Prominent medical ethicist calls for drug testing of doctors
Thursday, August 15, 2013
One of the most prominent figures in the field of medical ethics says there are circumstances under which doctors should be subjected to testing for drugs and alcohol that impair their ability to keep patients safe.
In a video commentary on the Medscape website (free registration required) titled “Doctors and Nurses Should Be Drug-Tested — Get Used To It,’ Dr. Arthur Caplan of the Division of Medical Ethics at the New York University Langone Medical Center said, “If we are going to push [patient] safety forward and make that a priority, if that’s going to become part of quality care, then I think we have to get on board [with] the notion that drug testing does have a role in our healthcare facilities, and that doctors and nurses should expect to do that.”
Caplan pointed out others responsible for consumer safety, such as airline pilots and train conductors, are tested “all the time” and are subject to random testing. He implied mandatory testing for medical professionals might not be necessary if doctors and nurses would blow the whistle on perceived possible drug problems in colleagues. “Unfortunately, the data doesn’t support peers being willing to do that,” Caplan said. “When you ask doctors, residents, even medical students hypothetically, ‘Would you report someone you thought was impaired,’ they tend to say ‘no.’ It’s something of an embarrassment.”
Caplan said he thinks passing a drug screening should be a requirement for getting a job as a doctor, and said he also supports random drug testing of doctors in certain situations. “When you have physicians and nurses in circumstances where drugs, anesthetics, are easily obtained and easy to abuse, you probably do need to do a certain amount of spot checking,” he said. “It may be that in certain areas of the hospital, [such as] anesthesiology, the occasional random test makes sense.”
The most justified use of drug testing, in Caplan’s view, is when there’s an “adverse event,” such as a patient death in the operating room. “When something serious happens, shouldn’t the people involved be subjected to mandatory drug testing?” he asked. “Some people will say, there’s no evidence that the kinds of errors, safety problems, in hospitals, nursing homes, that they’re linked to impairment. Well, that’s true, but we don’t monitor the situation and we don’t have drug testing following adverse events. Since we know that impairment is a problem in a small but significant percentage of physicians and nurses, I think we need to establish whether or not drugs, alcohol, some sort of abuse may have played a role in a medical mistake.”
Caplan added drug testing is not perfect and there can be false positives. As a result he thinks a positive drug test should call for an investigation rather than immediate firing. But he said, “Nonetheless, despite some of the flaws with testing, it seems to me if we’re going to commit to patient safety, to putting patients’ interests first, we have to make sure that problems, safety difficulties, adverse events, that these are not linked up to impaired physicians or impaired nurses.”
A California ballot initiative filed by Bob Pack of the Troy and Alana Pack Foundation calls for hospitals in the state to conduct random drug and alcohol testing of doctors who practice there and to test all doctors after an unexpected death or serious injury. Proponents hope to qualify it for the statewide ballot in November 2014.
Here is a video with some of Caplan’s comments:
— J.G. Preston