Physician Health Research Conference (Estes Park, Colorado--September 15-17, 1996): progress report one year later.

The 1996 Physician Health Research Conference was the first conference to focus exclusively on research issues and methods for impaired physicians. The conference was initiated by James Shore, M.D., professor and chairman of the Department of Psychiatry in the School of Medicine at the University of Colorado Health Sciences Center and superintendent of the Colorado Psychiatric Hospital, and Stephen Dilts, M.D., Ph.D., medical director of the Colorado Physician Health Program and clinical professor of psychiatry at the University of Colorado Health Sciences Center. Forty participants represented a wide range of national organizations. The conference was supported by contributions from the American Medical Association, American Psychiatric Association, Colorado Physician Health Program, Colorado Physician Insurance Program, and the Department of Psychiatry and Colorado Psychiatric Hospital at the Health Sciences Center. In addition, the conference was cosponsored by the American Academy of Addiction Psychiatry, the American Society of Addiction Medicine, and the Federation of State Physician Health Programs. This paper summarizes the formal presentations of the conference.

Autoimmune diabetes: the involvement of benign and malignant autoimmunity.

Our studies in the NOD mouse demonstrate that the autoimmune response can be either benign or malignant. In the former case /=100 days of age make up a heterogeneous group where some are in a benign state of autoimmunity, which can continue for a further |LX200 days, others are in a state of transition to the malignant state of autoimmunity, and others have a fully malignant autoimmune response and are diabetic. This heterogeneity developing within members of the population, in terms of pancreatic damage, is not consistent with the proposal that autoimmune islet damage in the NOD mouse is a slow, progressive process affecting all disease prone members of the population. In the NOD mouse, massive islet destruction is a late event in the autoimmune process and only develops following the conversion of the autoimmune response from the benign to the malignant state.

On the Szaszian argument.

The Szaszian argument claims that psychiatry is a rhetorical enterprise aimed at providing justification for involuntary treatment. Such treatment, the argument holds, is just when provided to those suffering from demonstrable brain lesions, but it is unjust in cases of "mental illness" because such "illnesses" lack objective histopathology and are therefore fictional. It is here argued that this distinction is irrelevant to the morality or immorality of involuntary treatment, since such treatment inevitably rests on a subjective determination of competency or dangerousness, which is not rendered substantially more objective by the criterion of histopathology. The Szaszian argument subscribes to a naturalistic fallacy in this regard, which leads it to inconsistencies in its philosophy of mind.

Self-disclosure and the treatment of substance abuse.

Identification and treatment of the substance-abusing physician has led to outcome studies focusing on years of abstinence and resultant work performance, but little has been written addressing the therapeutic changes recovery brings in the personal lives of these physicians or in their approach to similarly addicted patients. The unique position of recovering psychiatrists engaged in the treatment of substance-abusing patients has not been addressed. Self-disclosure is a major issue and becomes unavoidable if the psychiatrists meet their patients at Twelve-Step meetings. This paper begins a discussion of the issues of self-disclosure and anonymity for recovering psychiatrists. The informal method used to gather information highlights the sensitivity of these issues for both patients and psychiatrists. The clinical examples show the importance of evaluating the psychodynamic impact of self-disclosure on the patient, the psychiatrist, and their treatment relationship.

Physicians with substance abuse problems and their recovery environment: a survey.

Given the importance of social support to recovering chemically dependent individuals at risk of relapse and the concerns of treaters that professionals may avoid affiliation with 12-step groups, the authors sought to confirm the results of an earlier study in which a sample of recovering physicians in Atlanta identified 12-step programs as their most important source of support. Because the Atlanta cohort might have self-selected to favor 12-step programs, the authors studied a physician group that was more heterogeneous relative to treatment experience. The questionnaire used in the Atlanta study was sent to recovering physicians in Colorado. Like their Atlanta counterparts, many Colorado physicians identified the 12-step programs as more important to their recoveries than treating professionals and family members. Affiliative feelings toward 12-step program members equalled those toward close nonmembers. The 12-step programs provide some, but not all, chemically dependent physicians a source of social support during recovery.

Incidence of alcohol abuse in the parents of medical students.

An anonymous self-report survey of the medical students at the University of Colorado Health Sciences Center assessed how many of the students' parents were alcohol abusers. The results indicated that 27% of the student body were children of alcohol abusers, a rate twice that of the general population. This finding has implications for teaching strategies, student substance abuse, prevention efforts during the medical-school years, and provision of appropriate programs through student health services.

Establishment of the Colorado Physician Health Program with a legislative initiative.

The Colorado Physician Health Program, a statewide peer health assistance program for physicians, has been developed as a not-for-profit, freestanding corporation through the cooperative efforts of organized medicine. A recently enacted Colorado statute provides for funding through a surcharge on physician licensure fees. The use of an employee assistance model has minimized potential conflicts of interest and allowed the program to assist both physicians and the Colorado Board of Medical Examiners.

The Colorado Physician Health Program.

The Colorado Physician Health Program (CPHP), established in 1986, is a peer assistance program for impaired physicians modeled after employee assistance programs in business and industry. The CPHP involves identification, evaluation, treatment referral, monitoring, advocacy, and support for physicians who are experiencing problems severe enough to threaten their careers. The program is funded through a legislated funding mechanism that allows a portion of state physician licensure fees to be used to assist impaired physicians.

Stress in residency: proposals for solution.

Current problems leading to excessive stress in residency are presented and are compared with those of a generation ago. Solutions are proposed that can be summarized as follows: (1) commitment by the program director and chairman to resolving stress in residency and (2) flexibility by the American Board of Obstetrics and Gynecology and the Residency Review Committee. A general discussion is presented.

The alcohol emergency room in a general hospital: a model for crisis intervention.

The alcohol emergency room at Denver General Hospital provides a model for crisis intervention for alcoholics. The unit is staffed 24 hours a day by nurses. Patients spend an average of 45 minutes in waiting time and triage. About half the patients require inpatient treatment; the others are referred to outpatient programs. Unit staff emphasize consultation and liaison with other hospital staff to coordinate the treatment system and provide education on aspects of alcoholism. They also explain the patient's condition and needs to his significant others, who provide crucial external support. Staff currently see 400 patients and answer about 270 telephone requests for information about alcoholism treatment monthly.