Article

Physicians-in-training Attitudes Toward Caring For and Working with Patients with Alcohol and Drug Abuse Diagnoses

Authors: Michael Lindberg, MD; Cunegundo Vergara, MD; Rebecca Wild-Wesley, RN; Cynthia Gruman, PHD

Abstract

Introduction: Physicians in all specialties commonly encounter patients who abuse alcohol or illegal drugs. Working with these patient populations can be challenging and potentially engender negative attitudes. This study is designed to identify the progression of attitudinal shifts over time of physicians-in-training toward caring for substance abusing patients.


Methods and Materials: A 31-item survey was designed to capture demographic information of participants, attitudes toward treating patients with substance abuse diagnoses, previous participant education, experience in and comfort with diagnosing and treating substance abuse, and satisfaction achieved in working with this patient population. Medical students in their third and fourth years of education as well as residents in training, years one through four, were surveyed. Responses to the survey's attitudinal items were analyzed across years of training, looking for changes associated with time and experience.


Results: Fifty-seven percent of eligible participants anonymously completed the survey. There was general agreement across all years of training that health care professionals should be allowed continued employment in their professions when in recovery from alcohol abuse (P= 0.424) and drug abuse (P = 0.409). Across years of training there was agreement that patients can recuperate and provide meaningful contributions to society when recovering from alcohol (P = 0.847) and drug (P = 0.859) abuse. From medical school years through residency there were enhanced beliefs that alcohol-abusing patients (P = 0.027) and drug-abusing patients (P = 0.009) overutilize health care resources. Most trainees, despite year of education, believe patients who abuse alcohol (P = 0.521 and illegal drugs (P = 0.356) have challenging medical and social issues from which they can learn. There was consistency across years in the perception that providing care to alcohol-abusing patients (P = 0.679) and drug-abusing patients (P = 0.090) is repetitive and detracts from the care of others. All felt their training was adequate to care for alcohol (P = 0.628) and drug-abusing patients (P = 0.484). Satisfaction achieved in caring for alcohol (P = 0.017) and illegal drug-abusing patients (P = 0.015) consistently diminishes over years in training.


Conclusions: There are positive as well as negative aspects for physicians-in-training to caring for patients with alcohol and illegal drug abuse problems. Combining effective education strategies with the needs of physicians at specific points in their education may be effective in reversing the negative trends seen in attitudes toward caring for patients with substance abuse problems.


Key Points


* Physicians in all specialties and at all levels of training and experience commonly encounter and work with patients who have substance abuse problems.


* There are degradations in attitudes toward caring for substance abusing patients throughout the years of medical school and residency training.


* Combining effective education strategies with the needs of physicians at specific points in their education may be effective in reversing the negative trends seen in attitudes toward caring for patients with substance abuse problems.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Cherpitel CJ. Alcohol consumption and casualties: a comparison of two emergency room populations. Br J Addict 1988;83:1299–1307.
 
2. Kissen B. Medical management of the alcoholic patient. In:Treatment and Rehabiliation of the Chronic Alcoholic. Kissen B, Besleiter H (eds). Plenum Publishing Company, New York, 1997.
 
3. National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. The Economic Costs of Alcohol Abuse in the United States, 1992. Analysis by the Lewin Group: Harwood H, Fountain D, and Livermore G. Bethesda, MD: DHHS, NIH, NIH Publication No. 98-4237, 1998 Sept.
 
4. Moore RD, Bone LR, Geller G, et al. Prevalence, detection, and treatment of alcoholism in hospitalized patients. JAMA 1989;261:403–407.
 
5. Hahn SR, Kronke K, Spitzer, et al. The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med 1996;11:1–8.
 
6. Fisher JC, Mason RL, Keeley KA, et al. Physicians and alcoholics: the effects of medical training on attitudes toward alcoholics. J Stud Alcohol 1975;36:949–955.
 
7. Chappel JN, Schnoll SH. Physician attitudes. Effect on the treatment of chemically dependent patients. JAMA 1977;237:2318–1319.
 
8. D'Onofrio G, Nadel ES, Degutis LC, et al. Improving emergency residents' approach to patients with alcohol problems: a controlled educational trial. Ann Emerg Med 2002;40:50–62.
 
9. Fleming MF, Barry KL, Manwel, et al. Brief physician advice for problem alcohol drinkers. JAMA1997;277:1039–1045.
 
10. Ockene MF, Wheeler EV, Adams A, et al. Provider training for patient-centered alcohol counseling in a primary care setting. Arch Intern Med 1997;157:1334–1341.
 
11. Centilello LM, Rivera FP, Donovan DM, et al. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg 1999;230:473–483.
 
12. Wilk AI, Jensen NM, Havighurst TC. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med 1997;12:274–183.
 
13. Siegal HA, Cole PA, Eddy MF. Can a brief clinical practicum influence physicians' communications with patients about alcohol and drug problems? Results of a long-term follow-up. Teaching and Learning in Medicine 2000;12:72–77.
 
14. Gopalan R, Santora P, Stokes EJ, et al. Evaluation of a model curriculum on substance abuse at the Johns Hopkins University School of Medicine. Acad Med 1992;62:260–266.
 
15. Geller G, Levine DM, Mamon JA, et al. Knowledge, attitudes, and reported practices of medical house staff regarding the diagnosis and treatment of alcoholism. JAMA 1989;261:3115–3120.
 
16. Dove HW. Postgraduate education and training in addiction disorders. Defining core competencies.Psychiatr Clin NA 1999;22:481–488.
 
17. Davis DA, Thomson MA, Oxman AD, et al. Changing physician performance: a systematic review of the effects of continuing medial education strategies. JAMA 1996;274:700–705.
 
18. Davis D, O'Brien MAT, Freemantle N, et al. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcome? JAMA 1999;282:867–874.