The conspiracy of silence.

The issue of the impaired physician is compounded by not only mass denial of the problem, but also a 'conspiracy of silence' among many groups associated with the physician. The conspirators-including the physician himself, his family, community, professional colleagues and nurses as well as hospital boards and administration-are unable to reconcile deteriorating performance due to alcohol or drugs with an otherwise gifted professional who should know the dangers of substance abuse. They may also fear the effects of labels such as 'alcoholism', 'drug abuse' and 'psychiatric illness', and they may not know how to handle the problem.A Saskatchewan Medical Association committee was formed in 1976 to penetrate the shroud of silence by identifying and rehabilitating impaired physicians.However, the committee's experience since that time has been largely frustrating because its function has been viewed as more punitive than therapeutic.