Sean Fogler, MD is the Community Outreach Coordinator at the Pennsylvania Harm Reduction Coalition (PAHRC), a person in long-term recovery, physician and certified recovery specialist. He has over 15 years of experience in the healthcare industry working as a physician, and with patients, administrators, and insurance organizations. This is a two-part episode. In this first part, we talk about how common a substance use disorder is among physicians and why we are at higher risk than the general public. He then gives guidance on where to go to seek help if you have a substance use disorder. We discuss Physician’s Health Programs and some of the positives and areas for improvement of those programs. He then discusses some critical elements to recovery.
Sean is active in the recovery community and has a special interest in trauma and substance use disorders in professionals. He volunteers as a peer support specialist for Lawyers Concerned for Lawyers and works to improve public health policy for mental health and substance use disorders. Through his lived experience, he educates, informs, and works to battle the shame and stigma that keeps the disease of addiction alive. Sean’s role at PAHRC involves engagement, education, writing, speaking, fund raising and expanding knowledge of the disease of addiction and harm reduction. Sean holds a bachelor’s degree from The University of Toronto, and a Doctor of Medicine degree from Ross University School of Medicine. He completed an internship in Internal Medicine and a residency in Anesthesiology at Hahnemann University Hospital in Philadelphia,
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Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.Dr. Shawn Vogler is a community outreach coordinator at the Pennsylvania harm reduction coalition, a person in long term recovery physician and certified recovery specialist. He has over 15 years of experience in the healthcare industry, working as a physician, and with patients, administrators and insurance organizations. This is a two part episode. In this first part, we talked about how common is substance use disorder among physicians, and why we are at higher risk than the general public. He then gives guidance on where to go to seek help if you have a substance use disorder. We discussed physicians health programs, and some of the positives and areas for improvements of those programs, and he then discusses some critical elements to recovery. Sharon is active in the recovery community and has a special interest in trauma and substance use disorders and professionals. He volunteers as a peer support specialist for lawyers concerned for lawyers, and works to improve public health policy for mental health and substance use disorders. Through his lived experience, he cades informs and works to battle the shame and stigma that keep the disease of addiction alive. Sean’s role at pH RC involves engagement, education, writing, speaking, fundraising, and expanding knowledge of the disease of addiction and harm reduction. Shawn holds a bachelor’s degree from the University of Toronto and a Doctor of Medicine degree from Rockford University School of Medicine. He completed an internship in internal medicine and a residency in anesthesiology at hanaman University Hospital in Philadelphia.Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing kreb cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.Now, here’s Dr. Bradley Block.Dr. Sean Faircloth, thanks so much for being on the show today.Thanks for having me.So let’s start with the macro view of addiction in physicians and then get to more of the micro view. So first, how common is addiction in physicians?Well, I mean, this is something that’s that’s actually very common, more common than I think many of us realize. In the general population. They say you people with a substance use disorder are around nine to 10%. It’s hard to know exactly with physicians, but the numbers seem to be somewhere around 15%. And that can vary actually with specialties. So anesthesiologists tend to have a little higher rate psychiatrists, except especially female psychiatrists tend to have a higher rate. So it does, you know, there’s no exact answer, but it’s more common than it is in the general populace. Why do you think that is? Why do you think we’re at higher risk? I think there’s so many different factors. You know, even if you just look at General factors for addiction, your psychological biological things like anxiety, depression, we work at a very high pressure, high stress environment where lives are at stake. And, you know, I think a lot of it has to do with the systems we’re in and especially nowadays, as you know, with electronic medical records and more administrators looking for data and pushing us to work you know, longer, harder, faster. And this causes you know, the you hear about burnout and compassion, fatigue and trauma, vicarious trauma, almost like PTSD in a way where people can feel very isolated, they don’t feel valued, and I think one of the one of the most important areas that leads to substance use disorders in physicians is the culture of silence, where we really we don’t feel safe to come out and share, hey, I’m stressed out, hey, I feel depressed. Hey, I think I’m drinking too much because because of professional, you know, judgment, fear of consequences, right? If somebody reports you to, you know, your chief or to the medical board, the consequences can be quite dramatic. So I think we have a culture of silence that we don’t talk about this stuff. And I think many institutions talk about, you know, improving the culture, creating wellness programs, but I really, it’s almost like lip service. It’s like this is what we’re supposed to be doing. But they’re not really providing the time, the energy and the most important thing is probably the safe space, right, a space where you can share your struggles without fear of retribution and Anyway,this seems to be a theme in our profession. I had an interview a little while ago with Stacey Dearman about litigation. And that’s something that we’re not allowed to talk about, right. Like, if you’re if you’re involved in a lawsuit, you know, let’s talk about it. And that actually has led to physician suicide, right? Because you’re allowed, you’re, you’re, you’re involved in this, you feel terrible about something that happened, and then the lawyers use this against weaponize that against you. And then, you know, you’re, you’re you’re already in a extremely high stress situation, you know, and that and that has, on occasion turned out to lead to suicide. So this the fact that we’re so siloed, and that all they’re doing is paying lip service, right? They create a wellness program because they’re supposed to now, what’s the science and the data behind a wellness program? I actually don’t know offhand, but I would assume very little. Whereas the Safe Space seems to be really a great solution to this problem, but What What is their solution? Aside from the wellness programs, let’s say let’s say you do have a substance use disorder and you want to seek help. What is our current system for that?Yeah, it’s the system is not good.It really is good because it like, it’s funny. I was thinking about this the other day, and there’s, you know, I was thinking about all the, all the things that you that an individual physician can do, if they feel like they’re struggling with a substance use disorder. And the last thing on my list was the physicians health program, right, which is, which is awful. And it tells all because, you know, a physician’s Health Program, which is supposed to be about health and wellness for practitioners is a monitoring agency that says they’re about physician health and wellness, but what they’re really doing is protecting the medical board protecting the institution. And they’re monitoring agencies. And so like, I mean, if I if I had, I mean, it starts with being honest, which is really hard when somebody does have substance use disorder, I mean part, just part of the disease is, is isolation. Like I always say addiction or substance use disorders are diseases of isolation. And you become disconnected from yourself and from reality so and from the world around you. And so and as all these it’s rooted in fear, and shame, there’s a tremendous amount of shame. And so, like, I think, you know, starting with your family, if you can talk to your family, I think having a therapist or connecting with a therapist, is a great place to start. mutual aid groups like a and na are great places to engage with people if you know if you can take that step which is really hard at first really, really hard There are recovery communities. There’s produces meetings, which, you know, I’ve been going to produce meeting for almost five years now. Where it’s just doctoral level healthcare professionals. And those are great places to anonymously, you can, you know, you can contact employees as since programs. So, there are a lot of things, the last place I would do is, the last thing I would do would be pick up a phone and call a physician’s health program. Or even talk to your like, I think, you know, talking to your colleagues talking to senior clinical, you’re the chief of your department is, is tricky, you know, some places, that’s probably a great thing to do, and beneficial and in other places. It can be catastrophic. You know,ultimately, you don’t know what they’re, what they’re going to do with that information, right. Whereas if you’re with With a therapist, aren’t they obligated to keep it confidential?Exactly. And that’s the first place I would start. You got you have to find somebody who’s trusted. And where you can share this stuff in a in a safe space. I mean, that is, that’s, you know, and that’s one of the other things I do on the side. And you know, he can get into it. You know, a little bit more later, but I were I volunteer for this organization called lawyers concern for lawyers. And they provide peer support to lawyers, judges and their families and law students as well. And they do a better job than we do. They do a much better job than we do. And it’s all anonymous. The goal is to get you back to work healthy and whole. And it’s not punitive at all. Obviously, there’s extreme examples. I mean, if you land in the paper You know, you know your substance use disorder takes you in a direction that leads to something traumatic. There will be more monitoring. But in general, it’s it’s a more it’s a softer general way, gentler way, and approach that’s rooted in the idea of getting you healthy and back to work. And, you know, with physicians health programs, it’s not like that at all.You know, you keep going, you keep mentioning these physician health programs, and I think it bears discussion what what this is, so, I’ve heard you if I hadn’t listened to your podcast, I don’t think I’d know what a PHP was. So what is it? What?I had no idea what it was until I landed it myself, but a physician’s Health Program is a program and and almost every not every state has them but almost every state has them and they kind of operate in conjunction with that. Medical Board at a focus on physician health and wellness. And it’s usually physicians that are struggling with substance use disorders. Sometimes it’s behavioral issues. For a substance use disorder, at least in the state of Pennsylvania. What happens is you sign a five year contract the physicians health program, and your license usually stays intact. And there’s no public reporting of your issue. And there’s certain things that you have to do and one is going to therapy. One is going to group therapy. The other thing is either going to a certain number of 12 step meetings every week, which need to be logged in it. It also involves random urine testings, screening, and so and depending on the individual, there may be some other other requirements as well. And as you progress through it, the testing goes down eventually you don’t have to do group therapy and If If you listen to the physician health programs, you know, they have very high success rates. And, you know, that’s we don’t know. See, the problem is there’s there’s not really any oversight to physicians health programs. So we and we, they don’t share their data. So we don’t know the exact numbers, but historically, they claim very high success rates. That’s that’s kind of the short of it.So what that sounds reasonable, right? Yes. Go to group therapy. There’s a monitoring program, because part of the reason this exists is it’s a patient safety issue. She has to make sure that the practicing physicians that have a history of substance use disorder aren’t actively using substances. This all sounds reasonable. However, there are some flaws in their system. What What would you say the those what, where’s there room for improvement in the system?I think I think if it’s really like if these systems if these programs are really about health and wellness, I don’t think a cookie cutter approach is the way to go. And they really plug everybody in, for the most part into the same general program. And like, for me, I didn’t have an issue with it. When I entered the PHP, I was a year and a half into recovery. You know, I had no prob I was already doing therapy I enjoyed group, I was a 12 step person, but some people find it, you know, they, they either they’re not on board with 12 step, you know, maybe, you know, their religious background or they’re atheist, and they struggle with that. Somebody, why would that be? Um, you know, 12 step programs are problematic for some people that, you know, it’s all you know, it’s rooted in the idea that there’s a higher power, the first step and yeah, it will admitting your budget. powerlessness, you know that you’re powerless over drugs and alcohol. You know, that’s the first step. But some people find that problematic, right? And so it’s interesting, there was just a lawsuit and this is in Canada in British Columbia of a nurse, that that was denied his license. And he was in recovery, because he refused to go to 12 step programs. And this went, I think, all the way to the Supreme Court, and he just won. There was actually an article on it yesterday that he should not have to be required to do these meetings right now. There’s other stuff because recovery, you know, recovery isn’t just 12 step like recovery is many things to many people. And I always say it changes over time. So like, you know, to me, recovery is going out for a run, right or, or, or being connected with, you know, friends or family or you know, reading or meditating like, it’s not just 12 step in some of these rooms. programs. I mean, it doesn’t sound like a big deal. But when you’re forcing somebody, it’s almost like forcing someone to practice a religion for eight for a certain amount of time that they absolutely are opposed to. And that’s really not honoring their lives and you know, their life and their beliefs. The other thing is, we don’t have any evidence, the 12 step programs necessarily work like they work when they work. I found it very helpful. Some of my colleagues don’t find it helpful at all. And, and other colleagues find it actually harmful, you know, when they really struggle with it.So I think we have to, you know,like recovery and substance use disorders. It’s really different for different people and it’s not like you know, if you have hypertension, everybody’s and get the same drug feed everybody doesn’t get the same diet. Like, it doesn’t work that way, if it’s a disease, we should treat it like a disease. And, and the solution is not always the same. And it’s problematic. And the other, like, just the starting point to looking at these programs is they should be, we need to see their data, right? We don’t really know what’s going on behind closed doors, and you hear horror stories all the time of physicians committing suicide, you know, being homeless on the street. And, you know, for the right person that works. And for other people, it doesn’t necessarily work, but because it doesn’t work doesn’t mean that they’re not doing the right thing. Like, like the program itself can be a huge barrier, you know, to recovery.And then if they feel like that’s not working for them, then they feel like there’s something wrong with them. Why is it working for everyone else? It’s not working for me, there’s something wrong with me. And then that’s gonna push them backwards,right and then and then think about the stakes right? So it If you don’t do what they say, you don’t have a license, and then there’s public disclosure, right? So they report you to the board, the board posts something publicly, your license is suspended, you can’t work. Right? There’s a whole cascade of events that occurred that your life is and there, there are physicians that are broke, that are homeless, because they’re not able to, you know, to move through these programs and do what is required. But that what they are requiring doesn’t necessarily mean you’re successful and you’re healthy, right?It just means you jump through their hoops in the time jumping right? To do it. Yeah,right. And and addiction, you know, addiction is a chronic progressive relapsing disease, you know, stress induced, like if you look at the A Sam definition, but after five years, you get your seal of approval, and you can go and do whatever you want. Right, which is just that doesn’t even make sense itself, right. And my whole thing is like if we really are concerned about protecting the public, if we’re really concerned about physician health and wellness, the people that the physicians that are in the hospital or you know, in the clinics, offices, you know, all over the country, that, you know, we should be providing support for them. Right, like, they should be getting therapy, you know, they should be going into groups. And, you know, and and, you know, this is controversial, but, you know, should we be testing them, right, pilots get randomly tested. I mean, I’m not advocating for that, because tests, you know, drug and alcohol testing is problematic. It’s, you know, in and of itself, but we’re not doing anything for those. We’re just taking a select group that had an issue, putting them through some program that maybe, you know, maybe it has a great success rate. Maybe it doesn’t. There was a recent article in the New England Journal of Medicine, by Leo bell. Lenski and Dr. Sarah Wakeman up at Harvard, and the articles entitled practice what we preach and it’s really focused on opioid agonist therapy for people with opioid use for physicians with opioid use disorder, which is Suboxone? Right? And in these programs, Suboxone is a no, no. Right? You can’t be on Suboxone or buprenorphine or methadone and practice medicine and have a license.What’s the reasoning behind that? That’s,well, they, there’s no, you know, absolute, but, but the general thought thought process is, is that you’re impaired if you’re on these medications, but we don’t have evidence. We don’t really have good evidence on that. But what about, you know, a physician that takes Ambien at night or takes, you know, a Xanax or you know, some other benzo to go to sleep or is on some other site Could trophic you know, met some of these antidepressants? Are they in? No, it comes down to stigma, and are deeply rooted attitudes that these people are sick and flawed, you know, and are not safe. But we, but that’s not the truth. And it’s great, you should take a look at the article if you get a chance because it and I always say like, that’s the tip of the iceberg because it brings into questions so many of our attitudes towards our own colleagues, right. Like I always say, how we treat our own tells us everything we need to know, right, so, so how, you know, I treat my colleague who’s struggling with a substance use disorder really, you know, shows us what we’re thinking and what our beliefs are. And I think the stigma and the attitudes within the medical community towards people with substance use disorders is the is the worst is among the worst and I’m not there are some great people doing great work out there. But I think Jim In general, and as a system, we don’t do a very good job. Whenyou if you are building a PHP program from the ground up, right, let’s in this that seems like it’s state to state, right, like,well, that. And that’s the other problem. It varies from state to state. So these programs aren’t even uniform.Right? Like, interesting, we should be able to use that data then right? If there’s different you can you can then compare which ones are more effective, which ones are less effective? What’s the differences between them to try and figure out what are the what are the aspects of it that really help our physician colleagues? The best?That’s a great idea.Let’s say you had free reign, right? of over, you’re in Pennsylvania. Let’s give you a New Hampshire. I just chose that random. Random, right. You get to build it, you get to build it yourself. How would you do that? What would you what would the PHP consists of?Wow. That’s I mean, it’s a great question. I I think I would start with sitting down with a group of physicians that have had substance use disorders in the past, currently have substance use disorders and talk to them about exactly what are their wants and needs and like from my understanding and what I know about recovery you know, having connection having support having purpose is critical. Right. So, you know, when it comes down to, you know, the safe space like making, like, we have to change the culture will people, you know, put people in a place where they can open up and connect with their colleagues, you know, obviously there would have to be a treatment component, an education component. I think he would have to involve hospital systems, you know, senior leadership and hospital systems and have them involved in the in the program and just creativity. program where people can share their struggles get the support they need. And this is gonna, it’s gonna vary because, you know, some of it has to do with trauma. A lot of it has to do with trauma and and dealing with trauma and every individual is going to be different. Right. So I just, you know, to create one entire program, I think, I think the way you know, the lawyer is concerned for lawyers does it where there’s an anonymous component where you’re protected, where you’re referred, you know, in a confidential way to different resources that can help you and connect you I think peer support is a massive part of this. Being paired up with somebody with lived experience that’s been successful that can guide you through and support you is really really important in all of this like it’s like it’s like as like a sponsor, but I think more than a sponsor because you know, especially Sponsor takes you through the steps of whatever program it is, say say that a peer support is much more you know, peer support is someone you can look to and say, Hey, like, he’s had these struggles, or she’s had these struggles and has been successful. And this is what they did. And this is how they got there. And a sponsor doesn’t necessarily do that for you. I mean, a sponsor can be very important and is a really good sounding board. But I think somebody you know, appeared, peer support is like the next level. And it’s like, seeing is believing because a lot of times you get into recovery, and things are bad things are really bad. And life seems hopeless. And, you know, we’re always comparing ourselves to other people. And unless you can see a path forward, it can be very, you know, and I’m like a pretty village, you know, individual that had a ton of, you know, support and abundance of resources that led to a very strong recovery. But most people don’t have that. And everybody should have that, you know, everybody should have access to that. And I think aspects of the PHP are important. I think group therapy is really important. I think having a group of people around you that get to know you, they can call you on your bullshit and give you insight into yourself is one of the most powerful things you can do you know, group a group therapy, peer support, and support at work in the workplace because I think getting back to work, you know, assuming you’re in a mental state, where you can be successful is one of the most important things and I was taught I was talking to somebody the other day about Victor Frankel’s book, Man’s Search for Meaning.That’s my Bible like that. IsYeah, and there’s a line in there said like he who has a why can bear anyhow, you know, it’s a guy that was in a concentration camp like, you know, a psychotherapist, it’s like I address that was living and was just trying to survive and what like when you’re struggling with a substance use disorder It is about survival. I mean it is it is primal, you are just existing and surviving. And then you step into recovery. And it’s it is scary at first and it’s very confusing and it can feel very hopeless. And I think like, having meaning and purpose in your life is what I think is one of the most important things to recovery. And that’s why I think getting back to work, especially for us as physicians, where we’ve invested so much of our lives in doing this and most of us, it’s our identity, it’s who we are. And when you strip that away, which was my experience, which we’ll talk about a little bit, you know that that itself is extremely traumatic and very hard to deal with. And so I think getting back to work quickly, but then once you’re in the workplace, you need support, right? It’s because it’s not, everything’s changed. So you need guidance at work and we need we need systems and people at work in our institutions that we can go to and maybe it’s having groups you know, in the hospital, having you know, a therapist or a peer support individual in the hospital that you can on your break going, Hey, man, you know, I want to talk about this. I want to talk about that. It’s really about like, in essence, it’s about connection and support. Right and believing the people around you are invested in your success. Right. And I think most physicians that are in these physician health programs that I don’t want to totally bash them because there is a lot of good in there. I got and my personal experience was actually very good. But I think it’s a very, it’s a very for most people, it’s a very adversarial relationship. They see it, as you know, us versus them. And it shouldn’t be that relationship has to change, right? People don’t believe they’re there to lift them up and support them and make them successful. their belief is that they’re trying to catch me.Yeah, they’re there to catch them when they slip up. Not right.Help them not slip up. Right. Exactly. Which is a huge, like, it sounds like something small, but it’s massive. And it changes the relationship because, like what, like most of us, right, like the administrators, the insurance companies, you know, the PHP, it’s like, it’s this whole constantly, you know, it’s like the whole system is out to get us and we’re working in it just trying to survive and trying to do good. And so I don’t know if I totally answered your question is a great question. And I haven’t thought a lot about that. Butyou answered a lot of others. questions that I had along the way?That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests or have an idea for a future episode, send a comment on the webpage. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.Transcribed by https://otter.ai