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UCSF Residents Report Fall 2010

UCSF Residents Report Fall 2010

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Published by: souzakh on Oct 19, 2010
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Fall 2010
Newsletter of te Ofce of Graduate Medical Education I University of California, San Francisco
Doctors and Addiction 1News from SFGh 3housestaff honors 4APEX Update 5Award Recipients 5Procedures Consult 610 Questions 8New ACGME Policies 10New GME Curricular AffairsDirector 11Out & About 13Quality/Safety ProgramUpdate 14Resident/Fellow Council16GME Diversity 18Cyper 20
in this issue
UCSF School of MedicineGraduate Medical Education500 Parnassus AvenueMU 250 East, # 0474San Francisco, CA 94143tel (415) 476-4562fax (415) 502-4166www.medschool.ucsf.edu/gme
(continued on page 2)
Elinore McCance-Katz, MD, PhDAdjunct Professor, Psychiatry
Doctors and Addiction: helpingGood People wit a Bad Disease
Impairing illnesses can occur in anyone, including physicians. Impairing illnesses aredened as those disorders that cause a physician to be unable to perform their professionalresponsibilities adequately, including medical, mental or substance use. Substance usedisorders occur frequently in Americans. The Substance Abuse and Mental Health ServicesAdministration (SAMHSA) reports that approximately 10% of Americans currently meetcriteria for a drug or alcohol use disorder 
. Physicians are also vulnerable to substanceabuse problems and are thought to suffer these disorders at the same rate as other Americans. Substance use disorders are the most common cause of impairing illness inphysicians. Most of us know or have known a friend or relative with a substance abuseproblem and many of us have seen the devastation these disorders can bring. What dowe do when we think a colleague may have a substance problem? And what happens tophysicians who have been identied as having an impairing illness?Impairment in the workplace can be difcult to identify in our colleagues. Impairment in workfunction tends to be a late stage of illness rather than an early sign. However, there aresome signs of impairment that can be clues to illness in our colleagues (Table 1).
Possible Warning Signs of Impairment in Pysicians
Alcohol on the breath
DUI charge
Often late on Mondays
Calling in sick
Staying late or coming in early frequently
Mood swings
Drowsy at work
Slurred speech on phone
Inappropriate orders
Inconsistent work performance
Inappropriate orders
Missing medications
Unusual prescribing practicesHow does a physician get to the point of having a substance abuse problem without any of their co-workers knowing, with recognition often delayed until the impairment has reachedthe point of potential patient harm? Physicians often nd it difcult to recognize these
problems in themselves. Many are unaware thatsafe levels of drinking are less than two drinks a dayor less than ve drinks in a sitting for men and lessthan one drink a day and less than four drinks in asitting for women
and that there are no safe levelsestablished for street drug use or non-medical useof a prescription medication. Physicians often takecare of themselves last. Physicians often adhere tothe belief that a ‘good’ doctor does not have suchproblems and is self-sacricing, preferring to ask acolleague about a medical problem or symptomsrather than go to their own doctor. Doctors may beexposed to high-risk situations in their lives such asstress at home or at work; may have ready accessto mood-altering substances; or have a geneticvulnerability to addiction of which they may not beaware.
how Is te Diagnosis of Substance Abuse or Addiction Made?
The Diagnostic and Statistical Manual of MentalDisorders
denes SubstanceAbuse and SubstanceDependence (Addiction).Substance abuse requires oneof the following four conditionsin a 12 month period: recurrentuse resulting in failure tofulll major role obligationsat work, home, or school;recurrent use in hazardoussituations (e.g.: drinkingand driving); legal problemsrelated to substance use; or recurrent use despite socialor interpersonal problems.The diagnosis of substancedependence requires three of seven diagnostic criteria bemet. The diagnostic criteriainclude evidence of tolerance(greater amounts of drug needed over time-less effectif the same amount of drug is used); withdrawal (aconstellation of physical and mental symptoms usuallythe opposite of what the drug produces); periodsof more or longer consumption of the substancethan intended; difculty cutting down or controllinguse; a great deal of time spent getting, using, andrecovering from the effects of the substance; giving upor reducing usual activities in favor of substance use;and continued use despite the knowledge of a relatedhealth problem.
Wat happens if Impairment is Recognized in aColleague?
When impairment is observed an intervention must bemade, often by the medical staff well-being committeeor by the program director or other supervisingphysician depending on the level of the impairedphysician (i.e., an attending level physician versusa resident physician). The physician is removedfrom practice and assisted with entering a facilitythat has skills in the assessment and treatment of impaired health professionals. Physicians generallyenter treatment after a clinical assessment ismade. Treatment for physicians with substance usedisorders is usually undertaken in a residential settingfor 30 to 90 days. While in this program there will beassistance with medical withdrawal from substancesif needed and treatment for medical and/or mental illnesseswill be given; individual, groupfamily, and mutual help therapieswill be started; and initiation of pharmacotherapy, if appropriate,will be undertaken. FDA approvedmedications for treatment of substance use disorders areavailable. Naltrexone can beused to treat either alcohol or opioid addiction while disulram(Antabuse) or acamprosateare also available for alcoholdependence
4, 5
.Once treatment is completed andthe doctor has been discharged,he/she is generally referred toongoing outpatient substanceabuse treatment. Once abstinencehas been initiated as evidenced by continuation intreatment and negative, random urine toxicologyscreens, the physician will be considered for a returnto medical practice. This occurs under monitoringinstituted through the state physician health programor through the residency training program. Monitoringincludes ongoing random urine toxicology screening,
(continued from page 1)
Doctors And Addiction...
(continued on page 17)
Doug Eckman, MBAOperations Manager, SFGH Dean’s OffceRachael KaganDirector of Communications, SFGH
Steady progress has occurred through the summer on digging the new hospital’s foundation. That, coupledwith continuing success rerouting underground utility lines, spells real momentum on the project. The projecthas also installed new canopies at the hospital’s entrances to help guide pedestrians and drivers around themodied campus layout. There is a new turnaround and drop off point at the 23
Street side of campus.The trenching work in the basement of the existing hospital will be concluding this fall. We look forward to thestaged return of dislocated departments – including the sleep rooms – starting at the beginning of 2011.
With the current main hospital entrance set to close, the existing coffee cart at the main entrance is alsoclosed. The SFGH Foundation and Webcor (the company building the new hospital) have purchased a newtrailer three to four times the size of the current one to house the new concession. It will be located adjacentto the new turnaround on 23
Street side of the campus. The Foundation conducted a competitive biddingprocess for the new service and the vendor has been selected.
Another upcoming improvement includes a community mural along the Potrero Avenue gate bordering theconstruction site. The hospital has engaged the Mission non-prot arts organization Precita Eyes. The muralwas completed on October 2, 2010. The SFGH community extends a big Thank You to all that participated inthe design and painting.
How earthquake safe is the new hospital? What makes it that way? Answers to these and other questionswill be provided at the SFGH Rebuild Seismic Safety Fair. The October 23
event (9am – noon) will featurearchitects, engineers, builders and other experts who can talk about the exciting safety features of the newbuilding. While you are there, plan your own family disaster kit and talk to emergency preparedness experts.Please join us for an open house in the cafeteria (2
oor of the main hospital) for this community event.
Things around the SFGH campus have been changing rapidly and are a bit hectic and confusing at times. Wegreatly appreciate the can-do spirit of patients, staff, and neighbors as they negotiate the new routes and rules.Safety is the number one priority and we are working hard to provide appropriate signage, aggers, and safetymeasures. A project this large and complex truly is a partnership. Please let us know how it is going and alertus to your needs. There are many ways to reach the rebuild team:
Information line at 206-5784
Email atsfgh_rebuild@sfdph.org
24-hour safety hotline 206-4500Also, check out the web site:www.sfdph.org/dph/RebuildSFGH/ Department-specic questions? Ask your supervisor or Chief of Service.

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