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Introduction Burnout, substance abuse, and mood disorders are prevalent among neurology residents. Increased recognition of concerning behaviors might encourage more access to mental health resources and reduce burnout. Methods We created an educational resource reviewing burnout, substance abuse, and mood disorders for neurology residents. This resource included an online module (control) and a role-play scenario offered only to one cohort (intervention). Online surveys assessed knowledge as well as confidence in the ability to recognize concerning behaviors. A practical assessment using a previously published “Stressed Resident” video was also conducted among resident cohorts. Results Of neurology residents, 18 participated in the activity, with nine in the control group and nine in the intervention group. In the postvideo survey, the residents who participated in a role-play activity outperformed a control cohort of their peers when identifying signs of burnout, mood disorders, and substance abuse portrayed in the video (84% vs. 72%; t test, p = .01). Residents indicated increased confidence in the ability to recognize symptoms of maladaptive stress as well as identify resources for themselves and peers. Participants demonstrated no difference in knowledge-based questions scores on pre- and postactivity assessments. Discussion Our educational resource improved resident ability to recognize signs of maladaptive stress and to identify residents that are a risk to patient safety. The activity is easy to implement and can be easily adapted outside neurology. Limited sample sizes may limit the ability to demonstrate this tool's impact on knowledge of burnout, substance abuse, and mood disorders.

Abstract Background Physician health program websites in 23 states provide many descriptions of possible physician impairment. This study sought to determine whether these descriptions are so broad that almost everyone might potentially be suspected of being impaired given these descriptions. Methods The authors randomly selected 25 descriptions of impairment and then presented them anonymously online to members of the general population in full-time employment through Amazon’s Mechanical Turk (N = 199). Half of the respondents randomly received a narrowly worded version, and half received a broadly worded version of the survey questions. Results In the narrowly worded version of the survey, 70.9% of respondents endorsed at least one description of impairment, and 59.2% endorsed more than one. In the broadly phrased version, 96.9% endorsed at least one description, and 95.8% endorsed more than one. These respondents endorsed a median of 10 out of 25 (40%) descriptions. Conclusions These findings call into question whether these descriptions really identify persons with poor performance or who pose a high risk of substantial, imminent harm to self or others in the workplace. They also demonstrate the extent to which these descriptions could potentially be misapplied and brand almost anyone as impaired.

Introduction: The purpose of this two-part study was to determine the prevalence and severity of the burnout syndrome among South African anaesthetists working in the public and private sectors, and to identify areas of work-life (AWLs) that predispose to burnout. We reported our burnout findings in Part 1.1 In this paper (Part 2) we report on the AWLs. Methods: Invitations were e-mailed to 1 852 SASA members, requesting responses to a validated questionnaire, the Areas of Worklife Survey (Mindgarden Inc. Menlo Park, USA). The questionnaire results in scores for six AWLs that impact on the development of the burnout syndrome, namely workload, control, reward, community, fairness and values. Results: 189 public sector and 309 private sector anaesthetists responded. 85% of public sector respondents worked in academic hospitals. The values AWL could not be properly assessed due to respondents' misinterpretations regarding that particular item. Compared to private sector, public sector anaesthetists had lower (i.e. more adverse) median scores for five AWLs. Greater proportions of public sector anaesthetists had low scores for the five AWLs. Correspondingly, smaller proportions of public sector anaesthetists had high (i.e. favourable) scores for workload, control, reward, and fairness. Multivariable least squares regression analysis identified the following significant explanatory variables for the following burnout dimensions: For emotional exhaustion these were workload, reward, community and control. For cynicism they were workload, reward, control, gender and years of experience. Predictors for efficacy were reward, community, control and years of experience. Logistic regression analysis included workload, reward and control AWL as explanatory variables for a clinical diagnosis of burnout with workload the dominant variable. Conclusions: Public sector anaesthetists experience more adverse AWLs than those in private practice. The most important factor appears to be excessive workload. Additionally, the reward, community and control AWLs are important determinants of anaesthetists' psychological relationships with their work. [ABSTRACT FROM AUTHOR]

Background: Burnout is a psychological syndrome that develops in response to chronic job-related stressors. Its three predominant manifestations are emotional exhaustion, cynicism, and feelings of ineffectiveness and unfulfillment (low efficacy). Our study objectives were to establish the prevalence and severity of burnout among South African anaesthetists and to compare the results with previous studies. We also identified areas of work-life that predispose to burnout and we report these results in a separate paper (Part 2).1 Methods: We e-mailed invitations to 1 852 SASA members, requesting responses to two validated questionnaires, the Maslach Burnout Inventory and the Areas of Worklife Scale. We categorised respondents according to the "Emotional Exhaustion+1" principle, whereby a person is regarded as being clinically burned-out if he/she has a a high score for emotional exhaustion, plus either a high cynicism score or a low efficacy score. High scores for all three dimensions defined "extreme burnout". Results: 189 public sector and 309 private sector anaesthetists responded. 85% of public sector respondents worked in academic hospitals. Compared to those in private practice, public sector anaesthetists exhibited a greater prevalence and severity of burnout. This was manifested by: (1) more adverse scores for all three burnout dimensions; (2) a greater prevalence of clinically diagnosable burnout (36.5% vs. 14.2%) as well as "extreme burnout" (17.5% vs. 6.5%). Public sector anaesthetists experienced more burnout than in other countries. Conclusions: The prevalence of burnout is unacceptably high among South African anaesthesia providers, particularly in public hospitals. This poses an immediate threat to both anaesthetists' mental and physical health and to patient safety. The severity and prevalence in teaching institutions jeopardises the current effectiveness and future sustainability of the South African healthcare system. [ABSTRACT FROM AUTHOR]

Objective: To analyse the frequency of dependence on others for oral hygiene and its association with hand deformities, frailty and dependence on others for basic activities of daily living (BADL) among elders with a history of leprosy.Background: Dependence on others for oral hygiene has not been considered in multifunctional geriatric assessments.Material and Methods: Edentulous elders with a history of leprosy who used complete dentures and resided in a former leprosy colony were classified as independent or partially/completely dependent on others for brushing their dentures or rinsing and for BADL, and as frail or robust. The presence of hand deformities was assessed by an occupational therapist.Results: 28.4% and 14.9% were completely/partially dependent on others for brushing and rinsing, respectively. The dependence for BADL was observed in 21.6% and hand deformities in 17.6%. A higher odds of dependence for brushing/rinsing was found among elders who were dependent on others for BADL. Brushing dependence (61.5%) was more frequent among participants with hand deformities than those without this condition (21.3%) (OR: 6.8; 95% IC: 1.2-37.9; P = .028). There was no association between frailty and brushing (P = .068) or rinsing (P = .202) dependence.Conclusion: Approximately one-third of elders have a dependence on others for brushing; a smaller proportion is dependent on others for rinsing. Older people who are dependent on others for BADL and who present hand deformities are more likely to be dependent on others for denture brushing and rinsing. Elders may perform oral self-care even when they present frailty. [ABSTRACT FROM AUTHOR]

Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders in healthcare delivery must work together to develop and implement effective remedies for physician burnout. [ABSTRACT FROM AUTHOR]

The websites of many physician health programs provide lists describing signs of impairment or indications to refer physician-employees for evaluation and possible treatment. This study aimed (1) to determine how many of these descriptions likely provide physicians' employers with sufficient evidence to legally request mental health examinations under the general regulations of the Americans with Disabilities Act (ADA); and (2) to find out who they described. The authors applied US Equal Employment Opportunity Commission guidance documents and sought expert legal advice to evaluate the descriptions for their consistency with the ADA. They used directed content analysis to review and code these descriptions into categories. Very few, if any, of the 571 descriptions appeared to provide sufficient evidence for employers to request an examination under the ADA. About 14%, however, could refer to physicians attempting to defend themselves, assert their ADA rights, or otherwise complain about the hospital; and 27% either described physicians who complain or else had discriminatory effects in one of several different ways. Leaders within the medical field should ensure that their policies and state laws pertaining to physician impairment comply with and incorporate the language of the ADA. They should also reevaluate the functions of these policies, laws, and physician health programs, and the implications for patient safety, physician wellness, suicide, and other important issues. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This research intends to discuss sexual harassment within the doctor-patient relationship based on four parameters: doctor's characteristics, accuser's characteristics, accusation characteristics, and the evaluation by the Medicine Council of São Paulo. METHOD: It is a descriptive, quantitative approach using a retrospective documental analysis. Studied subjects were doctors who were allegedly engaged in sexual harassment. This analysis considered all accusations made from January 2000 to December 2005 (n=150). RESULTS: For this type of sexual abuse, there was a prevalence of male professionals (96.6%) who committed abuse against female patients (90.3%) during adulthood (77.7%). The mean age of the accused was 46.87 years, ranging from 30-76 years, concentrated between 46-75 years. The intrinsic difficulty of understanding sexual harassment by a professional constrained ethical evaluation of the cases, with 24.1% of the cases being considered proceeding charges by the professional council. When the cases were recognized as proceeding, they were either filed (88.2%) or were considered to be ethical infringement (11.8%) becoming Professional Ethical Process (PEP). In the majority of proceeding cases (87%), there was a Police Occurrence Report enclosed. DISCUSSION AND CONCLUSION: The incidence of sexual abuse by professionals was independent of education, as the accused professionals came from a large variety of medical colleges, without significant differences related to institution. The predominance of accusations against older professionals may occur due to the frail personality structure that allows professional acting out. Objective evidence is very important in ethical evaluations compared to psychological and subjective evidence.

Background Understanding of doctors' attitudes towards disclosing their own mental illness has improved but assumptions are still made. Aims To investigate doctors' attitudes to disclosing mental illness and the obstacles and enablers to seeking support. Methods An anonymous, UK-wide online survey of doctors with and without a history of mental illness. The main outcome measure was likelihood of workplace disclosure of mental illness. Results In total, 1954 doctors responded and 60% had experienced mental illness. There was a discrepancy between how doctors think they might behave and how they actually behaved when experiencing mental illness. Younger doctors were least likely to disclose, as were trainees. There were multiple obstacles which varied across age and training grade. Conclusions For all doctors, regardless of role, this study found that what they think they would do is different to what they actually do when they become unwell. Trainees, staff and associate speciality doctors and locums appeared most vulnerable, being reluctant to disclose mental ill health. Doctors continued to have concerns about disclosure and a lack of care pathways was evident. Concerns about being labelled, confidentiality and not understanding the support structures available were identified as key obstacles to disclosure. Addressing obstacles and enablers is imperative to shape future interventions. [ABSTRACT FROM AUTHOR]

Introduction: to evaluate the socio-demographic, occupational and biopsychosocial factors related to absenteeism of Fundación Clínica del Norte. Methods: an exploratory, empirical, analytical and cross-sectional methodological approach was used for this research, on a non-probabilistic sample of casuistry of 45 employees. Data on demographic, occupational and bio-psychosocial factors were collected through an online questionnaire and a corporate databases on absenteeism in the period 2013-2014. Both of them were analyzed by the SPSS statistical package. Results: prevalence of absenteeism of 78%. Relationship between socioeconomic strata 1 and 2 and increased absenteeism (value p= 0.031) was found; also largely absent among support staff (80%) compared to nurses (50%) was observed; as for gender, women incapacitated in higher percentage (81%) than men (63%), although it should be noted that these data did not have a statistically significant association. Conclusions: the results show a high percentage of absenteeism in the nursing staff and although it can not establish statistically significant association between many of the variables studied, we could establish a relationship between some of these and increased absenteeism. [ABSTRACT FROM AUTHOR]

The authors comment on studies which found that physician burnout is increasing, with physical medicine and rehabilitation (PM&R) being the third highest-ranked specialty reporting burnout. Topics covered include the lack of literature on physiatrists experiencing symptoms of burnout, the controversy in the literature as to whether burnout is a form of depression or a distinct syndrome, and the need for physicians to focus on their own sense of mission to recognize its role in burnout.

The article discusses research which investigated differences in lifetime substance use and abuse/dependence as well as other psychiatric disorders, comparing physicians undergoing monitoring with a general population that had sought treatment for substance use. Researchers evaluated 99 physicians referred to a Physician's Health Program (PHP). They found that physicians referred to a PHP had higher odds of abuse/dependence disorders than a general population sample.

The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision makers as they develop preventive policies. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician health program were conducted. The content analysis revealed that physicians divert medications by stealing from the office or hospital, by defrauding patients and insurers, by using medication samples, and by misusing valid prescriptions. The implementation of policy interventions targeting these mechanisms has the potential to mitigate the amount of physician diversion that occurs. [ABSTRACT FROM AUTHOR]

Abstract: Background: Many members of the American College of Emergency Physicians are now over the age of 50. Little is known regarding age-specific issues that may impact the careers of emergency physicians in the latter stages of their professional lives. Objectives: To determine issues of concern regarding aging and retirement among a cohort of emergency physicians in pre-retirement years. Methods: A survey of a randomized sample of 1000 American College of Emergency Physicians members over the age of 55 years was conducted with two separate mailings in the fall of 2006 and winter of 2007. The survey instrument consisted of 30 questions relating primarily to issues of health, finances, and the ability to practice emergency medicine. Four open-ended questions were included at the end of the survey, relating to means of promoting career longevity. Results: There were 802 usable responses received (response rate 80%). The average respondent was 57 years old and worked 30 clinical and 12 non-clinical h per week. The average estimated time to complete retirement was 7.8 years. Respondents generally viewed themselves as competent clinicians with improved ability to relate to patients and staff and little decline in procedural skills. However, a substantial proportion reported age-related concerns. Seventy-four percent reported less ability to recover from night shifts, 44% reported a higher level of emotional exhaustion at end of shift, 40% reported less ability to manage heavy patient volume, 36% reported less ability to handle stress of emergency medicine, 28% reported health limitations on ability to practice, 28% reported memory somewhat or considerably worse, and 25% reported less ability to incorporate new modalities of diagnosis and treatment. With regard to retirement-related issues, 42% reported concerns about adequate financial preparations and 44% reported concerns regarding loss of identity upon retirement. The practice modifications most commonly reported to impact career longevity were the reduction or elimination of night shifts, a reduction in the number of hours per shift, and an increase in physician and support staffing. Conclusions: Respondents to this survey generally viewed themselves as competent, empathic practitioners. Yet a substantial percentage acknowledged at least some degree of cognitive or physical decline. The results suggest a role for the national organizations in emergency medicine in endorsing practice modifications that promote career longevity and clinical competence among its senior members. [Copyright &y& Elsevier]

Objectives: The objective was to assess the prevalence and patterns of modafinil and zolpidem use among emergency medicine (EM) residents and describe side effects resulting from use. Methods: A voluntary, anonymous survey was distributed in February 2006 to EM residents nationally in the context of the national American Board of Emergency Medicine in-training examination. Data regarding frequency and timing of modafinil and zolpidem use were collected, as well as demographic information, reasons for use, side effects, and perceived dependence. Results: A total of 133 of 134 residency programs distributed the surveys (99%). The response rate was 56% of the total number of EM residents who took the in-training examination (2,397/4,281). Past modafinil use was reported by 2.4% (57/2,372) of EM residents, with 66.7% (38/57) of those using modafinil having initiated their use during residency. Past zolpidem use was reported by 21.8% (516/2,367) of EM residents, with 15.3% (362/2,367) reporting use in the past year and 9.3% (221/2,367) in the past month. A total of 324 of 516 (62.8%) of zolpidem users initiated use during residency. Side effects were commonly reported by modafinil users (31.0%)—most frequent were palpitations, insomnia, agitation, and restlessness. Zolpidem users reported side effects (22.6%) including drowsiness, dizziness, headache, hallucinations, depression/mood lability, and amnesia. Conclusions: Zolpidem use is common among EM residents, with most users initiating use during residency. Modafinil use is relatively uncommon, although most residents using have also initiated use during residency. Side effects are commonly reported for both of these agents, and long-term safety remains unclear. [ABSTRACT FROM AUTHOR]

Inflated rates of opioid addiction among anesthesiologists may be caused by chronic exposure to low doses of aerosolized anesthetic/analgesic agents in the operating room. Such secondhand exposure produces neurobiological sensitization to the reinforcing effects of these substances, making later addiction more likely. This article extends findings that fentanyl and propofol are detectable in the air of the operating room and demonstrates that fentanyl is also detectable on surfaces in the operating room. Secondhand exposure could, therefore, occur by inhalation and skin absorption. Additionally, data show that many physicians with opiate addiction have a family history of addiction, suggesting genetic vulnerability to the effects of secondhand exposure. Other new data demonstrate that the rates of marijuana and tobacco smoking are much higher among opioid-addicted physicians, suggesting that prior exposure to THC (the psychoactive component of cannabis) or nicotine might increase vulnerability to secondhand effects. Suggestions for reducing secondhand exposure in the operating room are discussed. [ABSTRACT FROM AUTHOR]

Physician impairment is a serious public health issue affecting physicians as well as their families, colleagues, and patients. Though physicians generally display healthier habits than members of the general population, overall rates of impairment are similar among both groups, and prescription drug abuse (including prescription opioids) is particularly problematic among physicians. The current review focuses mainly on prescription opioid abuse and dependence among physicians. It includes a brief history of early physician experiences with anesthetic and analgesic agents, and explores several hypotheses regarding the etiology of prescription opioid abuse and dependence among physicians. Barriers to identification and to treatment entry among physicians are discussed. In addition, methods of assessment and successful treatment in specialized impaired physician programs are described. Medical and psychosocial interventions, 12-step involvement, and extensive use of evaluations are highlighted. Attention is paid to typical follow-up contracting and monitoring strategies, as well as strategies for prevention. Given the extremely positive outcomes demonstrated by specialized programs for treating impaired professionals, it is recommended that their methods be disseminated and utilized in treatment centers for the general public. [ABSTRACT FROM AUTHOR]

Objectives: To explore the prevalence of substance use among emergency medicine (EM) residents and compare to a prior study conducted in 1992. Methods: A voluntary, anonymous survey was distributed in February 2006 to EM residents nationally in the context of the national in-service examination. Data regarding 13 substances, demographics, and perceptions of personal patterns of substance use were collected. Results: A total of 133 of 134 residencies distributed the surveys (99%). The response rate was 56% of the total EM residents who took the in-service examination (2,397/4,281). The reported prevalence of most illicit drug use, including cocaine, heroin, amphetamines, and other opioids, among EM residents are low. Although residents reporting past marijuana use has declined (52.3% in 1992 to 45.0% in 2006; p < 0.001), past-year use (8.8%–11.8%; p < 0.001) and past-month use (2.5%–4.0%; p < 0.001) have increased. Alcohol use appears to be increasing, including an increase in reported daily drinkers from 3.3% to 4.9% (p < 0.001) and an increase in number of residents who indicate that their consumption of alcohol has increased during residency (from 4% to 12.6%; p < 0.001). Conclusions: Self-reported use of most street drugs remains uncommon among EM residents. Marijuana and alcohol use, however, do appear to be increasing. Educators should be aware of these trends, and this may allow them to target resources for impaired and at-risk residents. [ABSTRACT FROM AUTHOR]

The article presents a study which provides an overview of Norwegian and international research into physician's health problems and their use of health services, focusing more on studies relating to The Norwegian Physicians' Survey. Results of the review suggests that physicians' physical health is similar to the general population, although female physicians tend to be in better health than other women, and that some mental disorders such as depression appear to be more prevalent.

Abstract: We surveyed physicians to determine what factors were associated with their reporting of impaired colleagues to Physician Health Programs (PHPs). We conducted a cross-sectional mail survey of 1000 randomly selected practicing physicians in the United States. A survey instrument asked the physicians whether they would report 10 hypothetical impaired colleagues to a PHP. The results show that a majority of the physicians would report physicians to PHPs, but were more likely to report hypothetical physicians involved in substance abuse than those who were emotionally or cognitively impaired . Respondents who felt they had a societal obligation as opposed to an obligation to protect the rights of the individual were more likely to report hypothetical physicians. Those respondents who stated they knew of guidelines on reporting impaired physicians had more frequently reported impaired colleagues . We conclude that physicians should be educated on the availability and functioning of PHPs and the ethical and legal obligations of assisting impaired colleagues. [Copyright &y& Elsevier]

The assessment and treatment of physicians with substance use disorders has been of considerable interest over the past twenty years. This study compares two cohorts of addicted physicians treated at a single program. Data from 101 physicians treated during 1985 to 1987 were compared with 73 physicians treated from 1995 to 1997. Although the cohorts were similar on demographic, physician specialty, and drug of choice variables, psychiatric comorbidity was significantly more prevalent in the later sample. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure satisfaction with a physician alcohol/drug and behavioral health monitoring program. Participating physicians rated the program's effectiveness, staff professionalism, monitoring and advocacy, relapse services, and sensitivity to women's issues. Correlations between satisfaction and successful recovery, source of referral, and legal involvement were computed. Responders' (N = 87, 82% male) contracts were 82% alcohol/drug and 9% behavioral health; 76% first contracts (no relapse). Sources of referral were self (32.2%), a friend/colleague (31%), the state medical board(14.9%), a hospital chief (11.5%), or a family member (3.4%). Satisfaction was associated with no relapse (mean rank = 47.6 vs. 30.0, p = .005), but not with gender (p = .47), type of contract (p = .39), source of referral (p = .75-.05), or board involvement (p = .24). Participants' reactions to the PHS program were influenced more by positive clinical outcome than other factors. [ABSTRACT FROM PUBLISHER]

Stress, emotional dysfunction, and work impairment are seen as accelerating phenomena in residency training, and have received increased attention in the medical literature. The authors review relevant literature in this area, and note continued deficiencies in programs for prevention and intervention. The present study focuses on the perceptions of key members of the academic hierarchy regarding housestaff stress and impairment. Chairmen, program directors, and chief residents in all specialties were asked to estimate the prevalence of several impairment syndromes, to describe any existing policies or programs to assist residents, and to express their opinions about developing such intervention strategies. The results are compared by respondent group, by resident postgraduate year, and by groupings of surgical and non-surgical programs. Suggestions for further research in this area are then offered. [ABSTRACT FROM AUTHOR]

Objectives: To describe how physicians think and feel about their perceived mistakes, to examine how physicians' prior beliefs and manners of coping with mistakes may influence their emotional responses, and to promote further discussion in the medical community about this sensitive issue. Design: Audiotaped, in-depth interviews with physicians in which each physician discussed a previous mistake and its impact on his or her lift. Transcripts of the interviews were analyzed qualitatively and the data organized into five topic areas: the nature of the mistake, the physician's beliefs about the mistake, the emotions experienced in the aftermath of the mistake, the physician's way of coping with the mistake, and changes in the physician's practice as a result of the mistake. Participants and setting: Eleven general internists and medical subspecialists practicing at a community, university-affiliated hospital in Oregon. Results: Themes emerging from analysis of the interviews were the ubiquity of mistakes in clinical practice; the infrequency of self-disclosure about mistakes to colleagues, family, and friends; the lack of support among colleagues; the degree of emotional impact on the physician, so that some mistakes were remembered in great detail even after several years; and the influence of the physician's professional locus of control on subsequent emotions. Conclusions: The perception of having made a mistake creates significant emotional distress for practicing physicians. The severity of this distress may be influenced by factors such as prior beliefs and perfectionism. The extent to which physicians share this distress with colleagues may be influenced by the degree of competitiveness engendered by medical training. Open discussion of mistakes should be more prominent in medical training and practice, and there should be continued research on this topic. [ABSTRACT FROM AUTHOR]

Physicians and other healthcare professionals are at increased risk for the development of substance use disorders when compared to the general population. Substance use is associated with impairment in neuropsychological functioning, which may impact physicians' ability to practice with reasonable skill and safety. This review describes common neurocognitive deficits observed following use of various substance classes, including stimulants, benzodiazepines, cannabis, alcohol, and opioids. It also reviews the neurocognitive impact of pharmaceutical treatments for opioid use disorder. Clinical implications, including evaluation, treatment, and planning for return-to-work, are discussed. The importance of continued testing/monitoring following the acute treatment phase is emphasized. A case example highlights important issues that must be considered when a physician is referred due to suspected impairment. • Substance use is associated with impairment in neuropsychological functioning. • Medication-assisted treatment for SUD may increase risk of cognitive impairment. • Neuropsychological testing is an important part of SUD evaluation for physicians. [ABSTRACT FROM AUTHOR]

Surgeons who are ill must sometimes make their own judgments about their fitness to operate. The profession might consider more explicitly how surgeons make such judgments. [Copyright &y& Elsevier]