Addiction Psychiatry

Biography

David G Petkash is a Physician as well as a Pharmacist. Upon graduating from St. John’s University College of Pharmacy he excelled in Pharmacology in medical school. During his Psychiatry Residency at Eastern Virginia School of Medicine he took interest in neuropsychiatry, chemical dependency and forensic psychiatry.  Completing a fellowship in geriatric psychiatry/neuropsychiatry at University of Pittsburgh Medical Center, he obtained clinical/academic positions as an Assistant Clinical Professor at University of Maryland Medical Center as well as Penn State University College of Medicine. His private practice forensic medical-legal evaluations have included psychopharmacological analysis, substance abuse and addiction psychiatry examinations concerning physicians and nurses. He is a Member of the Pharmacy and Therapeutics committee for not-for-profit HMO pharmacy benefit management organizations. His American Board of Psychiatry and Neurology certifications include: Addiction Psychiatry, Forensic Psychiatry, General Psychiatry, and Geriatric Psychiatry. His Membership includes American Academy of Psychiatry and Law, American Psychiatry Association, and American Academy of Addiction Psychiatry.

 

 

Abstract

Impaired physicians and associated healthcare professionals, i.e. HCPs, constitute a major problem and potential danger for US and international healthcare delivery systems. Patients, hospitals, and health networks are placed at an increased risk of incompetent medical provider care as well as an increased risk of medical malpractice and/or negligence by HCPs addiction. Estimates of HCP impairment for physicians range from 12-15%, nurses 15-20%, pharmacists 18-21%, and dentists 12 to 19%. Physicians experience the highest rate of suicide in any profession. The most common cause of physician impairment is substance abuse. Substance abuse risk stratification will be reviewed according to the medical specialty, with anesthesiology, emergency medicine, and psychiatry, constituting the highest risk. The predisposing personality characteristics of HCPs to addiction, including burnout syndrome, as additional risk factors will be reviewed. Examples and prevalence rates of specific substances of abuse for HCPs and comorbid psychiatry disorders predisposing to addiction as well as the most common reasons for addiction by HCPs at time of initiation of addiction treatment will be discussed. Reasons for the reluctance of physicians/HCPs to seek substance abuse treatment, including fear of stigma in seeking treatment are reviewed. Goals of the evaluation for HCPs will be reviewed by including the following components of a prototypical addiction psychiatry evaluation: obtaining an accurate diagnostic assessment of the underlying substance abuse disorder, and related comorbid medical and psychiatric disorders; provide an assessment of the individualized treatment needs of the affected HCP. Potential medical/legal consequences of HCP addiction will be reviewed including malpractice liability, loss of licensure, ethical considerations, as well as legal implications relating to return to practice. Finally, a case example of an addiction psychiatry evaluation of an impaired physician (independent medical evaluation) performed by the presenter will be discussed.