As it has developed and matured, this program has had increasingly good outcomes — and this particularly relates to earlier detection. Relapse rates have fallen considerably and suicide has been reduced.
Pethidine misuse: About half the doctors have a relapse in the course of their "first round" of treatment. In the second round, again about half relapse, and this relapse rate also applies to the very small number who go on to a third treatment program.
Mental health problems: The vast majority of these involve depression or post-traumatic stress disorder, and this group of doctors generally does well in treatment and complies very well with the management program set out by their treating specialist. The program is particularly useful in the case of hypomania. The backing of the Board for the specialist's management program goes a long way towards ensuring compliance with medication in doctors with this condition (which is characterised by poor medication compliance).
Some of the characteristics of health-impaired doctors that may assist in early intervention and education programs are given in the Box.
We have found that it is possible
to set up a system which has the powerful backing of the Medical Board, but which is, at least in the first instance, non-punitive;
to identify risk factors for drug misuse and mental health problems; and
to detect these problems early if the system, especially the medical system, is made well aware of possible avenues of help.
A result of the Health Committee activity, as described here, is that there is less stigma associated with the notion of impairment and therefore the opening up of more opportunities for helping impaired doctors. Assisting doctors who are isolated or not part of the culture to integrate in an atmosphere of collegiality seems to be an important part of achieving long-term favourable outcomes.
Some characteristics of health-impaired doctors
Working style: When these doctors describe their working style (and this is often supported by information from colleagues and their family), they appear as very conscientious people who work very long hours. They often have few friends within the medical profession and do not attend continuing medical education sessions. Sometimes an impression is gained that they have reached a point where "their only friends are their patients".
Family relationships: At the time of presentation, it is common to find that the doctor's family relationships have become disturbed and dysfunctional.
Isolation and alienation: A common finding is that more than half the doctors presenting with drug misuse did not train in Australia. In addition, there are a number who are sons or daughters of first-generation Australians, who are often by far the most highly educated of the extended family, and a great deal of faith has been put in their futures. In addition, solo practice is often over-represented, as is rural practice. As these doctors tell their stories, it becomes clear that they feel isolated, and perhaps even alienated, from Australian-trained doctors, and Australian customs and cultures. Their main solace as a doctor is in the actual practise of one-to-one medicine, and they do not share their experiences with their partners or in the wider setting of medical societies. They are often depressed or at least dysthymic.
In the wrong career: Some doctors feel isolated and estranged because they have come to recognise that they have made a mistake in going into medicine and do not know what else to do. Some of these doctors come from families with a strong medical tradition.