Hello all. I am so grateful for this posting. This is SUCH an important issue. I certainly felt more despairing when, due to a history of depression alone (no other significant illness, no substance abuse, no malpractice, excellent reviews by supervisors and colleagues during residency etc.) I was required to enroll in a 2-year PHP contract in order to get my license to practice following residency. The program required monthly visits with a case manager who asked me the same questions each time: had I abused substances, had I gotten in trouble with the law, had I complied with my psychiatrist's suggestions, etc. - even though none of these had been the issue to begin with. They were asking the wrong questions. It also required reports every 3 months from a "workplace monitor" (a colleague), my therapist, my family members, and my psychiatrist, on my "behavior." I was being treated as though I had committed a crime, when all I had done was voluntarily disclose on my licence application that I suffered from depression and had VOLUNTARILY chosen to take medical leave twice for a few months during residency, for more intensive treatment. I had an impeccable professional record and still do. This was extremely humiliating and the restrictions I had on my license (the fact that I had to comply with this monitoring program) have followed me every time I have had to apply for hospital privileges, or a license in a new place. Certainly the demoralization of this process exacerbates/exacerbated my depression, and exhaustion. I think we certainly do need programs specifically designed for physician mental health, but that these programs need to be there for the purpose of helping physicians - NOT for the purpose of policing them. I realize some physicians with mental health issues can at times be a risk to patients, but most are not. PHP's need to match the services they provide to each individual physician based on individual issues/risks/needs.

Given your experience, what program would you wish that you had available to you? What would you suggest that we offer to support (rather than punish or police) med students and docs. Thanks.

Thanks, Pam.

Now in my fourth decade, I can tell you that if I had mental illness, chemical dependency, or practically anything that could threaten my medical practice I would not tell anyone, including my one good physician friend who is my primary care doc. I don't have any of those conditions mentioned, but I am very sensitive to those who do. In my mind, the most untrustworthy physicians are the ones on the state medical boards. They seem to have one and only one goal... protect the public at all costs and toss physicians who show any weakness. I never get any communications from them when they want me to shell out my yearly fee or remind me that I need to have a certain amount of CME hours.

Our privacy is invaded by them even before we have a chance to declare it. Why is it that everyone in the world can know most everything about us as physicians from where we live to, but patient's information is rabidly protected with the HIPPA maul?

Thanks for your caring. Perhaps it is because a physician's story would be safe with you? Ours is truly one of the lonliest professions. I don't think we can trust anyone much, and am extremely careful about sharing myself as a person with anyone even though I have no mental illness or substance abuse issues.

Now I'm in my 33rd year...my goal is maybe 45 years and I'm done.

Warmest regards,

Ron

This is terrible. We need to bring more public awareness to these issues!

You're absolutely right. Many very talented and compassionate physicians' and nurses' and PA's careers are being destroyed by these self-righteous state-protected psychopaths. And this malignancy is soon to move to broader professional horizons - lawyers, counselors, teachers ... just about anybody who needs a license to practice. All done under the virtuous banner of "protecting the public," all the while depriving the professional of due process and operating without any oversight or accountability! And ... all the while, these programs turn a handy profit by using their state-sanctioned authority to refer to their friends running "preferred programs."

Is there a way to protect due process by contract as well as by law? Web sites such as this can offer model contracts for doctors. H

Due process is in the NC law, and in the contract that NCPHP had with the NC Medical Board.
It made no difference, as they just did not respect the law and offered no due process.

I don't tell m doctor that I'm a doctor or even in healthcare. I make a point of going further out of town to get any major treatment. The only time my doctor knew who I was is when I had to have some orhto surgery.

I don't trust any of them. Actually I don't trust most doctors when it comes to these type of things. They will sell you out. They sell their own out for less.

Doctors have gone into hiding, Cruel "health care" system.

That is just so overwhelmingly sad -- a doctor not being able to trust most other doctors. As a patient, I continue to struggle to try to understand why the same people who become doctors to help people can be so heartless and untrustworthy to each other. And yet, at the same time, a lot of doctors marry other doctors.

We are beaten up. We came into this profession with compassion and a desire to serve. Instead we have been bullied, hazed, victimized, and if we ask for mental health help . . . (just read the stories here to see what happens then). I couldn't make this stuff up. Truth is stranger than fiction.

We are held to an inhuman standard and we have no safe accessible mental health care. It's insane. No wonder we have such high rates of suicide. Again, I will ask, who is helping us?

Pamela,

No one is helping us. No one will. We are the overpaid evil doctors who are just in it for the money. Didn't you know that?

The guy selling vitamins makes millions and he is a good businessman.

The lawyer makes millions on BS lawsuits and he is a brilliant attorney.

The doctor makes millions serving patients, doing a good job and saving lives or improving peoples live and he must be a crook or doing something wrong.

Doctors don't feel that way about other docs, do they? I don't either, for what it's worth. But even if that is the dominant image that the public has of doctors (and I'm not agreeing that it is), how does that explain how ruthless docs can be toward other docs?

The PHP system is a funnel for psychopathy. Many of these doctors had a history of manipulating the system, got caught and had their licenses revoked. By claiming the salvation card, blaming their bad behavior on drugs and alcohol, and claiming they were redeemed through 12-step they got their licenses back. Unlike the doctors telling their stories here, many of these doctors were criminals who got caught doing something very bad. Many of these doctors joined their state PHPs and others found work in the drug and alcohol assessment, treatment and testing industry. It is these doctors who are involved in the culture of harm you see here. In my opinion what we are seeing is the result of corporate psychopathy and this system makes Enron look like a preschool picnic.

The final common pathway for many sociopaths is jail. This depends on them getting caught. The final common pathway for a sociopathic doctor who gets caught would likely be a PHP. And what do you think might happen when a group of these doctors find each other? Some of these individuals should never have had their licenses returned. Giving them power without any oversight or accountability probably wasn't such a bright idea.

One of the common themes reported is the complete lack of empathy these people exhibit.

The PHP system is the physician's rabbit hole into the twilight zone. Don't go near one. Voluntarily or otherwise.

If a doc with a substance abuse and/or mental health problem opts to seek help from a direct pay private practice psychiatrist or other doc with no insurance records, are the helping docs required to report the docs with problems to anyone (medical board, doc's employer, etc). Or are they both protected by doctor/patient confidentiality?

However, that said, it is also important to note that some / most states' medicals boards have "position statements" that say that you must report an impaired colleague. My guess is that this pertains when you a) know an impairment exists; and b) have tried other means of intervention such as you or another colleague talking with the doc. Otherwise, this "duty to report" turns colleagues into undercover secret Stasi and creates distrust and further isolates and disrupts the necessary existence of a collegial community.
Now, if a physician with a run-of-the-mill illness like anxiety or depression or excessive use of alcohol or similar is in treatment with a private doc, my personal belief is that the private treating clinician's 1st duty is to one's patient. If there is a question about potential impact of that patient's illness on others (e.g. their own patients) then I think it's incumbent on the treating clinician to seek wise and confidential consultation with knowledgeable (non-PHP) colleagues.

Speaking of MB position statements in re: reporting impairment, it is also important to note that MBs also have position statements re: reporting of unethical behavior. A number of physicians have reported the profoundly unethical behavior of the PHP clinician to the MB as unprofessional (and illegal) behavior (e.g. the violation of due process; coercive referral to preferred programs etc.). The MB has repeatedly declined to even consider the complaint. Appears they get to choose what is "unethical." And apparently anything involving the illegal and abusive behavior of MBs and PHPs is immune from being considered "unethical." Seems like they like a rigged game.

Have most of the docs who have filed complaints with the MB about unethical behavior by the PHP been docs who were treated -- or mistreated -- at the PHP? I'm guessing that the MBs find it easy to blow off the opinions of docs who have a substance abuse problem as disgruntled resistant participants. Have any docs with no personal substance abuse problem and no need for a PHP filed any complaints about PHPs? Or are they reluctant to get involved with that can of snakes?

MGH tried to remove me from PHS and the MGH attorneys, my Chief and his Chief had a conference with them to attempt this. When things got confrontational with one of the Chiefs they asked him how much he drank in a not so thinly veiled threat. The Boards have agreed not to second guess the PHPs and they are free to do what they want. Boards do not investigate PHP members--at least here in Massachusetts.

Wow! to the way they threatened the Chief who tried to support you. I imagine there's a certain amount of CYA going on here by everyone in case a patient gets hurt badly by a doctor down the line. Nobody wants to share the blame if that happens.. But, at heart, it sounds like PHPs are far too lucrative and that money train is what they're protecting at all costs. Aren't they supposed to be nonprofit organizations with the dual mission of protecting patients and helping doctors? How easy would it be to follow and document the money being made by PHPs and those who run them? Expose how lucrative they really are and you expose the motive. I'm really sorry that you're having to go through this but I love how you're fighting back!

Wow.

There is no duty to report anyone (i.e. mandated reporter) unless there is child abuse, elder abuse or intended harm. There is no duty to hospitalize unless the patient is a danger to oneself or others or incapable of self care. I would argue that if a therapist reported confidential information to anyone without explicit consent of the patient, they have violated their professional ethics and should a) be reported to their board and b) should be put on a "do not use" list.

I'd like to know the answer to that too! Anyone know? Michael?

As with most groups of people 95 + percent of doctors are honest and sincere individuals with moral compass and kind heart. They inherently "do the right thing." The doctors who have erected this scaffold predominantly come from the same pool of like-minded addiction specialists.

In the 1980s some of these physicians realized they could make money by holding a doctors medical license hostage. The first step was the specialized facilities for doctors. It makes no sense on any level for doctors to spend 3-4 months in rehab. There is no difference between doctors and anyone else other than the specific education, training and experience they have. To claim doctors are "unique" and require different treatment is ludicrous. It is a dicto simpliciter argument that can be refuted just by pointing it out. It is an urban legend that exists to this day and one of many that must be addressed with critical reasoning, common sense and evidence-base.

And believe it or not it is this same group that has created the moral panics that has tarnished the image of doctors.

http://disruptedphysician.c...

Wow. This whole discussion about state PHPs has been a real eye opener to me, especially, assuming it's true, that many of the people who run PHPs are doctors who lost their licenses for criminal reasons. it sounds like, to justify their jobs and maybe to retaliate for what happened to them, they go after other docs.

Even if 95% of docs are good people, I can see how the fact that any doc could be one of the 5% who might turn on you creates an atmosphere of threat and mistrust among doctors. This truly dark side of the healing profession is extremely disheartening. As a patient, I want there to be a way to keep dangerous doctors from practicing but there has to be a better way.

Exactly why we are conversing publicly. There must be a better way. Curious what reform you would suggest?

One more thought: Are there any countries that are handling the issue of treating doctors' mental illness and substance abuse better? Or is this a worldwide issue for docs? If there are places that are handling it in a better, more fair/humane, less corrupt way, how are they doing it?

Other Countries have PHPs but this model originated here and is also in Canada and has been put in place in the UK and some other countries facilitated by the countries equivalent of ASAM. Other countries PHPs are the same as the EAPs used by the rest of society. After all that's how it should be. Specialized programs for doctors is not needed and there is no evidence for 3 months of treatment . This same group just made it up as a way to make money and bamboozled others into believing the lie. And they are still at it.

What a great question! Just off the phone with a female doc in Canada with similar horror stories.

Heh. I'll let you know if/when I come up with any replacement ideas. To be honest, your OP and the comments here and on Medscape are making me aware of and educating me for the first time about PHPs. I knew nothing about them before this. But what I'm reading now is outrageous. You need to make more patients like me aware of this.

Clearly, replacing the current system is not going to happen overnight. But I would start with exposing the corruption of individual doctors in positions of power in these things. Systematically start to discredit the whole system, thereby creating a need for something new.. Find the docs who weren't broken by the PHPs but instead emerged stronger, even if they are no longer practicing medicine. They are some of your potential leaders. I sure don't have any instant solution. Just thinking out loud here. Brainstorming strategy was part of my former work.

Great ideas!

It is indeed the "dark side." It's eerily akin to "Shutter Island." Once you go there, you'll never escape. An if you try to visit just to investigate, whoa boy - they just don't like snoops crashing their game.

I didn't think of Lehane's (or Scorceses's) Shutter Island while reading this thread. But now that you mention it. I did think of Kesey's One Flew Over the Cukoo's Nest while reading through this thread.

as was said about nurse Ratched "she likes a rigged game - know what I mean?"

It doesn't. competition does. the threat of losing your practice or license due to a malpractice suit because some other as hole doctor said negative things about you does. Happens all the time.

Fear really cause some strange behavior in humans.

I agree.

I agree. Living in a constant state of fear is a horrible way to live. I've lived that way a few times briefly but couldn't take it so I had to just say "FU fear", shake it off and refuse to live in fear of things that may never happen or that I have no way of stopping them if they do. I did this living in NYC after 9/11 as the smoke from the WTC blew by my apartment windows. I did this after my ovarian cancer dx. I did this after I had to be my own lawyer in housing court to keep a roof over my head. I still do this on a daily basis, living paycheck to paycheck when there is a paycheck, not being able to afford food everyday and still pay my bills. Maybe it's easier for me than it is for docs to choose not to live in fear because I don't have much to lose anymore except for my life. But still, docs should try to remember that they can't use fear as a tactic against you if you refuse to live in fear.

As an independent doc. let me tell you my fears.

malpractice
board certification
constant state of am I going to have enough cases and patient to keep clinic going and for how much longer
Can I do this for the rest of my career
I'm so stressed today and don't know if I can continue this any longer
How am I going to pay the bills
Is there going to be some doc. my competition that is going to bad mouth me today. They have before.
The list is longer but I'll spare you.

I know it's like the refugees but it a different kind of fear.

I'm truly sorry that you're living with all of that. I certainly didn't mean to minimize your fears. I really don't believe in competitive pain or fear (as in whose is worse). I do think life is stressful for most of us, each in our own ways, and that we can't really avoid stress in this world, only manage it. For me, swimming and laughing regularly are two of my best stress busters. I hope you find a way to manage yours and be happy. I guess there really is a kind of freedom in nothin' left to lose. But let me tell you, even though I lost everything material and financial, in the past two years I did fight hard in deep uncharted waters (like our healthcare system) to live since my cancer dx. And now that I'm alive and kicking, I get to start over in my late fifties. I probably should be terrified. But I'm just happy to still be here.

I wish you the best in life. Stress is stress so your stress has most likely been more than mine.

Hang in there.

You've got a good glass-half-full attitude!

And doctors are human.

For the record, I want my docs to be human.

People who are injured and afraid may act as irrational as an injured raccoon or squirrel. Have you ever tried to help an injured animal? They'll bite you. Furthermore, a cycle of abuse perpetuates itself. Those who have been abused often become the abusers.

Yes, I actually have helped and been bitten and clawed by injured animals. And I certainly understand, from the perspective of families with domestic violence and abuse, how some of the abused become abusers themselves. I also know several guys who I know were abused by their fathers as boys and who broke that cycle and, instead of becoming abusers themselves, grew into the least violent men I know -- basically, they became the opposite of their fathers instead of becoming their fathers. This abusive dark side of medical culture is truly disturbing. Doctors are supposed to be healing and nurturing (as are families), not viscous and vindictive and sadistic.

Any time we try to change anything bad in this world, the first step is always awareness, shedding light on the darkness and spreading that awareness. Because of the nature of the problem, clearly, docs can't fix this on their own. You'll need to get others to work with you to change this. But you also need good activist leaders like you, Dr Wible. Keep kicking those doors down and shedding that light.

You must be referring to the specialist. No primary care docs making millions (that I know of).

The media has certainly portrayed us poorly. And doctor bashing stories somehow get much more traction than others.

People don't know or care about the difference. To them we are all the rich doctor. And so what if we make a good living.