Quoted: Substance abuse in residency

[Doodledog]

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Posted for an SDN member

I was a pgy1 fm resident. Had a bad call day and some conflicts with another resident who was afraid of me after I took a leave of absence 2/2 depression. I was "asked" to submit to a full psych eval. There was a UDS involved. I tested pos for THC. I was asked to resign. I did. I went to a professionals rehab program, have abstained for 6 months now, I go to NA, I am receiving productive tx for my depression, i am monitored twice a month. I want to enter the match this year for EM. My former PD is very supportive of me and is willing to write me a LOR. I am spending this month shadowing 2 ER docs in a small town who will be writing me LORs.

Am amg. Step 1 239, step 2 222.

Am I screwed in clinical medicine?

I have a bs in computer and electrical engineering. Any ideas on what I could do in the field of informatics. Or any ideas.

 

[NotAProgDirector]

The honest answer to your question is: apply and see what happens.

You have several "reg flags" in your application: Your resignation / positive drug screen, and history of leave for depression.

The first is a mixed bag. Some programs won't touch you at all because of it -- they get many applications from people with pristine applications, so they see no need to bother with anyone with a problem. And, drug abuse / diversion is a bigger problem in Anesthesia and EM as the drugs are "looser" there -- it's not uncommon to have syringes of narcotics, etc, hanging around. On the other hand, some PD's will see THC as "not a serious drug" and will really not care. There's no way to know, so you'll be applying to a wide array of programs. You cannot afford to be choosy.

The second is also a mixed bag. In a perfect world, it shouldn't be considered at all. However, we all know that depression is a chronic illness, and those who take a leave for depression are more likely to take another leave in the future. But, you may never have a problem with depression again. It's impossible to know. If you took your prior leave while a resident, you'll know how disruptive it was to your program, and PD's try to avoid problems like that. So, this may also be an issue. Again, some PD's will care less than others.

Bottom line is that you'd be smart to apply widely, and see what happens. You'll also need to decide whether you want to apply to another, less competitive field as a backup.

 

[Apollyon]

The esteemed aPD has said something which I have to counter. It is a long-held belief that EM has a higher rate of impairment due to access, but that is just not true. Anesthesia and dentistry, along with ENT, are a few of the few specialties where physicians have hands on medicines, and especially those of abuse (like fentanyl and topical cocaine). However, in EM, I order the meds, but I do not have them in my hand - ever. I have been required to push propofol, but (Michael Jackson notwithstanding) that is not a drug of abuse, generally.

I have never, myself specifically, given a patient a narc by mouth, or anything like Dilaudid or morphine parenterally. It is in the same vein (no pun intended) that nurses in the ED divert, because they ARE indeed putting hands on meds, out of the Pyxis (not coming up premixed from the pharmacy).

The easiest way for EM to get meds would be to divert to a shill patient (not a real patient) - and that is very easy to tease out, and the guys with the gold badges (DEA) are all over that.

 

[nitemagi]

My understanding is that the EM substance abuse issue is alcohol, usually starting as a way to "wind down" from the overdrive of EM shifts.

 

[NotAProgDirector]

The esteemed aPD has said something which I have to counter. It is a long-held belief that EM has a higher rate of impairment due to access, but that is just not true. Anesthesia and dentistry, along with ENT, are a few of the few specialties where physicians have hands on medicines, and especially those of abuse (like fentanyl and topical cocaine). However, in EM, I order the meds, but I do not have them in my hand - ever. I have been required to push propofol, but (Michael Jackson notwithstanding) that is not a drug of abuse, generally.

I have never, myself specifically, given a patient a narc by mouth, or anything like Dilaudid or morphine parenterally. It is in the same vein (no pun intended) that nurses in the ED divert, because they ARE indeed putting hands on meds, out of the Pyxis (not coming up premixed from the pharmacy).

The easiest way for EM to get meds would be to divert to a shill patient (not a real patient) - and that is very easy to tease out, and the guys with the gold badges (DEA) are all over that.

My understanding is that the EM substance abuse issue is alcohol, usually starting as a way to "wind down" from the overdrive of EM shifts.

Thanks for the correction. I think it's probably fair to say that the ED has changed since my rotations there.

As to alcohol, I don't think that's specific to ED docs.

 

[tkim]

My understanding is that the EM substance abuse issue is alcohol, usually starting as a way to "wind down" from the overdrive of EM shifts.

A couple fingers of a fine single malt scotch hasn't hurt anyone, although there are times after a shift when I can't wait to get to my car ...

 

[tkim]

Thanks for the correction. I think it's probably fair to say that the ED has changed since my rotations there.

The only med I usually hold in hand is propofol, since I'm the one pushing it.

I can order any med out of the Pyxis, but I can't pull any of them from the Pyxis. Sort of frustrating if I want to give a med RIGHT NOW and the nurse isn't available, but since I don't have access, can't be accused.

 

[kevin512]

A couple fingers of a fine single malt scotch hasn't hurt anyone, although there are times after a shift when I can't wait to get to my car ...

Hasnt hurt anyone? Are you joking?

 

[NotAProgDirector]

Suffice it to say that alcohol in moderation is fine, but that some people have a problem where overuse leads to catastrophe. And with that, this thread is officially off topic, so I am closing it.