doctors addicted to drugs came as no surprise to
Dr Martin Hatcher. As a junior anaesthetist,
he couldn't get through the day without them
A study in The Lancet tells us that 60 per cent of doctors drink too much. My reaction was to wait for the punch line, but that was apparently it. Still reeling from that revelation, we were told that 10 per cent of junior doctors use other substances like Ecstasy or amphetamines, which led to a lot of tut-tutting on GMTV that morning. Certainly it is nice to hope that the doctor treating you is not completely off their head, but if anyone close to me was in a casualty department with an acute "recreational" drug reaction, it would also be nice if the doctor treating them had some personal experience of the issues involved. More worrying than the small Lancet survey is the British Medical Association's estimate of 9,000 doctors at any one time needing help for addictions of one kind or another. I was one of those 9,000, although someone else, at least for now, has taken my place.
The trouble with addiction is that it's just such a logical thing to do. You discover something that makes you feel good - you want to do it again, if you've any sense. If you happen to be addicted to parascending or rock-climbing, it looks good on your CV. If you happen to be addicted to controlled pharmaceuticals, it can lead to all sorts of problems. Being a logical person, when I discovered that a few mils of fentanyl (a synthetic morphine-like drug) taken in a glass of orange juice would make a night on call as a junior anaesthetist a complete doddle, I started to do it on a regular basis. I was never "stoned", at least to start with. It would just ease that ache across the shoulders, and would make the pager bleeping at 4am a little more bearable. Then things drifted a little. I started taking stuff home in the evenings to help me relax. And then at weekends. And then because I was studying like crazy for the most arduous set of exams I had ever sat (all of which I passed). And then I started taking fentanyl for any excuse whatsoever. Most of the time I just took it to feel roughly normal, but since I was using in one shot (intra-nasally by now) more than the average patient would get through in a two-hour general anaesthetic, "normal" is one thing I definitely wasn't.
Then, inevitably, I was caught. At a strange hospital where I was doing a week's locum (for the drugs, you understand, not the money), someone saw me pocket a syringe and the police were called. Eventually, it was decided no charge would be made against me and I was only cautioned. But it was also the end of my career in anaesthetics, and the beginning of the worst three years of my life. I was suspended from work, naturally, and also referred by the police to the General Medical Council.
The GMC has a very polite way of doing things, and I was sent a letter inviting me to refrain from medical practice, and placing me under the supervision of a consultant psychiatrist. During the entire time I was under GMC supervision, when the most intimate details of my personal background were discussed between them and my supervising psychiatrist, I never once received letters from anyone other than a member of the administrative staff there. The letters only referred to "The Screener", an Orwellian term for the GMC's screener for health, who always remains anonymous. I have since been told that this is to protect "Screeners" from attack by mad, drunken, disgruntled doctors whom they refuse to allow to practice. (I now treat mad, drunken, disgruntled patients every day, but like all other doctors in the real world, I don't have the privilege of anonymity.) At the end of 1997, the GMC had 181 doctors under supervision which, according to the BMA figures, leaves a lot unaccounted for.
The psychiatrist whose supervision I was under was very straightforward. Common sort of thing, anaesthetists hooked on opiates. Quick course of methadone, Bob's your uncle. Maybe a bit of counselling. Then keep your nose clean for a while and find a new career path. I almost started to look forward to it. Unfortunately my "counsellor" had never dealt with an addicted doctor before, and seemed to regard me as some sort of minor celebrity. So I was advised not to take part in any of the group sessions. Then the methadone stopped. Then my "new career" was suggested as psychiatry itself, mainly it seemed because none of the drugs on offer are the type people take through choice.
The next couple of years are still, thankfully, a bit of a blur. I stumbled through a few crappy jobs with little or no help. Doctors with drug problems don't get plum jobs - the crappy ones are the only ones left. I bought a lot of codeine cough linctus, fiddled a lot of prescriptions, and faked a lot of urine tests. One of the patients I saw for a while was a former consultant psychiatrist still fighting an obviously lost battle with drink. He, too, was under GMC supervision. His supervising consultant was the one I was working for at the time, but the two hardly ever met. Instead, this by then pathetic figure was palmed off on to me. We exchanged platitudes once a fortnight for a short time, and then he died. Such is the care lavished on the profession by their own.
The low point must have been that morning my long-range pager went off because I was late for my psychiatry out-patient clinic. I knew there were 10 depressed patients waiting to see me. The reason I was late was because I was wandering around B&Q looking for a suitable piece of piping to fit in the car exhaust. One that was also long enough to reach the car window. I was worried that an ordinary hosepipe might melt or something. It's strange how the mind works at such times.
But, as you'll have guessed by now, the car exhaust plan was never followed through. Instead, with the help of people around me I realised I wasn't getting the treatment that was right for me. So I requested and, unusually, got a change of supervisor. I also got to see another counsellor, who was less susceptible to bullshit than the previous one. (Being impervious to the complete load of toss that addicts use as excuses for their behaviour is a prerequisite to being a good drugs counsellor.) My life is not perfect. I do not, however, need to resort to controlled drugs any more. I hold down a responsible and stressful job in acute medicine, and the people I work with know about my past.
The authors of the Lancet paper question whether it is time to do what they do in the US, and start random testing of doctors for drugs. But such tests do not appear to have had much impact on the use of prohibited substances within sport, and if anyone knows how to falsify a urine test, it's a doctor. My own opinion is the only thing that will help doctors who abuse substances is a change in the culture. A change which recognises that this problem has always existed, and allows the topic to be discussed in something other than shocked whispers. A change that would mean coming forward for help did not mean an automatic letter from the GMC. Their new motto ("Protecting Patients, Guiding Doctors") is I suppose the right way round, and requires them to be able to instil fear into miscreants. But I cannot see how the sword of Damocles will encourage doctors to seek help. The protection of patients is simply mutually exclusive with the effective, early treatment of sick doctors.
We need an independent body that doctors know they can approach in confidence, and through which they will receive first-class advice and treatment. Better treatment than anyone, in fact, because we know every trick in the book. The BMA has a 24-hour counselling service, and there is also the National Counselling Service for Sick Doctors, both of which represent a start. How effective either is I cannot at the moment say. If I ever need to find out, I'll let you know.