Spill The Wine (Not Your Guts) by Pat Conrad MD

Up front, I admit that this article has a couple of heartstrings-red flags suggesting some sensationalism.  But even so…

We all say that we want each other to be healthy, and we all encourage each other to reach out and seek help.  The suicide figures in the medical profession are not inflated.  But the physician who is open to his colleagues, coworkers, employers, and government courts a terrible reward.  Anesthesiology resident Gary Hammen was judged to appear more sleepy than he should:  “’They asked me, is this a drug problem? Are you sure you’re not using drugs?’ he recalled. “I was floored.’”  Did he appear inappropriately sleepy in a training program with long hours and possibly easy access to narcotics?  I don’t know.  The doctor states he had a known sleep disorder, for which he was not accommodated.  Is this so, and should he have been?  Discuss.

But his assertion is that the next step was that his program referred him to a scarier program.  “An organization called a Missouri Physician’s Health Program wanted him to fly to an addiction recovery center in another state, to be checked out.”  Should he have volunteered a urine sample, followed by hiring an attorney?  Hammen says that colleagues told him failure to comply could cost him his career.  The local TV station filing this report states that Physician Health Programs, while having stated goals of addiction recovery, are often tied to state medical boards and hospital groups.  For all the concern over protecting the public, this has to be a huge conflict of interest as well. 

The piece quotes an ex-PHP doc:  “The physician is basically at the mercy of the PHP.”  Sometimes just “a tip about a supposed problem doctor” can trigger a personally expensive, career-threatening evaluation at a treatment center with no chance of appeal.  “That center has complete authority to decide which doctors need treatment and how much.”  Hammen states he was given the diagnosis of  “provisional alcohol disorder” because he admitted to enjoying wine with his wife.  “They hadn’t even talked to my wife to see if I drink,” he said.  Maybe there is another side to this, but it is consistent with the way state medical boards view individual physicians:  presumed guilty.

Another thing that rings true:  “The I Team found many of the ‘preferred’ treatment centers also donate money to the PHP trade organization: the Federation of State Physician Health Programs (FSPHP). Newsletters on the FSPHP website show several treatment centers are donors and exhibitors at FSPHP events.”  Why in hell does there need to be a “Federation” for these programs?  This sounds horribly like the sort of umbrella extortion racket the ABMS runs, also with the public intention of protecting the public.  The former PHP physician says, “Even in cases where there was no substance dependence, these centers come back and say, ‘You need to stay for 30 or 90 days of treatment.  It is very hard not to think that financial motivations were behind the misdiagnoses.” 

Apparently certain states can force their doctors to go to geographically inconvenient programs, with no option of independent evaluation, even if there were closer, legitimate centers.  Why should a state medical board or PHP have a “preferred” program? 

The National Federation of State PHPs wouldn’t answer the interviewer’s questions on specifics, responding instead with a lot of boilerplate blah blah about stress, burnout, and keeping physicians healthy.  They Federation says that it lessens “the significant barriers that stand in the way of physicians asking for help.”  Uh-huh.  More boilerplate, and then this curious conclusion:  “Additional research demonstrates successful graduates of PHP’s have a lower risk of malpractice.”  To me, that was the most chilling of all.  The casual tone of this tacked-on line was too reminiscent of the ABIM claim that board certification reduces mortality and incidence of state medical board disciplinary action.  I suspect manipulated data used to justify a cash cow, based on docs threatened or beaten into submission, who dare not color outside of the lines ever again. 

 Physicians who need help should be encouraged to seek it.  But if at all possible, they should do so on a cash-only basis with ironclad confidentiality unobservable by the government or any corporate interest.  As with Medicare auditors, any personal information or disclosure will absolutely be used against you, not only now, but also in subtle, forever ways.  It is a sad but true statement that they put that green hood on you during medical school graduation to distract you from the bull’s eye they are tattooing on your back. 


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Spill The Wine (Not Your Guts) by Pat Conrad MD

  1. Bob
    February 27, 2019 at 8:09 pm

    I have seen completely innocent and blameless doctors who cooperate with these entities be rewarded with endless grief and even ruin, while doctors with obvious issues lawyer up and go unscathed. It is not a system designed to help. I think the comparison to the ABMS/ABIM corruption is apt.

  2. Unlisted
    February 27, 2019 at 9:27 am

    I need to remain anonymous as a result of a legal settlement. 30 years ago I was employed by another doctor. We did not get along and he told me he would not renew my contract and I should leave. My wife had a high risk pregnancy and we were told not to relocate. I had to remain in his employment for the time for health insurance. An anonymous call was made to the medical society that I had come in to the hospital stoned. First, I never used any illicit drugs, prescribed drugs, etc. I am a one beer person. Since I was under investigation, he terminated the contract and the health insurance. I paid COBRA. The Medical Society and Board cleared me. I am prohibited from giving more details at this time.

    • Pat
      February 27, 2019 at 5:44 pm

      Doctors don’t have the same civil rights as others. It’s an unhealthy, high-risk job, as this topic suggests.

  3. Brian Wilhelmi
    February 25, 2019 at 12:13 pm

    100% accurate story about PHPs. These are organizations that have zero due process and hold a physicians property rights in their license in their hands. They have a huge conflict of interest in that if they refer for treatment they are often able to refer to treatment centers in which one or more of the members of the PHP have a financial interest. New laws and regulations need to eliminate potential conflicts of interest and instill due process rights. Please use this minute to consider writing a resolution to the state medical society you participate in to begin this advocacy. We are at a point in medicine where, like the ABMS, we see unprecedented stripping of practice rights by regulatory bodies rife with ulterior motives.

  4. James Tinsley
    February 24, 2019 at 8:59 am

    Whistle blowers never get medals and become pariahs. I left the VA without completing the exit interview. I received straight excellent blocks on my review and a nice end of the year bonus for working 11-12 hours a day for over a year while listening to an administrator for the Chief of staff tell me it didn’t matter. Going DPC now and Never been happier.

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