Certain occupations are so high-risk that the public feels compelled to subject people to drug testing: military pilots, train engineers, bus drivers ... but, anesthesiologists?
Two renowned hospitals -- Massachusetts General Hospital in Boston and the Cleveland Clinic Foundation in Ohio -- seem to think the profession needs it and recently implemented random urine drug testing in their anesthesia residency teaching departments.
Given the history of addiction within the anesthesiology community, few anesthesiologists are surprised.
A 2005 survey by the Cleveland Clinic estimated that 80 percent of anesthesiology residency training programs reported problems with drug-impaired doctors, and an additional 19 percent reported a death from overdose.
"The problem is that we are exposed to, and we have the use of, very highly addictive and potent medications," said Dr. Michael G. Fitzsimons, administrator for the substance abuse program of the department of anesthesia and critical care at Massachusetts General Hospital in Boston.
But testing doctors can be problematic.
Doctors familiar with the signs of addiction are sometimes able to mask their drug use from coworkers, making it difficult to detect when they are using and need help. And those determined to hide their habits have been known to find creative ways of beating drug tests -- even submitting fake urine samples.
Despite the difficulties, the administrators of the programs in Boston and Cleveland believe they have been successful, and now hope more comprehensive studies will be done to determine whether such programs help stave off drug use long-term.
Dr. Raymond Roy of Wake Forest University in Winston-Salem, N.C., is still moved by an experience he had 10 years ago with a promising doctor he recruited into his anesthesiology residence program.
"We thought this guy was wonderful, but one day he and his wife showed up in my office saying, 'I'm going to an addiction treatment program in Atlanta,'" said Roy, who asked to keep the doctor anonymous out of concern for his family.
After some further questioning, Roy discovered the doctor had had an addiction problem since high school, but was smart and savvy enough to make it through college, medical school and a previous specialty program.
"He would come to work early to require drugs to inject to keep him from going into withdrawal, not to get high, but enough to make it through the day where he could get drugs at home," said Roy. "We had no clue."
That same doctor died from an overdose in Roy's program, even after completing drug rehabilitation and returning to an area without access to drugs.
Struck by how clueless he was to the young man's problem, Roy decided to ask his staff if they saw signs of addiction.
"When he died, I sent out a questionnaire out to every single resident, any nurse who had worked with him, any doctor," said Roy. "I got 100 percent response on the questionnaire, and nobody suspected anything."
Yet, after this experience, Roy said he would still be wary of implementing urine drug testing to screen for drug abuse.
"He was too smart. He would have figured out the testing so fast," said Roy. "That sounds good in theory, but there are so many flaws in it."
For decades, anesthesiologists have tried addiction education programs and accounting safeguards in hospitals to detect drug abuse.