Substance Use and Behavioural Disorders
Approved: October 3, 2012
Revised: June, 2014
The College of Physicians and Surgeons of Alberta (CPSA) is mandated to ensure that physicians are fit to practice and through their practices do not pose a risk to themselves, the public, or patients. There are numerous conditions which can affect fitness to practice and will necessitate monitoring. Some of these conditions have the potential for a recurrence of the original disorder; when substance use or behavioural disorder is the condition, recurrence is known as relapse. Identification of those at risk of relapse is essential during recovery: active outreach to those individuals during and after the recovery process is also essential.
Physicians who have relapsed may be required to meet with the Assistant Registrar when they have demonstrated sufficient recovery and are deemed suitable to return to practice. The physician must commit to maintaining recovery; however, it is the nature of the medical condition that a successfully recovered physician may unfortunately experience a brief or prolonged relapse. This is not necessarily a therapeutic failure, but rather may be an opportunity to improve and enhance treatment.
An individual in relapse may show behaviours such as:
- Failing to keep appointments.
- Refusal or evasion of drug screens.
- Positive drug screen.
- Experiencing feelings that may present as anger, sarcasm, depression, mania, or suicidal ideation.
- Being interpreted by others as moody, irritable or unreliable.
- Occasioning complaints from patients, colleagues or staff.
Identification of a relapse can come through a variety of means including, but not limited to, self-reporting, third party identification, and clinical toxicology tests if applicable. Ideally, physicians will report themselves to the CPSA. Regardless, the identification of relapse shall be viewed as an opportunity where adjustments can be made to the process of recovery, increasing the potential for therapeutic success, and thereby increasing the potential for the relapsed physician to return to practice.
To facilitate the restoration of a relapsed physician to a state of health, relevant information may be gathered by the Assistant Registrar or through consultation with appropriate others
The Assistant Registrar will consult the physician’s treatment team, including the Physician and Family Support program, if applicable, to determine the most appropriate management strategy for the relapsed physician. Examples of potential therapeutic options include:
- An individualized recovery program organized through meetings with specialists in the area of the relapsed disorder (psychiatrists, psychologists, addictions health experts, etc)
- A change in the random or scheduled clinical toxicology testing
- Participation in the Physician and Family Support Program
- Increased attendance at support group meetings (Caduceus, alcoholics anonymous, narcotics anonymous, etc)
- Increased involvement with a sponsor or,
- Admission to a facility capable of treating the physician’s relapse.
The Assistant Registrar may consult with the Physician Health Monitoring Committee about the appropriate course of action. Information about the physician presented to the Physician Health Monitoring Committee will be de-identified. All Physician Health Monitoring Committee discussions shall remain confidential.
Recommendations by the Physician Health Monitoring Committee to the Assistant Registrar are considered and communicated to the physician.
If no agreement can be reached between the physician and the Assistant Registrar, either may request that the relapse be adjudicated by the Registrar.