Dr. Kildaire is in his mid-50s, and has been a well-respected general surgeon in his community for many years. However, colleagues have become aware of problems in his office; two of his nurses have resigned recently. In addition, he has been cutting back on his surgery schedule and seems less interested in the difficult cases as he once was. His hospital rounds have become more erratic, often taking place at odd hours and generating minor patient complaints.

His colleagues are especially concerned about a change in his appearance: over the last six months, he has begun to look much older than his real age. His surgical skills appear unchanged. However, he is much more abrupt with nurses and other hospital staff, and this behavior is more common in the morning hours.

When we think about approaching colleagues whom we suspect may have a problem such as addiction, many of us tend to be very ambitious and to have high expectations of ourselves. After all, we’re health care professionals—our job is to effect cures and to stamp out disease, is it not?!

And so we tend to think in terms of a definitive Johnsonian-model intervention.¹ This requires careful planning, advance meetings, professional assistance, and a cohesive team. It is the classic model that many of us in the addictions field grew up with, and organized correctly, can be very effective. However, it’s quite intimidating to consider organizing a formal intervention. And to be most effective, the participants in an intervention really need some emotional, financial, or other leverage going in to the process.

However, several other approaches have been shown to be effective as well. A simple expression of concern can sometimes lead to action on the part of the professional. Even if no immediate effect is seen, a fairly brief conversation may well “plant the seed” for future intervention or treatment. It’s often a worthwhile goal just to try and move the colleague from pre-contemplation (i.e., not yet thinking about the problem) to contemplation (actively thinking about the problem).²

Another approach that can be very useful with both patients and colleagues is an agreement to a trial of abstinence. The goal is to get the individual to agree to remain abstinent from the substance for a defined period of time, usually a minimum of several months. This has the effect of getting the person free of the cognitive effects of the substance as well as giving them information as to how hard or easy is it to be abstinent. Ideally, the person will also agree to go to treatment or get some other form of help if they are not able to stay abstinent for the agreed-upon period of time, a so-called “contingency plan”. For physicians and others engaged in active patient care, this approach will only be appropriate if the problem is known to be minimal and/or early such that there is clearly no risk of harm to patients.

If the situation does warrant a formal intervention, and sufficient support can be lined up for the process, then it’s wise to get outside help. This usually means consultation from an interventionist experienced with health care professionals.

The most difficult part in dealing with colleagues, especially those who we know and like personally, is in not getting too wedded to the outcome. This holds true for the classic intervention, or a lower-level approach. The individual ultimately has to be ready to accept help. We can encourage and cajole, and we may need to take more drastic action in order to prevent harm to patients. However, we cannot take on the responsibility for our colleague’s engaging in treatment or the overall outcome.

Dr. Kildaire’s friend and colleague ultimately approached him and shared his concerns for his well being. He offered a referral to NCPHP in lieu of bringing the issue to the attention of medical staff leadership in a formal way, and said that Dr. Kildaire would need to authorize NCPHP to let the friend know that he had been assessed and was getting appropriate care and monitoring. In part because Dr. Kildaire knew from their longstanding relationship that his friend was genuinely concerned, he agreed to contact NCPHP and begin the process of getting better. After Dr. Kildaire entered treatment, other physicians approached the friend and revealed that they, too, had been concerned but afraid to approach the surgeon because of his stature in the community.

1. Johnson Institute (1987). How to Use Intervention in Your Professional Practice. Minneapolis, MN: The Institute Books.

2. Prochaska JO & DiClemente CC (1983). Stages and processes of self-change in smoking: Toward an integrated model of change. Journal of Consulting and Clinical Psychology 5:390-95