Doctors & Sobriety

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WestCoastNative said:
Do doctor have to remain sober after their shifts? What if you decide to have a couple of brews with a few friends after your shift, and you get called in?
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You should be sober while you are on call. You will (mostly, sorta, kinda) typically only be called in if you are the doc on call.
 
No way I'd ever be non-sober as doctor on call or off. You already have enough demands placed upon you and enough responsibilities to keep track of without being cognitively impaired.
 
mrh125 said:
No way I'd ever be non-sober as doctor on call or off. You already have enough demands placed upon you and enough responsibilities to keep track of without being cognitively impaired.
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I'm not a huge booze person - I mean, I don't think I've had any etOH in...god, months...completely incidentally - but I don't avoid it (I've just been busy) and I CERTAINLY don't plan to change my attitude towards it once I'm a doc. I think it's a bit overkill to be the 100% responsible 'oh gods what if someone needs me' person 24/7 for the entire rest of your life once you get an MD. Sounds like a good way to go bat**** crazy. You've got to be able to let yourself off the hook to relax every once in a while - it's an important skill.
 
mrh125 said:
No way I'd ever be non-sober as doctor on call or off. You already have enough demands placed upon you and enough responsibilities to keep track of without being cognitively impaired.
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Everything in moderation.
 
mehc012 said:
You've got to be able to let yourself off the hook to relax every once in a while - it's an important skill.
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I agree with this, but you make it sound like without the sauce, this isn't possible.
 
mrh125 said:
No way I'd ever be non-sober as doctor on call or off. You already have enough demands placed upon you and enough responsibilities to keep track of without being cognitively impaired.
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Relax, adcoms aren't reading this. There's nothing wrong with drinking in moderation. Working in a private practice means no on-call ever right? Unless you're moonlighting?
 
mehc012 said:
I'm not a huge booze person - I mean, I don't think I've had any etOH in...god, months...completely incidentally - but I don't avoid it (I've just been busy). I think it's a bit overkill to be the 100% responsible 'oh gods what if someone needs me' person 24/7 for the entire rest of your life once you get an MD. Sounds like a good way to go bat**** crazy. You've got to be able to let yourself off the hook to relax every once in a while - it's an important skill.
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You have a very good point. The last time I drank was uhmm..........last november and before that was uhm may on my birthday. It's a mindset that serves well for all the rigorous demands in school and w/ standardized tests that affect your future. Those same rigorous demands cause a lot of us to be really burnout though, and once we're doctors being able to more flexible and relax during our free-time definitely would help considerably after all of the years of stress. Relaxing doesn't have to just involve alcohol though.
 
WestCoastNative said:
Relax, adcoms aren't reading this. There's nothing wrong with drinking in moderation. Working in a private practice means no on-call ever right? Unless you're moonlighting?
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My Doctor is part of a private practice and he still goes on call. idk about the moonlighting biz though.
 
Rik1111 said:
I agree with this, but you make it sound like without the sauce, this isn't possible.
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That wasn't the intention. It's more the idea that you could Never Ever drink because of everything you have to deal with and all of the responsibility - to me, that implies 24/7 on-the-hook. That is what I disagree with.
As far as booze goes, I was trying to say that I don't plan to change my attitude towards it at all just for being an MD. As far as the rest, I was just commenting on how troublesome that particular attitude is to me.

How about: you have to be able to let yourself relax now and then, or you'll go crazy. If relaxing for you occasionally involves etOH, why should that change between now and then - unless you are not really letting yourself off the hook?
 
Godspeedyou said:
wouldn't trust a doctor who can't down a 40 in one sitting
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You know, I've never seen someone straight drink 1 40. I've seen them savor a Mo or a Brass Monkey, and I've seen 40hands (2 40s, of course), but I have actually never seen anyone just...drink a 40, by itself, outside the context of some larger event.

Aaaand now I swear I wasn't lying before when I said I don't drink much...
 
If you are a shift worker (ER, ICU, etc), then when you're off-shift, you're free to do what you want. Most hospitals will have something about not drinking within a certain number of hours of the start of your next shift, but beyond that your life is yours to do whatever legal activities you want. We frequently go out after shift (the docs, nurses, techs, residents, etc)...

If you are in a specialty with a call-schedule, then when you're on call, you're still "on duty" even if you're at home/a restaurant/movie, etc...
If you're a private practice doc who takes all of your own call, then it's a little more blurry. It depends on how you structure your practice
 
mehc012 said:
You know, I've never seen someone straight drink 1 40. I've seen them savor a Mo or a Brass Monkey, and I've seen 40hands (2 40s, of course), but I have actually never seen anyone just...drink a 40, by itself, outside the context of some larger event.

Aaaand now I swear I wasn't lying before when I said I don't drink much...
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I mix my 40s with whey protein and it makes for the perfect post-workout shake
 
mehc012 said:
You know, I've never seen someone straight drink 1 40. I've seen them savor a Mo or a Brass Monkey, and I've seen 40hands (2 40s, of course), but I have actually never seen anyone just...drink a 40, by itself, outside the context of some larger event.

Aaaand now I swear I wasn't lying before when I said I don't drink much...
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So you've seen someone gay drink 1 40?
 
Doctor Bob said:
If you are a shift worker (ER, ICU, etc), then when you're off-shift, you're free to do what you want. Most hospitals will have something about not drinking within a certain number of hours of the start of your next shift, but beyond that your life is yours to do whatever legal activities you want. We frequently go out after shift (the docs, nurses, techs, residents, etc)...

If you are in a specialty with a call-schedule, then when you're on call, you're still "on duty" even if you're at home/a restaurant/movie, etc...
If you're a private practice doc who takes all of your own call, then it's a little more blurry. It depends on how you structure your practice
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Our hospital includes etoh on their random drug screenings. They are sensitive up to 72 hours previously. It would really suck to be reported to the nursing board on a Monday because I drank on Saturday, but I've seen it happen.

I don't drink anyways; not opposed to it, no stigma about being around it...there are just too many alcoholics in my family.
 
acceptmeplease said:
Our hospital includes etoh on their random drug screenings. They are sensitive up to 72 hours previously. It would really suck to be reported to the nursing board on a Monday because I drank on Saturday, but I've seen it happen.

I don't drink anyways; not opposed to it, no stigma about being around it...there are just too many alcoholics in my family.
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This does not sound correct.
 
acceptmeplease said:
Our hospital includes etoh on their random drug screenings. They are sensitive up to 72 hours previously. It would really suck to be reported to the nursing board on a Monday because I drank on Saturday, but I've seen it happen.
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This definitely does not sound correct. I've never seen a screen that can pick up ethanol after it's been metabolized and excreted. Even the GC/MassSpec panels for tox can't pick up ethanol metabolites that far out.
If someone claimed their ethanol level on Monday came back elevated because they drank on Saturday, it's because they didn't want to admit to actually drinking late Sunday night or early Monday morning. Or they drank so heavily on Saturday that they still hadn't metabolized all of the ethanol by Monday and they were still drunk. But that's unlikely because with the rate of metabolism the Saturday amount would need to be a lethal level.
 
Doctor Bob said:
This definitely does not sound correct. I've never seen a screen that can pick up ethanol after it's been metabolized and excreted. Even the GC/MassSpec panels for tox can't pick up ethanol metabolites that far out.
If someone claimed their ethanol level on Monday came back elevated because they drank on Saturday, it's because they didn't want to admit to actually drinking late Sunday night or early Monday morning. Or they drank so heavily on Saturday that they still hadn't metabolized all of the ethanol by Monday and they were still drunk. But that's unlikely because with the rate of metabolism the Saturday amount would need to be a lethal level.
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Our lab specifically uses the urine test with EGT. It can detect 3-5 days.

The traditional urine test is like 10ish hours depending on metabolism.
 
acceptmeplease said:
Our lab specifically uses the urine test with EGT. It can detect 3-5 days.

The traditional urine test is like 10ish hours depending on metabolism.
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and what is the point of this for a random drug screening? It's not like you're all on probation.

If I had a nursing license and was reported to the board for popping positive on an EGT test, I'd fight it and very likely win. Unless the hospital policy is that you can't drink at all in your time off (which would be ridiculous), I couldn't see it going any other way.

On top of that, nurses have awesome unions. 😛
 
medic86 said:
and what is the point of this for a random drug screening? It's not like you're all on probation.

If I had a nursing license and was reported to the board for popping positive on an EGT test, I'd fight it and very likely win. Unless the hospital policy is that you can't drink at all in your time off (which would be ridiculous), I couldn't see it going any other way.

On top of that, nurses have awesome unions. 😛
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Most states have nurse practice acts that prevent unions. My state is one of them.

I think it's dumb, too, but if tested positive, literally the only way to save your license is to self-report and pray. This is, of course, true for my state. Every state is different.
 
Considering pretty much every social function in medicine after medical school involves alcohol (including copious amounts at every residency interview) I think people should realize that medicine as a whole is a culture than accepts alcohol after hours as a reasonable, even if not universal, behaviour. I have a glass a scotch almost every night that I have free time. It has nothing to do with intoxication, which one glass isn't going to do anyways. It's just a soothing, routine activity that takes my mind off the day by contemplating the taste.
 
If you read the fine print, part of your physical before medical school involves implantation of a microchip. Among its other functions, it detects alcohol. One drink and you're out on the lawn.
 
Haven't you guys read House of God? They kept a bottle of Jack at the charge desk for overnight shifts. Makes the night go by faster, and it helps you stay happy if the gomers hurt you.

WestCoastNative said:
Do doctor have to remain sober after their shifts? What if you decide to have a couple of brews with a few friends after your shift, and you get called in?
Click to expand...
 
mehc012 said:
You know, I've never seen someone straight drink 1 40. I've seen them savor a Mo or a Brass Monkey, and I've seen 40hands (2 40s, of course), but I have actually never seen anyone just...drink a 40, by itself, outside the context of some larger event.

Aaaand now I swear I wasn't lying before when I said I don't drink much...
Click to expand...
Usually the same crowd that drinks 40s are the ones that partake in payday loans or know where the nearest pawn shop is. If you live in a bad neighborhood, you'll see a few 40s here and there, but in a nice town it's hard to even find a liquor store that stocks them, aside from name brand 40s that aren't legit malt liquor.
 
Mad Jack said:
Usually the same crowd that drinks 40s are the ones that partake in payday loans or know where the nearest pawn shop is. If you live in a bad neighborhood, you'll see a few 40s here and there, but in a nice town it's hard to even find a liquor store that stocks them, aside from name brand 40s that aren't legit malt liquor.
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Those guys that make a job out of bumming change at the gas station so they can go inside and get another 40 to eat.
 
Mad Jack said:
Usually the same crowd that drinks 40s are the ones that partake in payday loans or know where the nearest pawn shop is. If you live in a bad neighborhood, you'll see a few 40s here and there, but in a nice town it's hard to even find a liquor store that stocks them, aside from name brand 40s that aren't legit malt liquor.
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Well, yes, but generally where there's one straight-up 40, there are more coming, unless it's in the context of some 40-specific social event.
I lived next to the all-night gas station (in a state where those had booze) for years and years...I saw more than a few 40s. Where there's one, there are (or were) many more.
 
acceptmeplease said:
Our lab specifically uses the urine test with EGT. It can detect 3-5 days.

The traditional urine test is like 10ish hours depending on metabolism.
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Wut. That test is notoriously unreliable. It's so sensitive that you'll test positive from using mouthwash for pretty much the rest of the day. No court would ever uphold a decision based on its results. I'll leave this one to a government agency statement in the matter:

The U.S. Substance Abuse and Mental Health Services Administration has cautioned that the test is "scientifically unsupportable as the sole basis for legal or disciplinary action" because the highly sensitive tests "are not able to distinguish between alcohol absorbed into the body from exposure to many common commercial and household products containing alcohol or from the actual consumption of alcohol."
 
Mad Jack said:
Wut. That test is notoriously unreliable. It's so sensitive that you'll test positive from using mouthwash for pretty much the rest of the day. No court would ever uphold a decision based on its results. I'll leave this one to a government agency statement in the matter:

The U.S. Substance Abuse and Mental Health Services Administration has cautioned that the test is "scientifically unsupportable as the sole basis for legal or disciplinary action" because the highly sensitive tests "are not able to distinguish between alcohol absorbed into the body from exposure to many common commercial and household products containing alcohol or from the actual consumption of alcohol."
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Why don't any of our nurses use the hand sanitizer?!?
Sir, we fired all of the ones that did...
 
Mad Jack said:
Wut. That test is notoriously unreliable. It's so sensitive that you'll test positive from using mouthwash for pretty much the rest of the day. No court would ever uphold a decision based on its results. I'll leave this one to a government agency statement in the matter:

The U.S. Substance Abuse and Mental Health Services Administration has cautioned that the test is "scientifically unsupportable as the sole basis for legal or disciplinary action" because the highly sensitive tests "are not able to distinguish between alcohol absorbed into the body from exposure to many common commercial and household products containing alcohol or from the actual consumption of alcohol."
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Yea. No one is saying it's a good policy, but it's a catholic hospital. Literally, I think the people who run this place are insane.

I have 47 shifts left until I start medical school. I'm just keeping my head down until my exit interview.
 
acceptmeplease said:
Our hospital includes etoh on their random drug screenings. They are sensitive up to 72 hours previously. It would really suck to be reported to the nursing board on a Monday because I drank on Saturday, but I've seen it happen.

I don't drink anyways; not opposed to it, no stigma about being around it...there are just too many alcoholics in my family.
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Does your contract specifically say that you can't consume alcohol when not at the hospital? This makes no sense.

Edit: Not sure what Catholic has to do with alcohol rules. The two are not really connected on any level... Unless the implication is that Catholic institutions are more prone to being run by people who are insane...

Just a few tidbits... First, everything comes down to the contract that you have with your hospital or practice. Most do not have specific stipulations about alcohol, but they do in general have clauses about impairment. Now, on the other hand the legal side of things is pretty clear. Consuming alcohol or even being to the point of being above the legal driving alcohol is NOT automatically considered impairment or an indicator of liability. This has been shown in multiple state courts. It can contribute, but it isn't a drink alcohol = guilty. Maybe its just being in surgery, but I don't know a single physician that is opposed to grabbing a drink after work. I also don't know anyone who drinks or thinks about drinking just prior to coming into the hospital.

Personally, I rarely drink even when I'm off so this is really a non-issue. I also know that if my parents got sick and there was an emergency there are doctors that I'd trust with an EtOH of 250 than others that are completely sober.
 
acceptmeplease said:
Yea. No one is saying it's a good policy, but it's a catholic hospital. Literally, I think the people who run this place are insane.

I have 47 shifts left until I start medical school. I'm just keeping my head down until my exit interview.
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Oh, religious affiliation. That makes sense. Hopefully no one's drinking the holy wine during mass!
 
mrh125 said:
You have a very good point. The last time I drank was uhmm..........last november and before that was uhm may on my birthday. It's a mindset that serves well for all the rigorous demands in school and w/ standardized tests that affect your future. Those same rigorous demands cause a lot of us to be really burnout though, and once we're doctors being able to more flexible and relax during our free-time definitely would help considerably after all of the years of stress. Relaxing doesn't have to just involve alcohol though.
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You have it backwards. UG is the time with flexibility and relatively low stress. I wouldn't consider hitting that attending status as the "light at the end of the tunnel" for stress reduction.
 
TheWeeIceMan said:
You have it backwards. UG is the time with flexibility and relatively low stress. I wouldn't consider hitting that attending status as the "light at the end of the tunnel" for stress reduction.
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Specialty dependent. Some EM docs work 13 days a month and don't take work home.
 
Rik1111 said:
Specialty dependent. Some EM docs work 13 days a month and don't take work home.
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I was more taking issue with the implication that being a practicing physician is somehow going to be less stressful than UG.
 
TheWeeIceMan said:
You have it backwards. UG is the time with flexibility and relatively low stress. I wouldn't consider hitting that attending status as the "light at the end of the tunnel" for stress reduction.
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ehh, for me undergrad was hellishly hard and time-devouring. I had like no down time and was severely fizzled by my last quarter.
 
TheWeeIceMan said:
You have it backwards. UG is the time with flexibility and relatively low stress. I wouldn't consider hitting that attending status as the "light at the end of the tunnel" for stress reduction.
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I would. Maybe its more or less easy that UG (I think less, even for most premeds), but for most specialties the end of residency is the start of a 40-50 hour/week job. Also good pay, significant vacation time, and the ability to negotiate even lower hours if you want them. Anyway if that's not the light, then there's nothing but darkness ahead, and its time to find another road.
 
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TheWeeIceMan said:
I was more taking issue with the implication that being a practicing physician is somehow going to be less stressful than UG.
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Yeah, that's a fair assessment. It can be a light at the end of the tunnel, though, for some specialties. For some it just continues until the REAL light at the end of the tunnel. 😉
 
Perrotfish said:
I would. Maybe its more or less easy that UG (I think less, for most premeds), but for most specialties the end of residency is the start of a 40-50 hour/week job. Also good pay, significant vacation time, and the ability to negotiate even lower hours if you want them. Anyway if that's not the light, then there's nothing but darkness ahead, and its time to find another road.
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Depends where we are doing the comparison. Are you going to be less stressed as an attending than as a resident? I would assume so. My only issue was with the idea that UG is some rigid, stressful, grind compared to the life of a physician.
 
[QUOTE="WestCoastNative, post: 15089767]Working in a private practice means no on-call ever right? Unless you're moonlighting?[/QUOTE]

No.

Being in PP still means taking call. Someone has to be manning the office phones 24/7. You can't just turn them off at 5 pm.

Patients call at all hours even about ridiculous things that could have waited until morning. Hospitals call with consults. If you have patients in hospital or whom show up at a local urgent care or ED, you can be called.

During the week my office partner and I split call; on weekends it's split between all 6 of the partners in our group. My best friend, in a solo practice, takes all of her call 24/7. So yes, even in PP you have to be on call.

A little true story about the topic at hand: my ex (a trauma surgeon) had a couple of drinks one night and got called in. No surgery was needed but patient smelled alcohol on his breath and reported him to administration. He was lucky that's all she did - Admin and the senior partner talked to him about it and he vowed never to drink while on back up/second call again. He was so scared, called me crying, because if shed reported him to the board there would have been an investigation.
 
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