Objectives
Substance related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of the present study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring due to substance-related impairment, in order to develop better mechanisms of prevention and intervention.
Methods
A total of 55 physicians (94.5% male) who were being monitored by their State professional health program due to substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from nine separate focus groups, lasting 60–90 minutes each. Qualitative analyses were conducted to examine themes.
Results
All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented five primary reasons for prescription drug misuse: 1) to manage physical pain, 2) to manage emotional/psychiatric distress, 3) to manage stressful situations, 4) for recreational purposes, and 5) to avoid withdrawal symptoms.
Conclusions
Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, though recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education occurring throughout the physicians’ careers.
Clinicians routinely assess patients' mental capacity on a daily basis, but a more thorough assessment may be needed in complex cases. We aimed to identify the characteristics of inpatients in a general hospital, who were referred to a liaison psychiatry service for mental capacity assessment, reasons for the referrals, and the factors associated with their mental capacity. A 6-year retrospective study (2008-2013) was conducted using data collected routinely (e.g., age, gender, diagnosis, Thai Mental State Examination score, reasons for the referral, and the outcome of capacity assessment) on referrals for mental capacity assessment to a Consultation-liaison Psychiatry Unit at a university hospital in Thailand. Among 6194 consecutive referrals to the liaison-psychiatry services, only 0.6 % [n = 37, mean age (SD), 59.83 (20.42)] were referred for capacity assessment, 43.24 % of which lacked mental capacity. The most common requests from referring physicians were for assessment of testamentary capacity (15 assessed, 53.33 % lacking capacity), financial management capacity (14 assessed, 50 % lacking capacity), and capacity to consent to treatment (9 assessed, 22.22 % lacking capacity). Delirium, rather than dementia or other mental disorders, was associated with mental incapacity (p < 0.001) and being more dependent during the admission (p = 0.048). There were no significant differences for mean age (p = 0.257) or Thai Mental State Examination score (p = 0.206). The main request from referring clinicians was to assess testamentary capacity. Delirium and being more dependent during the admission were associated with lack of mental capacity, whereas age and dementia were not.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.