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Wednesday, December 06, 2006

Dr. House: Impaired but Functional?
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A subplot in the latest episodes of House deals with Dr. House's own problem, his addiction to the painkiller Vicodin. It began innocently enough - when House needed the meds to control his chronic pain - but quickly spiraled out of control. Even while showing off his diagnostic prowess, House still finds the time to feed his habit.

By introducing the concept of House as an impaired physician, the writers let the viewers in on a little secret: House (like all doctors) is a human being, with human weaknesses. And sadly, House's drug problem actually represents a condition more common than the majority of medical issues portrayed on the show. Estimates suggest that approximately 2% of all physicians have a current substance abuse problem, and that between 8 and 18% of physicians will be impaired as a result of substance abuse at some point in their lives. Alcohol is the most common substance abused by physicians, but prescription opioids (House's drug of choice) and anti-anxiety medications are also commonly abused by those in the medical profession.

The notion of a doc with a drug habit is not novel. In fact, drug abuse is considered by many to be an occupational hazard of practicing medicine, and physicians historically have had high addiction rates. Combine a stressful job with the relative accessibility of drugs in a person who may be genetically or otherwise predisposed to substance abuse or addition, and there's physician impairment waiting to happen.

But is House really impaired in the strictest sense of the word? The U.S. Federation of State Medical Boards defines an impaired physician as:
One who is unable to practice medicine with reasonable skill and safety because of a mental illness; a physical illness or condition that adversely affects cognitive, motor, or perceptive skills; or substance abuse.

So far, House is probably still practicing within the limits of reasonable skill and safety, at least in terms of his usual performance. As with many addicts, outsiders likely would perceive him as functioning at a seemingly high level. And the numerous signs of drug addiction in physicians - the things colleagues are taught to watch out for - include bizarre behavior, mood swings, confrontational relationships, erratic habits, and inappropriateness. Fans of the series know where I'm going with this. Dr. House's unimpaired personality was, at best, unique and somewhat deviant from the norm. So at least some of the signs of addiction might simply go unrecognized in this character.

Is he going to defeat his addiction? Only the writers know for sure, but the odds are in his favor. Physicians are more likely than the general population to have a favorable outcome when treated for substance abuse, with recovery rates ranging up to 91% for docs in substance abuse treatment programs. Still, there's always the danger of relapse. We'll just have to wait for next season.


Related Topics:
  • RX Drug Abuse: Common and Dangerous
  • U.S. RX Painkiller Deaths Up


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    Posted by: Melissa Stoppler_MD at 12/06/2006 12:06:00 PM

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