Story From Grateful Alum of MPHP

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Story From Grateful Alum of MPHP
Hello, Friend: My name is [Fill in your name, here], and I am an addict. My name can definitely go in this blank. I became addicted to the prescription sleeping medication AmbienTM in the late 1990s.
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Professional Sexual Misconduct: A new paradigm of understanding
An overworked married pediatrician was attracted to a single mom in his practice. They became friendly and one day he offered to help if she ever needed anything fixed around the house. Eventually she called and asked him to come over to fix a leaky faucet. This started an affair that lasted several months. When his wife discovered the affair, he broke it off.
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Family Support through De Novo

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Family Support through De Novo
The internal and external stresses associated with a physician’s life often affect the family. When the physician is abusing drugs or alcohol, the pressures are magnified. There may be long hours, emotional isolation, excessive devotion to medicine, pressures from regulatory agencies, threats or reality of liability suits, complacency about physical health, spending sprees, infidelity, eating disorders and sleep disturbances.(See Table 1, page 6, for other possible stressors for the family.)
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Chemical Dependence in Anesthesiologists: What you need to know when you need to know it - Part 1
Impairments in physicians present risks to the public, the physician, the family, the hospital, and to professional colleagues of the physician. Impairment may result from psychiatric illnesses such as depression, from advancing age, from physical disabilities and from dependence upon drugs.
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Process Addiction

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Process Addiction
This year MPHP encountered our first physician with a process addiction involving video gaming. What is process addiction? It can be defined as a compulsion to engage in a pattern of behaviors (sex/pornography, eating, internet, video games, gambling, compulsive shopping/spending, etc.) and to continue in the pattern despite adverse consequences.
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Chemical Dependence in Anesthesiologists: What you need to know when you need to know it - Part 2
Intervention is the process of proving to an addict that he or she is ill and is in need of immediate evaluation and treatment. Its primary purpose is to overcome the denial that is inevitably present. Rather than being punitive, an intervention is advocacy, or in the words of recovering addicts, a demonstration of “tough love”. Only when substantial evidence confirming the presence of addiction has been collected should intervention be attempted.
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Reducing the Risk of Malpractice

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Reducing the Risk of Malpractice
Physicians who are extremely competent medically may still be likely to face a malpractice suit during their careers. The good news is that the physician can significantly reduce the likelihood by implementing some behavioral changes relating to his or her patients.
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Detecting Alcohol Use with EtG and EtS

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Detecting Alcohol Use with EtG and EtS
State physicians health programs began using EtG, a minor non-oxidative metabolite of alcohol, to test for alcohol consumption in 2003. This followed a large study of alcoholics in a psychiatric facility in Germany in which EtG was found to be a more sensitive and accurate test than urine alcohol.
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Why a Multi-Disciplinary Assessment?

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Why a Multi-Disciplinary Assessment?
MPHP frequently uses multidisciplinary assessments to identify all the factors that may have contributed to a physician’s referral to our program. We are often asked by administrators what is involved and why we use multi-disciplinary assessments. The following will address these questions.
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Medical Malpractice: Anatomy of an Alabama Lawsuit and How to Cope When your Physician Spouse is Sued - Part One
by The Alliance of the Medical Association of the State of Alabama and The Alabama Physician Health Program Malpractice Stress Syndrome by Gregory E. Skipper, MD, FASAM, Medical Director, Alabama Physician Health Program
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Prevention of Sexual Harassment

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Prevention of Sexual Harassment
MPHP has spoken with some physicians who were not aware that their behavior was considered by others as harassment. With that in mind, we are presenting some information that defines sexual harassment and provides guidelines for identifying when one’s conduct is unwelcome.
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Medical Malpractice: Anatomy of an Alabama Lawsuit and How to Cope When your Physician Spouse is Sued - Part Two by The Alliance of the Medical Association of the State of Alabama and The Alabama Physician Health Program
Trial: • Seating: The plaintiff is always seated closest to the jury. • Jury Selection: During a procedure called voir dire questions are asked of the potential jury members to determine if there are any reasons the person should not serve, such as preconceived ideas against physicians or people who sue, friendship or business ties to a party or attorney or whether the plaintiff’s present condition would cause the juror to automatically want to to find for the plaintiff.
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Medication Errors Among Depressed and Burnt Out Residents: Prospective Cohort Study by Fahrenkopf, et al.
The authors’ objective was to determine the frequency of depression and burnout among residents in pediatrics and to establish if there was a relationship between these disorders and medication errors. They studied 123 residents in three residency programs in the United States.
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MOSBIRT: Brief Substance Abuse Interventions in Trauma Centers
The Department of Mental Health, Division of Alcohol and Drug Abuse has been awarded a five year grant to support the development of the Missouri Screening, Brief Intervention, and Referral and Treatment (MOSBIRT) services in targeted areas of the state. The Missouri Institute of Mental Health has been charged with implementing the project.
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The Value of Physician Health Programs by Greg Skipper, MD
The first national study of Physician Health Programs (PHPs) was recently conducted. It was carried out by an independent outside research team sponsored by a Robert Wood Johnson Foundation grant. The study sought to identify which states had PHPs, how they were structured and staffed, their scope and purpose, and finally in Phase II, to measure their outcomes by examining records from over 900 participating physicians who'd signed monitoring agreements 5 years or more previously.
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Medical Malpractice How to Cope When your Physician Spouse is Sued, Part III by The Alliance of the Medical Association of the State of Alabama and The Alabama Physician Health Program
The Role of the Physician’s Spouse • Be a Counselor and Personal Cheerleader: Because a physician’s statements concerning a case are potentially admissible against him in a trial, he does not have the outlet most other people have in discussing things that happen in his job.
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Program Notes on our 25th Anniversary by Bob Bondurant - July 2010
This year we celebrate 25 years of service to Missouri physicians. 1985 was the year that the Missouri Physician Health Foundation became incorporated as a 501c3 not-for-profit corporation. Prior to 1985, the MSMA had a program to assist physicians under the leadership of Dr. Donald McIntosh. Dr. McIntosh volunteered his time and dedication to helping troubled colleagues.
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Boundary Crossing or Violations: What to do if you are concerned you are at risk
• Document any inappropriate behavior on the part of the patient. • Focus objectively on the patient’s needs and best interests. • Establish and maintain appropriate boundaries; look at the relationship from three perspectives
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Aging Physicians Present Both Issues and Opportunities by Betsy White Williams, Ph.D., M.P.H.
A combination of demographic and economic forces combined with changes in health and longevity suggest a probable increase in the number of physicians practicing well into old age. Over the next 20 years the number of older physicians as well as the proportion of older physicians in the workplace is projected to rise significantly.
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Introducing Michele Kilo, MD., Member of the Physicians Health Committee
Dr. Michele Kilo is Chief of the Section of Developmental and Behavioral Sciences at The Children’s Mercy Hospital. She graduated from the UMKC School of Medicine and remained in Kansas City for her Pediatric Residency and Neurodevelopmental Disabilities Fellowship, both at CMH. Immediately upon completion of her fellowship, Dr. Kilo was asked to become Chief of the Section of Developmental Medicine and Psychology.
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Medicine and Motherhood: Can We Talk? A Consensus Statement March 2010
This work is based substantially on the publication named Medicine and Motherhood: Can We Talk? authored by the task Force on the Accommodation of the Pregnant Physician, published by the Physician Health Program of British Columbia. The original report can be found at www.physicianhealth.com/medicineandmotherhood.
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November 2010 - Program Notes by Bob Bondurant

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November 2010 - Program Notes by Bob Bondurant
We are pleased to present an excellent report authored by the task force on the Accommodation of the Pregnant Physician, published by the Physician Health Program of British Columbia called Medicine and Motherhood: Can We Talk? This study has many implications for the health care delivery system in this country, and includes specific recommendations on addressing the issues involved.
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Recommendations Before Pregnancy: Creating a Healthy Foundation
Recommendations for Workplaces 1. Ensure that policies and guidelines regarding pregnancy and parental leave are in place and well communicated, in order to make the process of accommodation as open, smooth and rewarding as possible. Do so whether or not any pregnant physicians are present in the workplace, since existing mechanisms for accommodation send a positive signal to female employees and recruits whose futures include starting a family.
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Credibility in Urine Screening by Gary D. Carr. MD, Medical Director
Editor’s Note: This commentary was written to the participants of a program in Mississippi. Even though the references are to PHN, his comments are valid and applicable to those participants in the MPHP.
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Program Notes by Bob Bondurant

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Program Notes by Bob Bondurant
Our economy is a major concern. I referred to this last year in this column and it is as true today. Each year we rely on our contributors to continue or increase their level of financial support. The MPHP is not dependent on governmental support but it does need the ongoing support from our friends, the contributors, each and every year. They are our lifeline.
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Facing the Stigma of Depression by Nancy Morton, B.S., Hospital Services Coordinator
Part of the culture of medical professionalism is that physicians are always capable of making sound decisions for themselves. This includes decisions about their own self-care and well-being. Sadly, however, when physicians experience serious depression and or high levels of stress they are too often reluctant to seek care for themselves. Often they fear the results of coming forward in terms of career repercussions, or possibly being regarded as less competent by their peers.
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Suicide Up Close by Mary Fahey, LCSW, Clinical Coordinator
The effect of suicide on those left behind is profound and forever changing. When we see the families and friends after their loss, we see emotions that overwhelm them. We see the "what ifs" and why didn't I's" questions that will never be answered. As a survivor of my own sister’s suicide, I still struggle with why couldn't I have done more, especially being in my chosen field. What I have learned through tremendous pain, suffering and searching is that we are just not that powerful.
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Survey Suggests Physicians Feel Conflicted About Reporting Impaired or Incompetent Colleagues by Nancy Morton, B.S., Hospital Services Coordinator
JAMA recently published an article, “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues” 1 and an editorial in the same issue titled “The Role of Professionalism and Self-regulation in Detecting Impaired or Incompetent Physicians”. The study was designed to investigate attitudes and willingness of fellow physicians to report a physician that is impaired or incompetent.
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A Strategy for Medical Liability Reform by Arthur Gale, M.D.
Over the past thirty years there have been literally thousands of articles written about our broken medical liability system. Although some progress has been made, trial lawyers continue to oppose tort reform legislation and they continue to relentlessly file non-meritorious lawsuits against doctors.
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Smoking and Recovery: Unhappy Bedfellows

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Smoking and Recovery: Unhappy Bedfellows
Here’s a startling statistic: More than 50% of people in recovery from drug and/or alcohol addiction will die from a smoking related illness or condition. This means that more than half of people in recovery are really still dying from an addiction - an addiction to nicotine.
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Medical Marijuana - a Prescription for Trouble? by Doris C. Gundersen, MD, Medical Director, Colorado Physicians Health Program
Those in the healing profession have prescribed cannabis, known in the vernacular as Marijuana (MJ), for at least five millennia. MJ was prescribed in China as early as 2737 B.C. for ailments ranging from “absentmindedness” to “female weakness.” In the United Sates, physicians routinely prescribed MJ until the late 1930’s when it seemed to fall out of favor.
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Book Review: Finding Balance in a Medical Life by P. Bradley Hall
Have you ever wondered why physicians have a burnout rate of about 67% annually and why we struggle to work our way out of this rut? After all, we are very smart, creative, and well-meaning people. It should be easy to address our own unhappiness. The medical profession is unique, particularly as practiced in the United States, with extraordinary challenges and demands made upon its members ... a practitioner tax per se.
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Medical Record Challenges -- A Subtle Sign of a Potentially Impairing Condition? by Judith Eaton, MD
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.
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45 Seconds: Memoirs of an ER Doctor from May 22, 2011
My name is Dr. Kevin Kikta, and I was one of two emergency room doctors who were on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday May 22, 2011. You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: waking up, eating, going to the gym, showering, and going to my 4 00pm ER shift. As I drove to the hospital I mentally prepared for my shift as I always do, but nothing could ever have prepared me f...
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Carla Fine Speaks on Physician Suicide

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Responding to two recent physician suicides in Missouri, MPHP arranged presentations by Carla Fine, a well-known author and speaker on suicide, at two Missouri hospitals. Our objectives were to help physicians and other staff deal with the aftermath of these two deaths and to encourage open discussion of the issue.
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Suicide in Physicians: Toward Prevention by Michael Myers, MD, and Carla Fine, MS
No one talks about suicide -- especially in the medical community. When Carla Fine's husband, a prominent New York physician, killed himself, his colleagues reacted to his unexpected death with extreme discomfort and collective silence regarding the circumstances.[1] Her initial reaction was to cover up her husband's death in order to "protect" his medical reputation and preserve his legacy as a healer and fixer, and this placed a huge burden on her emotional state.
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Learning How to Recognize Substance Abuse by Nancy Morton
“The most troubling finding is 94% of primary care physicians failed to include substance abuse among the five diagnoses they offered when presented with early symptoms of alcohol abuse in an adult patient.” This quote is taken from the CASA National Survey of Primary Care Physicians and Patients on Substance Abuse.
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A Synopsis: Alcohol Abuse High Among Surgeons by Christina Frangon
A recent study summarized in General Surgery News, January 2012, reported that one in six surgeons met the criteria for alcohol abuse or dependence. Women, furthermore, had even higher numbers: 25.6% of female surgeons screened positive, while 13.9% of male surgeons were scored positive.
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How to Approach Someone with Potential Suicide Risk by Nancy Morton, BS
According to Mike F. Myers, MD, Professor of Clinical Psychiatry at SUNY-Downstate Medical Center, Brooklyn, NY, 85-90% of the people who kill themselves have been living with some kind of psychiatric illness, whether it is depression, substance abuse, both, or some type of personality disorder, bipolar illness, etc.1 What makes it particularly problematic is that the illness may be unrecognized by others as well as by themselves. However, that person’s associates can often detect behavioral ch...
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Tips From Dr. Bill W. – May 2015

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Tips From Dr. Bill W. – May 2015
In 1972, Elton John released an album, “Honky Chateau”, that included one of his most popular singles entitled “Rocket Man,” with lyrics by Bernie Taupin. Some have speculated that the lyrics describe the misery of addiction, and I agree. It describes well the loneliness of what I experienced prior to my recovery. Please take the time to re-listen to this tune (I know you have all heard it) to decide if you agree with me.
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Spotlight on Jeremy Duke, MA, LPC

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Spotlight on Jeremy Duke, MA, LPC
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.
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Speaking to the Future Leaders of Organized Medicine
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.
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A New Concept in Educating Chief Residents-An Example for Others
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.
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Physician Death by Suicide

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Physician Death by Suicide
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.
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The Physician Lifeline - May 2015

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The Physician Lifeline - May 2015
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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Opioid Prescribing Requires Close Patient Monitoring by Kevin B. O’Reilly
A 
study 
finds 
that 
primary 
care 
doctors 
avoid
 urine
 screening
 and
 other
 methods
 to
 prevent
 abuse 
of
 the
 pain
 medication s
even 
with
 highest-risk
patients. Opioid analgesics help alleviate the symptoms of patients with chronic pain, but they are also vulnerable to abuse.
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Responding to Workplace Suicide by Nancy Morton, B.S.
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:
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Money: A Barrier to Mental Health Care

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Money: A Barrier to Mental Health Care
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.
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The Limits of Treating Loved Ones

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The Limits of Treating Loved Ones
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.
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“Disruptive Behavior”: Case I by Betsy Williams, PhD
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.
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