Physicians who work under the influence of alcohol unsurprisingly have a risk of poor outcomes, but patients and support staff may be reluctant to raise concerns about them, a review of 17 disciplinary cases suggests.
The review analysed proceeding taken agains 17 hospital physicians in Poland who collectively treated a total of 157 patients . There was direct evidence of harm in four cases, which included omissions in care, misdiagnosis and treatment complications.
However the review also showed that only 11 patients noticed signs of alcohol use and made a complaint , while 142 patients “had no significant objections to the doctor’s work and the quality of the health benefits provided”, according to author Dr Damian Sendler, an epidemiologist with an interest in medical malpractice from the Felnett Health Research Foundation in New York.
Writing in Forensic Science International, Dr Felnett notes that most of the treatments provided by doctors under the influence of alcohol were low-risk, requiring either a disposal of medications, follow-up treatment planning or a minor treatment execution, e.g. removal of sutures from one patient’s forehead.
Of the four patients who were harmed, one case involved a doctor missing an abnormality on a uterine ultrasound in a patient who subsequently experienced bleeding.
The other instances – improper treatment for a twisted ankle, a post-operative complication and a misdiagnosed pneumonia – resulted in lesser penalties with doctors able to return to work within six months.
His review highlights several common themes among the cases of doctors who were working under the influence of alcohol. Most were working in areas of doctor shortages and were working longer than usual hours. In addition, most doctors were working night shifts, although it was not clear of this was a conscious choice to try avoid detection. The review also shows there was poor communication between staff and with hospital management, which may have been a factor in the doctors’ alcohol use not being notified.