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The example of House on American television presents drug addiction in the medical profession as an element of the lead character's tortured genius, but the effect of addictions in the real world have shown up in recent news coverage of accidents and medical negligence cases caused by incapacitated doctors.
The American press has reported widely on a Californian programme that allows addicted doctors to continue practising, although with more supervision than they may otherwise have had. This has had some success stories, in which focusing on work has kept doctors clean when enforced idleness would have worsened their condition. However, a number of other stories have arisen, including some horrific tales of botched operations.
Here in the UK, a number of organisations exist that try to deal with the problem of addicted doctors in a manner similar to the Californian programme. The British Medical Association has its own counselling service, for example, and the Substance Misuse Management in General Practice project also faces this issue head on, arguing that addicted doctors should not be removed from practice as a knee-jerk reaction.
Another organisation, the Sick Doctors Trust, also aims "to provide early intervention and treatment for doctors suffering from addiction to alcohol or other drugs, thus protecting patients while offering hope, recovery and rehabilitation to affected colleagues and their families". Protecting patients and offering recovery sound like the ideal pairing.
But do the Californian stories of malpractice mean that this approach is misguided? Some people, on both sides of the Atlantic, have suggested that this is naive, optimistic or even foolish as an approach to medical practice. Some even take the zero-tolerance attitude that any doctor with an addiction should be instantly struck off.
California can also provide examples suggest that this might be counter-productive, not least in the story of one obstetrician hiding alcoholism in an attempt to avoid the earlier zero-tolerance policy there. During one delivery, this doctor was drunk, and accidentally severed the baby's spinal cord. If there had been a way for doctors to report their addictions without ending their careers, this case may have been averted.
If we accept, then, that a zero-tolerance policy can even encourage serious accidents and instances of clinical negligence, this means that the approach taken by the Sick Doctors Trust and the BMA is appropriate. It is important to remember, though, that this does not mean infinite tolerance; doctors with substance addictions are suspended and struck off when appropriate.
It is also important to remember that estimates of the range of this problem are not large, extending to, at most, 5% of doctors. The General Medical Council gives figures that show it to be monitoring approximately 700 doctors at a given time, and suggests that more are being watched locally. This not only means that a patient is unlikely to be treated by a doctor with an addiction, but also leads to the conclusion that an addicted doctor's practice should be no less safe than a colleague's.
This cannot avoid the risks of medical negligence entirely - indeed, as long as medical treatment exists, there is probably nothing that can. But a humane response that aims to cure doctors of their addiction, rather than remove another medical professional from the NHS forever, is surely the rational response.
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