Substance abuse and dependence in anaesthetists.

The incidence of substance abuse amongst anaesthetists in the United Kingdom is unknown. In the interests of patient safety, it is essential that the dependent doctor is identified and entered into a treatment regime. No national strategy is in place to treat and, where possible, return the anaesthetist in recovery to work. It is important therefore, that individual employers have a standing operating procedure to deal with the addicted doctor. It is essential that the initial approach is made by a competent panel, each of whom has experience of dealing with dependent doctors. This is an extremely stressful time for the doctor involved; it is therefore essential that active support is given. It is not always necessary to suspend the doctor from work whilst treatment is undertaken. In the dependent doctor sudden withdrawal of the substance of addiction can be life-threatening. It is therefore essential that the supervising physician has specialist knowledge of the treatment of addiction. Residential care probably provides the greatest hope of success. In the United States, Canada, Australia and New Zealand 'impaired physician' programmes are in place which allow some doctors to return to work, initially under strict supervision. Registration with a self-help organisation is essential; a list of such groups in the United Kingdom is appended.