Vandy Behavioral Interview?

[Gern Blansten]

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While the idea of "second hand exposure" to fentanyl seems pretty far-fetched, it has been discussed by addictionologists and from what I have heard ( I believe it was from a paper by the same author out of Gainesville FL), fentanyl can be detected (in picogram levels) in the bloodstream of a non abusing anesthesiologist.
http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
I will wait to pass judgment on this issue until more is known. Currently, it seems that Gold is the only researcher completely on board with this theory. It will be interesting to see what comes of the further research.
Gold's premise is that anesthesiologists and surgeons are over-represented in treatment facilities, in part, because of second hand exposure to aerosolized fentanyl et al which sensitizes the person to have an addiction problem if they are subsequently exposed to the agent.
Before you shoot the messenger, let me just say that I am not sure I buy into this, I am only reporting it. I will say that I think it COULD be possible. If so, I think it plays a minor role in the overall picture.
In a study of anesthesiology residents treated for substance abuse, 85% disclosed that one of the reasons they were initially attracted to the specialty was drug access (K Gallegos et al. QRB 1988: 14: 116-122). I think this is a huge part of the problem. Screening these types out seems impossible. If you are willing to devote that many years of your life to gain better access to drugs only to throw a career away with addiction, I am not sure they can be helped.

 

[coprolalia]

In a study of anesthesiology residents treated for substance abuse, 85% disclosed that one of the reasons they were initially attracted to the specialty was drug access (K Gallegos et al. QRB 1988: 14: 116-122).

This is called "seletion bias" and is not a reason to subject people who've done nothing wrong to personality testing.

-copro

 

[Gern Blansten]

This is called "seletion bias" and is not a reason to subject people who've done nothing wrong to personality testing.

-copro

I agree, but it is a disturbing finding. As I mentioned, I doubt personality testing is going to capture any of that type of person anyway. I would suspect they would be able to give answers that would reflect what you wanted them to say. That is the thing about those tests anyway. There is no way to know if they are going to answer honestly on the questions.

 

[coprolalia]

That is the thing about those tests anyway. There is no way to know if they are going to answer honestly on the questions.

Exactly. And, you're administering them to a group that is already very intelligent, understands the nature of them, and may or may not represent themselves truthfully on it because of this. It is well-documented that healthcare professionals make the greatest malingerers. They know the diseases and how to mimick them better than anyone else. I would imagine that the opposite also holds true, which would account for anyone who doesn't meet the definition for psychosis. And, that would be obvious to anyone regardless of personality testing.

-copro

 

[militarymd]

Exactly. And, you're administering them to a group that is already very intelligent, understands the nature of them, and may or may not represent themselves truthfully on it because of this. It is well-documented that healthcare professionals make the greatest malingerers. They know the diseases and how to mimick them better than anyone else. I would imagine that the opposite also holds true, which would account for anyone who doesn't meet the definition for psychosis. And, that would be obvious to anyone regardless of personality testing.

-copro

You just very eloquently explained why we need to do drug testing.

 

[trixie]

I know this topic has strayed, but for anyone who wants another person's input, Vandy didn't ask me any questions that I hadn't already been asked at another interview. The interviews were low stress and I wasn't made to feel that there was a 'wrong' answer to the behavioral questions. So don't stress about it 🙂

 

[coprolalia]

You just very eloquently explained why we need to do drug testing.

I respectfully disagree.

When you are healthy and know how to fake being sick, that's pretty easy to do if you're a decent actor. When you are sick, on the other hand, it is pretty hard to fake being healthy no matter if you believe you can put on an Oscar winning performance. Show me a practitioner who's strung-out on fentanyl and no one suspected it, and I'll show you a room full of liars.

-copro

 

[Gern Blansten]

I respectfully disagree.

When you are healthy and know how to fake being sick, that's pretty easy to do if you're a decent actor. When you are sick, on the other hand, it is pretty hard to fake being healthy no matter if you believe you can put on an Oscar winning performance. Show me a practitioner who's strung-out on fentanyl and no one suspected it, and I'll show you a room full of liars.

-copro

I think in the advanced stage of narcotic abuse, you are correct that it seems something is wrong. The significant other usually knows long before anyone else. In my experience and in almost all of the cases I have heard about, it is very difficult to see in the early stages. These are very smart people we are dealing with for them to have gotten this far. They know exactly what to do and say to convince you it is not a problem. They hide it very well. The other factor is that it is usually the last person you would suspect. Maybe they are the hardest worker, the smartest in their class, a devout family man etc. When someone has a strong reputation previously, people tend to cut them a little slack if they have an "off" day. Anesthesiologists tend to work with different attendings, nurses, etc every day, so it takes a while before people begin to notice trends or problems. Therefore, I think the problem can go on for several months undetected by coworkers.

Several months is all it takes for the problem to get bad enough that there is a patient injury or the affected resident is found dead in a call room.

The problem with random testing is that most routine screens don't reliably pick up fentanyl. The cost of the test that does is pretty prohibitive.

Most residency programs test at the start of residency (probably useless but seems to be standard) and then only for cause after that. All in all, probably a pretty ineffective system.

 

[militarymd]

I respectfully disagree.

When you are healthy and know how to fake being sick, that's pretty easy to do if you're a decent actor. When you are sick, on the other hand, it is pretty hard to fake being healthy no matter if you believe you can put on an Oscar winning performance. Show me a practitioner who's strung-out on fentanyl and no one suspected it, and I'll show you a room full of liars.

-copro

I'm no expert in addiction medicine, but I do know enough to know that, work performance is one of the VERY LAST things to get affected.

To catch them before the "end stage", is the key....short of psych testing everyone on a routine basis....pissing in a cup at random intervals seem the only viable, if not perfect way, to go.

 

[Gern Blansten]

work performance is one of the VERY LAST things to get affected.

That is my understanding as well. Personal life is usually affected much earlier and the reason that the significant other usually knows something is different much sooner than anyone else.