bell commission was instated.

                    As far as residents with substance problems...I really do mean it's a LOT of residents. In all truthfullness, if I reported every resident I knew of at various hospitals that smoked or drank too much, it would amount to like 75 people.
                     

                    Arctic Char

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                      P.S. MtMed...like your avatar. A not quite obvious but primitive throwback to organic chem!

                      i knew if i posted enough on here i would get a compliment. ; )

                      you make a good point Anasazi that's worth elaborating on: we all definitely have our episodes of over-indulgence (OK, maybe no ALL of us). i'd say a good 50% of my class drinks regularly on the weekends; to not-so problematic amounts. but i've just noticed this individual 1) failing my questionably subtle CAGE exam and 2) just saucing way too much. given the large proportion of my class that embibes, its a dangerous environment for this individual, so i thinks its worth bringing up to everyone that a probem exists.

                      i think its christians that say "we are our brother's keeper".
                       

                      Anasazi23

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                        MtMed said:
                        P.S. MtMed...like your avatar. A not quite obvious but primitive throwback to organic chem!

                        i knew if i posted enough on here i would get a compliment. ; )

                        you make a good point Anasazi that's worth elaborating on: we all definitely have our episodes of over-indulgence (OK, maybe no ALL of us). i'd say a good 50% of my class drinks regularly on the weekends; to not-so problematic amounts. but i've just noticed this individual 1) failing my questionably subtle CAGE exam and 2) just saucing way too much. given the large proportion of my class that embibes, its a dangerous environment for this individual, so i thinks its worth bringing up to everyone that a probem exists.
                        You say he's not into clinical rotations yet. He may very well be forced to clean up his act and cut back to a couple beers at night once clinical rots start.
                        i think its christians that say "we are our brother's keeper".
                        Actually, it was Cain that replied to God in the Old Testament, "I know not, am I my brother's keeper?" in response to God's inquiry regarding Cain having killed his brother. (Genesis 4:9)
                        Yes, though. Christians generally extrapolate this to Jesus' teaching dealing with 'loving our brother.'

                        Wow, what a thread hijack. :)
                         

                        Poety

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                          psisci said:
                          AA is not the accepted model for most mental health types. The harm reduction model is much more realistic, and based in science not religiosity. As a colleague you should tell them you are concerned and that they should get help, but unless they are working impaired it is up to them to make the changes. If they are compromising patient care by working impaired report them, otherwise try to help. Coming off in a holier than thou parental way will never help......
                          I feel interventions are for families, not medical students.


                          We were all very very very close - it wasn't a whole class thing - it was those of us who were closest to her and literally spent all our time with her. She wasn't really a full blown alcoholic though, she just drank to excess, would attempt to drive, and was taking part in some really self abusing behavior (things I'm sure we've all done at some point in our lives) Our intervention wsn't formal either, it was us getting together, explaining how shes messing everything up and that she needs to slow down - and she did. I should have clarified this before sorry!
                           

                          Poety

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                            Poety said:
                            We were all very very very close - it wasn't a whole class thing - it was those of us who were closest to her and literally spent all our time with her. She wasn't really a full blown alcoholic though, she just drank to excess, would attempt to drive, and was taking part in some really self abusing behavior (things I'm sure we've all done at some point in our lives) Our intervention wsn't formal either, it was us getting together, explaining how shes messing everything up and that she needs to slow down - and she did. I should have clarified this before sorry!


                            edit: and we too were not in rotations yet, this may have been just the left over college party days type deal :oops:
                             

                            ckitty

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                              Anasazi23 said:
                              You say he's not into clinical rotations yet. He may very well be forced to clean up his act and cut back to a couple beers at night once clinical rots start.

                              Actually, it was Cain that replied to God in the Old Testament, "I know not, am I my brother's keeper?" in response to God's inquiry regarding Cain having killed his brother. (Genesis 4:9)
                              Yes, though. Christians generally extrapolate this to Jesus' teaching dealing with 'loving our brother.'

                              Wow, what a thread hijack. :)

                              Actually in the new testament there are countless places that the Bible says to watch out for others, take care of your brothers, etc. - don't make me whip my Bible out!!
                               
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