I have been the Mid-Missouri Regional Coordinator for the MPHP since February 2008. Since that time, I have seen many physicians graduate from the program. Throughout, I continue to be amazed by the transformations I see as physicians grow in their recovery and careers. I believe the key to these transformations is the longterm commitment that the MPHP makes to ensure their participants' success.

On Monday, February 16, of this year, our Executive Director, Bob Bondurant, had the opportunity to meet with the AMA-UMKC chapter’s student members. These are medical students who are interested in future involvement with organized medicine. This presentation was at the invitation of Hima Veeramachaneni, MD candidate, class of 2017.

Recently, St. Louis University, invited our Executive Director, Bob Bondurant, to speak to their Chief Residents. The administration of St. Louis University decided to offer a program about four years ago to present information for their Chief Residents that is not typically covered in their core curriculum.

With the recent death of Missouri Auditor, Tom Schweick, the subject of suicide has been ever present. It is not a comfortable topic and very sad for family and friends. We always wonder what could have been done to prevent this sad loss.

IN THIS ISSUE: Physician Death by Suicide A New Concept in Educating Chief Residents Speaking to the Future Leaders of Organized Medicine Spotlight on Jeremy Duke Tips from Dr. Bill W Warning Signs of Alcohol and/or Durg Use & Signs & Symptoms of Chemical Dependency in Medical Students

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patients. Opioid analgesics help alleviate the symptoms of patients with chronic pain, but they are also vulnerable to abuse.

During an interview with Dr. Mike Myers, Professor of Clinical Psychiatry at SUNY-Downstate Medical Center in Brooklyn, New York, held last September, I asked how the medical workplace should respond in the event of a suicide by a physician. His suggestions were as follows:

A recent article published in The Chronicle of Higher Education presented information about the challenges “facing stressed-out and debt-ridden medical students and trainees.”1 The author, Katherine Mangan, cites recent studies published in The Journal of the American Medical Association, which argue that students’ mental health issues may have a deleterious effect on their patients.

Physicians who provide medical care for themselves or family risk losing objectivity and letting their personal feelings interfere with what is best for the patient. By Carolyne Krupa, amednews staff. Posted 2.6.12. Reprinted with permission from American Medical News, Copyright 2012, American Medical Association. All rights reserved.

This is the second in a series of articles on disruptive behavior. Much like a physician treating a patient needs to assess their patient prior to prescribing a treatment course, finding the correct remedial strategy for a healthcare provider whose behavior disrupts the smooth functioning of their system requires an understanding of the individual and the system.

Doctors learn early in their training that one important and unavoidable part of their job is to complete medical records in a timely fashion. As house staff, their paycheck may be withheld for failing to do so; as attending doctors, they may lose admitting privileges.

Maybe some of you have a parent who has gotten to the age when driving a car is no longer safe. Not long ago, my 90 year old father passed out in the middle of busy intersection and shortly thereafter proclaimed himself fit to return behind the wheel.

Abstract Objective To evaluate factors associated with work-home conflicts (W-HC’s) of US surgeons and their potential personal and professional consequences. Design Cross-sectional study. Participants Members of the American College of Surgeons.

Because of stigma (feared or real), overwork and denial of vulnerability, many physicians do not take good care of themselves. Yet we are not immune to those conditions or illnesses we encounter in our medical practices on a routine basis, independent of specialty.

Physicians have always had burnout problems, it’s inherent in their personalities and the occupation they have chosen. T. Jock Murray, MD, the director of the medical humanities program at Dalhousie University in Halifax was quoted3 in a 2001 article as having said, “We want people who are driven, who are compulsive, who can excel at anything that they do. What do they do when they get into practice? They try to do everything, and they have this complex which also says they must succeed at eve...

Batya Swift Yasgur, MA, LMSW Introduction When endocrinologist Francine Fitzhugh (not her real name) opened her mailbox, the last thing she expected was a letter from her state's Medical Board. "An obese patient filed a complaint against me, stating that I was responsible for her 36-pound weight gain."

You may not be alone. Recent studies indicate that about 15-20% of physicians have been stalked at some point during their careers. As physicians often don’t report these incidents, experts think the numbers are higher than reported. Stalking can vary between seemingly innocuous behavior to more intrusive and concerning behavior such as loitering around the office, sending gifts or threats, excessive curiosity about your personal life, or worse.

Findings from a study recently presented at the AMA/CMA/BMA International Conference on Physician Health showed that although starting from a higher risk category, PHP participants decreased their risk to 20% below that of a non-PHP group after monitoring. Michael Gendel, MD, a Denver psychiatrist and medical director emeritus of the Colorado PHP suggested that “one advantage of PHP participation is increased safety and not just better health”.

Just last week a new family client asked, “... so you think people can really change?” Although commonly asked, it is a strange question to ask those of us in counseling services. If we didn't believe change was possible, why be a counselor? I finished my undergraduate degree at Drury University and went to Missouri State University for my Master’s in Guidance and Counseling.

If you are a physician requiring the assistance and/or monitoring of the Physicians Health Program (PHP), then you are like me. If you have a problem with substance abuse or other addiction, then you are like me. If you are in recovery, then you are like me. Or, are you? Compliance with the monitoring requirements of PHP is a really important accomplishment, but it does not mean that you are in recovery.

Everyone Wants Free Advice There are some situations for which medical school simply doesn't prepare you. Consider Thanksgiving dinner, when Aunt Myrtle buttonholes you about a recurring rash that's been bothering her. Or the sideline consult that one of the parents at your kid's football game wants to have, right after her son lands awkwardly trying to catch a pass.

Our recent trip to the PHP [Federation of State Physician Health Programs] conference in Denver highlighted some of the controversy surrounding the recent legalization of marijuana. It has raised several complex issues. I endorse the American Society of Addiction Medicine policy on medical marijuana.

Research presented at the 2012 AMA/CMA/BMA International Conference on Physician Health in 2012 showed physicians who are monitored by a physician health program (PHP) reduce their risk of a paid malpractice claim to 20% below that of non-monitored physicians. Michael Gendel, MD, Medical Director Emeritus of the Colorado PHP, suggests that PHP participation not only leads to better health but also to increased safety.

New research published in JAMA Internal Medicine points to fatigue on the part of prescribers affecting the number of antibiotic prescriptions written, which may be contributing to the rise in antibiotic resistance.

A recent study done by Vanderbilt University of 141 Tennessee physicians evaluated for fitness-for-duty assessments found an “astoundingly” high rate of suicide if the physician was 1) found unfit to practice, 2) was in solo practice, or 3) if he/she was taking benzodiazepines (anti-anxiety drugs).

Alcoholics and Narcotics Anonymous are just that. . . anonymous. And physicians have a particular concern regarding anonymity because of the public trust required for them to function effectively. Simply put, we are concerned that, if the word gets out, others who don’t understand the program will derogatorily label us publicly as alcoholics and/or addicts, thus negatively affecting that public trust.

“New admit,” the page reads. “14 y/o F r/o IBD, needs c-scope.” In person, the patient is spunky, sassy, filling the team’s day with joy. She dreams of professional dance, being en pointe under the bright lights. She is a fair sprite, ghostly pale after months of bloody diarrhea. After answering our questions, she declares that the hospital isn’t such a bad place and hunkers down with a Cake Boss marathon on television and several liters of prep.

Nowadays, as in 1951, the very mention of the disease concept of addiction arouses passionate reactions, both positive and negative. While proponents of this concept are fervent in their belief, they often do not have a clear articulation of what this phrase means, or the actual mechanisms and dimensions of this disorder. Critics often argue that this is merely an excuse for addicts to avoid responsibility for their behavior. Rarely is there a middle ground sought or found.

Richard S. Sandor, MD, practices psychiatry and addiction medicine in Santa Monica, California. He is a past president of the California Society of Addiction Medicine and is the author of Thinking Simply About Addiction (March 2009, Tarcher/ Penguin).

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices.

As I write this column, I am grieving the recent loss of a friend to alcoholism. What makes this event more painful is the fact that it clearly illustrates the importance of recovery over abstinence, the very theme of my column.

Dear Friends and Colleagues, It has been a while since I have addressed you in our newsletter. I am taking this opportunity to present a serious matter. In our now 30th year, the MPHP has

Dear Friends and Colleagues, It has been a while since I have addressed you in our newsletter. I am taking this opportunity to present a serious matter. In our now 30th...

Introduction To the besotted poet, love is intoxicating, exasperating, invigorating. To the doctor - if the would-be paramour is a patient - it’s also unethical. But physician responses to Medscape’s 2012 ethics survey clearly indicate that many physicians aren’t willing to condemn every romance. When asked, “Is it ever acceptable to become involved [in] a romantic or sexual relationship with a patient?” more than two thirds (68%) of the 24,000 doctors who responded resoundingly say “no.”

Slamming a portable X-ray machine into a wall in front of a patient. Screaming at a nurse. Throwing instruments. Death threats. All of these infractions are reasons physicians have been referred by hospitals, medical boards, and even their own attorneys to programs that assess their behavior and work with them to correct it. However, even less-dramatic behavior seen by a coworker as passive-aggressive, manipulative, or threatening can result in a referral as well, leaders of the programs s...

Even the best physicians face the possibility of a lawsuit nearly on a daily basis. However, research shows that many lawsuits today are not about medical errors, but about poor communication and misunderstanding. Ensuring effective communication should become a systematic and integrated approach into overall efforts to minimize errors, improve outcomes, control med-mal costs, maintain contracts and manage the reputation of your practice.

Attorneys and experts recommend that practices have policies that address how to define and handle a colleague who might represent a safety threat to patients. An impaired or incompetent physician can be a liability to a medical practice and pose a safety threat to patients. Still, some practices have found it difficult to discipline or report such a physician, especially if he or she is a partner in the practice or a longtime colleague with a previously impeccable career.

Recently in the news, CVS Caremark announced that it will stop filling opioid prescriptions for physicians classified as “excessive prescribers”. Excessive prescribers were classified on the basis of those who wrote opioid prescriptions for younger patients, patients paying primarily with cash or for those people driving long distances to fill prescriptions. Those practitioners that stood out were “prescribing 20, 30, up to 50 times as much pain medication as the average prescriber...”1

Physicians are highly influential role models for their patients, colleagues, families and the public at large, and that esteemed status makes their personal well-being a key determinant in health promotion, as noted by the American Medical Association¹. Nevertheless, medical professionals are not immune to the risk factors which make the general population more susceptible to developing addictions, including but not limited to genetic predisposition, childhood trauma and the presence of anxiety...

I can remember back to the first time I saw pornography. I was walking home from school in the first grade and found a single page from playboy [sic]. I took the page home and hid it in the bathroom. I felt so much shame about having it, but at the same time was compelled to keep it so that I could look at it again. This week my children graduated from kindergarten and them term first grade was mentioned. I was immediately reminded of my experience that day walking home from school and a huge...

Orthopedic surgeon, Ralph Blasier, M.D., J.D., has voluntarily set an end date for his time in the operating room--age 65, about three years from now. “I want to make sure I stop before I lose my skills,” said Blasier, who works in private practice in ... Michigan. “The surgery is what I really enjoy, so if I’m going to stop surgery, I might as well stop seeing patients.”

Creative street chemists never run out of ideas about how to come up with designer drugs that can be abused. These drugs are usually marketed to young people as a safe, fast way of getting high. Numerous cases of date rapes, bad trips and deaths have been linked to their use.

Recently, St. Louis University, invited our Executive Director, Bob Bondurant, to speak to their Chief Residents. The administration of St. Louis University decided to offer a program about four years ago to present information for their Chief Residents that is not typically covered in their core curriculum.

I’m the oldest of 13 children. I was born in northeast Kansas to German and Irish parents and raised up in the Catholic tradition. I spent most of my childhood and adolescence on the plains of eastern Colorado and western Kansas helping in family farming and ranching ventures. I entered military service in 1970.

In 2008, after a long and successful career of some 28 years, I decided to branch out and start a new business. It happened to be the delivery of telemedicine to non-urban communities, and after some two years, the company had gained substantial traction and I was making a respectable income. All the while, I had not had occasion to practice clinically, so I began considering the idea of simply retiring my license and leaving clinical medicine for good. After all, the requirements of maintaining...

A major deficiency still plagues the MPHP! As we begin 2014, I would like to revisit what this is and ask for your help. During 2013 as I would interact with a variety of administrators and physicians, I again found that the range of services that we offer is not well known or remembered. What really caused me to pause and reflect on this was the termination of a highly qualified physician who could have benefited from some legitimate help. The group he was associated with responded to his is...

1. Is addiction a disease? What are the arguments for and against this notion? People often disagree with the idea of calling addiction a disease in the same way we call conditions like diabetes a disease. The behavior of addicts is frustrating, ugly - even criminal. How can driving drunk be a symptom of a disease?

Recovery is oftentimes misunderstood only as abstaining from addictive substances and/or activities, when in fact it is our life-long journey to restoring relationships with our inner self, God and others. In the first of the 12 steps, we admit we are powerless over our addiction(s), and acknowledge our lives have become unmanageable.

I am so pleased to announce that Cedar Bridge, located in Joplin, Missouri, a private residential treatment center, designed to treat physicians with drug and alcohol addiction has been approved by the Missouri Board of Healing Arts for the referral of Missouri physicians.

If you would ask Dr. Niskey how she got into the field of psychotherapy, she would say a murder and a friend’s drug-related death. 1 Prior to these two events, she was teaching school in California with the Los Angeles City Schools. It was there that the first event occurred when one of her young students thought little of murdering his father with a butcher’s knife.