Appropriate-doc
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This very sad post on /r/residency about a student that died by suicide prompted me to write this up:
More doctors should be aware of how badly any doctor with a history of addiction is being mistreated. The above story is one of many examples.
Many residency programs and medical boards ask invasive and discriminatory questions about mental health that violate the Americans With Disabilities Act (ADA).
Many medical schools (and pretty much all medical boards) also violate the ADA by demanding students and doctors to get involved with the state's physician health program (PHP). They don't get a say in their own medical treatment regardless of whether or not they've had any legal, professional, or behavioral issues. PHPs are known for their disregard for evidence-based treatment (eg they often demand participation in AA meetings). The link at the bottom has several articles that go into extensive detail. Physician health programs from all over the country force doctors to go to Kansas. These places are extortion rackets and they're getting away with coercing physicians into expensive, unnecessary, non-evidence-based monitoring and treatment. Dr. Wesley Boyd who used to be a director of a PHP has written a lot about how badly these places are abusing physicians. Here's a few more horror stories:
I-Team: Some NC doctors, patients still don't trust medical watchdog
Doctor left destitute after seeking help from physician health program
Doctors fear controversial program made to help them
Here's several academic articles about the abuses of PHPs.
Read on for my own horror story: My medical school tried to force me into going to one of these facilities for a four-day evaluation (you pay for lodging) in the middle of interview season. The eval would have cost $5,000 to $10,000 out-of-pocket. I also learned that these facilities use lie-detectors as part of their evaluation, just one of the many ways they disregard evidence-based medicine. Also they both diagnose and administer the expensive "treatment". Talk about a conflict of interest. A frequent result of these evaluations are 60-90 day inpatient stays that cost up to $50,000 also out-of-pocket even for people without a history of substance use disorders! What did I do to deserve this? Surely, something horrible right?
I never had a single legal or professionalism issue. My third year evals were average. I passed all my classes. 80th percentile for step. Unfortunately, I found myself drinking more and more starting third year. I tried to moderate, but failed repeatedly. I was still getting the grades and evals I was shooting for at the time, but it was moving in a bad direction so I sought help. After my doctor talked me into it, I was stupid enough to self-report to the school. They forced me, under threat of expulsion, to go to the PHP.
The PHP director has no background in addiction medicine or psych. His only qualification was 20 years of AA. Here's what they demanded of me:
1) Daily AA meetings for the first month (I was on my surgery rotation at the time). It was later decreased to 2/week. The director actually increased the number of required meetings after I asked for them to be decreased (these meetings are religious and not helpful to me), so it was 3/week for about half my time with the program.
2) 5 urine drug screens a year, 2 hair follicle tests a year, and a variable number of PeTH tests (for alcohol) a year (which the Substance Abuse and Mental Health Services Administration recommends against because it's so sensitive that using hand sanitizer can cause a false positive). Each test was around $70-$100 out-of-pocket. They didn't care that alcohol was the only substance I was having issues with. I would have to check-in to an app every day which would tell me whether or not I had a drug test. They were random. Also they watch you pee, which was just one of the many ways I felt degraded and humiliated by the program. I have to leave a lot of the particulars about their other behaviors out.
3) A breathalyzer that I would have to use every morning and evening within a certain time window. It would take a picture of you when you used it and send the data to them. I would later get in trouble for being outside of the time window for as little as 40 minutes (which has no effect on the result). This costs $270 a month out-of-pocket.
They lied about the length of the contract I signed. I was told until graduation. It was actually 5 years, which is typical. They also didn't prescribe any meds or provide or even recommend any actual counseling/therapy. For reference, here's what my pattern of drinking looked like at the time I got started with the program: I'd get home after rotations tired and anhedonic, and I'd drink about a pint of vodka over the course of the evening and just chill at home alone. I'd do this about 3-4 days a week. On weekends I'd get started sooner.
They required me to go to Kansas not because I tested positive for anything. I blew into the breathalyzer over 600 times. Every time was negative. I took over a dozen drug tests. All were negative. I was required to travel all the way to Kansas after I blew into the breathalyzer 40 minutes outside the time window. The director was on a power-trip and saw my previous compliance issues (eg I was short the required number of AA meetings on 2 occasions) as rebelliousness on my part. This wasn't the first power-trip from this person. Doesn't matter to them that being 40 minutes late doesn't change the result. These programs have an outdated cookie-cutter approach to addiction. I was with people that had their lives destroyed by alcohol and treated as if I was in the same situation.
See the above stories to see what happens to people that go to these evaluations. They have a team of social workers, psychologists, psychiatrists who will produce a 20-page report about how much a mentally ill degenerate junkie you are (even if you've never had a history of substance use problems). They will diagnose you with anything they can get away with even if that means making things up. Good luck telling the medical board that the 90 day inpatient stay they'll require is overkill at that point. Won't matter if you get a second opinion. The school was aware of all this and tried to coerce me into complying. I'm talking repeated threatening emails and phone calls.
Fortunately, thanks to Dr. Boyd's work and the Center for Physician Rights (a non-profit dedicated to helping people in this exact situation), I learned about the abuses of PHPs beforehand so I lawyered up and was able to tell the PHP and the school to **** off without going to the evaluation. This only worked because I'm still a student as they didn't have the leverage of licensure over me. That whole process was a horror story in and on itself, but I can't go into that without revealing too many details. The above is fairly typical for these programs though. I matched ok, but I don't know what I would have done if the PHP had messed that up, which came dangerously close to happening. Despite the misery caused by the PHP, I haven't had a drink since that first doctor appointment.
TL;DR: I self-reported to a PHP and it was the biggest regret of my life. Cost me a lot of misery, anxiety, money, and nearly ended my career before it even got started. These places are abusing and extorting physicians and residency programs and medical boards are complicit.
Original posts on /r/medicine and /r/medicalschool
More doctors should be aware of how badly any doctor with a history of addiction is being mistreated. The above story is one of many examples.
Many residency programs and medical boards ask invasive and discriminatory questions about mental health that violate the Americans With Disabilities Act (ADA).
Many medical schools (and pretty much all medical boards) also violate the ADA by demanding students and doctors to get involved with the state's physician health program (PHP). They don't get a say in their own medical treatment regardless of whether or not they've had any legal, professional, or behavioral issues. PHPs are known for their disregard for evidence-based treatment (eg they often demand participation in AA meetings). The link at the bottom has several articles that go into extensive detail. Physician health programs from all over the country force doctors to go to Kansas. These places are extortion rackets and they're getting away with coercing physicians into expensive, unnecessary, non-evidence-based monitoring and treatment. Dr. Wesley Boyd who used to be a director of a PHP has written a lot about how badly these places are abusing physicians. Here's a few more horror stories:
I-Team: Some NC doctors, patients still don't trust medical watchdog
Doctor left destitute after seeking help from physician health program
Doctors fear controversial program made to help them
Here's several academic articles about the abuses of PHPs.
Read on for my own horror story: My medical school tried to force me into going to one of these facilities for a four-day evaluation (you pay for lodging) in the middle of interview season. The eval would have cost $5,000 to $10,000 out-of-pocket. I also learned that these facilities use lie-detectors as part of their evaluation, just one of the many ways they disregard evidence-based medicine. Also they both diagnose and administer the expensive "treatment". Talk about a conflict of interest. A frequent result of these evaluations are 60-90 day inpatient stays that cost up to $50,000 also out-of-pocket even for people without a history of substance use disorders! What did I do to deserve this? Surely, something horrible right?
I never had a single legal or professionalism issue. My third year evals were average. I passed all my classes. 80th percentile for step. Unfortunately, I found myself drinking more and more starting third year. I tried to moderate, but failed repeatedly. I was still getting the grades and evals I was shooting for at the time, but it was moving in a bad direction so I sought help. After my doctor talked me into it, I was stupid enough to self-report to the school. They forced me, under threat of expulsion, to go to the PHP.
The PHP director has no background in addiction medicine or psych. His only qualification was 20 years of AA. Here's what they demanded of me:
1) Daily AA meetings for the first month (I was on my surgery rotation at the time). It was later decreased to 2/week. The director actually increased the number of required meetings after I asked for them to be decreased (these meetings are religious and not helpful to me), so it was 3/week for about half my time with the program.
2) 5 urine drug screens a year, 2 hair follicle tests a year, and a variable number of PeTH tests (for alcohol) a year (which the Substance Abuse and Mental Health Services Administration recommends against because it's so sensitive that using hand sanitizer can cause a false positive). Each test was around $70-$100 out-of-pocket. They didn't care that alcohol was the only substance I was having issues with. I would have to check-in to an app every day which would tell me whether or not I had a drug test. They were random. Also they watch you pee, which was just one of the many ways I felt degraded and humiliated by the program. I have to leave a lot of the particulars about their other behaviors out.
3) A breathalyzer that I would have to use every morning and evening within a certain time window. It would take a picture of you when you used it and send the data to them. I would later get in trouble for being outside of the time window for as little as 40 minutes (which has no effect on the result). This costs $270 a month out-of-pocket.
They lied about the length of the contract I signed. I was told until graduation. It was actually 5 years, which is typical. They also didn't prescribe any meds or provide or even recommend any actual counseling/therapy. For reference, here's what my pattern of drinking looked like at the time I got started with the program: I'd get home after rotations tired and anhedonic, and I'd drink about a pint of vodka over the course of the evening and just chill at home alone. I'd do this about 3-4 days a week. On weekends I'd get started sooner.
They required me to go to Kansas not because I tested positive for anything. I blew into the breathalyzer over 600 times. Every time was negative. I took over a dozen drug tests. All were negative. I was required to travel all the way to Kansas after I blew into the breathalyzer 40 minutes outside the time window. The director was on a power-trip and saw my previous compliance issues (eg I was short the required number of AA meetings on 2 occasions) as rebelliousness on my part. This wasn't the first power-trip from this person. Doesn't matter to them that being 40 minutes late doesn't change the result. These programs have an outdated cookie-cutter approach to addiction. I was with people that had their lives destroyed by alcohol and treated as if I was in the same situation.
See the above stories to see what happens to people that go to these evaluations. They have a team of social workers, psychologists, psychiatrists who will produce a 20-page report about how much a mentally ill degenerate junkie you are (even if you've never had a history of substance use problems). They will diagnose you with anything they can get away with even if that means making things up. Good luck telling the medical board that the 90 day inpatient stay they'll require is overkill at that point. Won't matter if you get a second opinion. The school was aware of all this and tried to coerce me into complying. I'm talking repeated threatening emails and phone calls.
Fortunately, thanks to Dr. Boyd's work and the Center for Physician Rights (a non-profit dedicated to helping people in this exact situation), I learned about the abuses of PHPs beforehand so I lawyered up and was able to tell the PHP and the school to **** off without going to the evaluation. This only worked because I'm still a student as they didn't have the leverage of licensure over me. That whole process was a horror story in and on itself, but I can't go into that without revealing too many details. The above is fairly typical for these programs though. I matched ok, but I don't know what I would have done if the PHP had messed that up, which came dangerously close to happening. Despite the misery caused by the PHP, I haven't had a drink since that first doctor appointment.
TL;DR: I self-reported to a PHP and it was the biggest regret of my life. Cost me a lot of misery, anxiety, money, and nearly ended my career before it even got started. These places are abusing and extorting physicians and residency programs and medical boards are complicit.
Original posts on /r/medicine and /r/medicalschool
