While most doctors are against drinking any alcohol while on call, nearly one-quarter of the 135 doctors surveyed in a recent study from Hamilton County, Tenn., admitted to drinking alcohol while on call - with 64 and 27-percent respectively reporting having encountered colleagues whom they suspected had used alcohol or were impaired by alcohol while on call.
Jimmy Wallace - a 1999 graduate of The University of South in Sewanee, Tenn., who is now a graduate student in public health at The University of North Carolina in Chapel Hill - received a Tonya Foundation grant for the research through Erlanger Medical Center, which is affiliated with the Chattanooga Unit of the Department of Medicine at the University of Tennessee College of Medicine. He joined with James Peterman, professor of philosophy at The University of the South; Tahir Ahmad, internal medicine resident at Erlanger Medical Center; and Norman Desbiens, chief of internal medicine at Erlanger and a University of Tennessee College of Medicine professor, on the study. They produced a paper titled "Doctors' perceptions of drinking alcohol while on call: questionnaire survey," published in last month's BMJ -- a professional journal formerly called British Medical Journal.
"I think the subject of this study has not been an issue that's been discussed previously. That, in itself, is surprising," says Peterman. "There is no standard rule about what is acceptable (for doctors drinking alcohol while on call), so people then make up their own rules - and there are no rules then for medical students on this. There is ambiguity in doctors minds as to whether on-call time is private time or work time. That's, in a way, the question that needs to be brought out in people's minds, so a decision can be made on it."
The researchers developed a survey with 10 questions to probe doctors' perceptions about their own and their colleagues' use of alcohol while on call. They obtained a list of all doctors in Hamilton County, Tenn., from The American Medical Association, and sent their survey to a 20-percent random sample from each listed specialty. Of the 206 surveys sent, 135 (65%) responses were returned.
Fourteen-percent of the respondents felt that social drinking while on call was acceptable, and one-fourth thought that in their specialty, some alcohol use is safe. Twenty-four-percent reported consuming alcohol while on call, but only half of those doctors responded that they report their alcohol use to the patients they treat during that time. In response to asking how many drinks a doctor in their specialty could safely drink while on call, 73-percent answered zero, nine-percent answered one, four-percent answered two, five-percent answered three, and 13-percent answered four or more. Almost all doctors (98%) believed that patients care whether they use alcohol while on call, but doctors were divided about their obligation to inform patients before seeing them. While sex and specialty were not associated with doctors' responses, older doctors were more likely to report encountering doctors whom they suspected had used or were impaired by alcohol while on call.
"Although almost all doctors think that patients care whether they use alcohol while on call, there is substantial disagreement about the use of alcohol while on call, and the doctors' obligation to inform their patients," says Peterman.
"More data needs to be obtained about these issues, and the medical profession and society need to discuss the balance between personal freedom and professional obligation to patients. Medical societies need to include stronger declarations about drinking alcohol while on call in their ethical codes, before the issue is decided for them. There are clear rules and regulations about alcohol use in the aeronautical industry, so there should be in the medical profession too."
A copy of the present paper may be viewed on the web at http://bmj.com/cgi/content/full/325/7364/579?lookupType=volpage&vol=325&fp=5. Peterman is heading a more detailed analysis on the results of the study, which he hopes to have published in another professional journal soon. The researchers are also planning to reproduce this study on the national level later this year.
RSS