Right of Reply: Dr Jane Richards

The BMA replies to Dr Martin Hatcher's article about alcohol and drug abuse by doctors

Dr Martin Hatcher's account of his drug dependence and recovery holds some important lessons. He describes vividly how doctors deny and conceal addiction and how, even when they have been rumbled, they sometimes run rings around those providing support and treatment.

However, he demonstrates that the picture is not universally bleak. Once you get doctors into appropriate treatment programmes for alcohol or other addiction, they make good patients and have an excellent chance of recovery. The US has an impressive "Impaired Physicians" programme which gives doctors the support and supervision they need to be able to return to practice safely.

Doctors in this country need a similar system. That may sound like special pleading but it is vital for patient safety. We need to be better at detecting problems sooner. We must break the culture of cover-up which means doctors are reluctant to blow the whistle on colleagues and we must offer addicted doctors a route back from disaster. It costs around pounds 200,000 of public money to train a junior doctor. Simply naming and shaming doctors with drug or alcohol problems is therefore a very expensive waste of their skills and experience.

There are no reliable figures on the extent of alcohol and other drug dependence in the medical profession. A figure of 9,000 (one in 15 doctors) is often quoted and attributed to the BMA. How- ever, this figure is based on the assumption that doctors have roughly the same risk of developing dependence as other adults. The risk is that one-in-15 doctors, at some time in their professional lives, may have a problem with alcohol or other drug dependence. It does not mean this number is not fit to practise.