Physicians-in-training Attitudes Toward Caring For and Working with Patients with Alcohol and Drug Abuse Diagnoses

Authors: Michael Lindberg, MD; Cunegundo Vergara, MD; Rebecca Wild-Wesley, RN; Cynthia Gruman, PHD


Introduction: Physicians in all specialties commonly encounter patients who abuse alcohol or illegal drugs. Working with these patient populations can be challenging and potentially engender negative attitudes. This study is designed to identify the progression of attitudinal shifts over time of physicians-in-training toward caring for substance abusing patients.

Methods and Materials: A 31-item survey was designed to capture demographic information of participants, attitudes toward treating patients with substance abuse diagnoses, previous participant education, experience in and comfort with diagnosing and treating substance abuse, and satisfaction achieved in working with this patient population. Medical students in their third and fourth years of education as well as residents in training, years one through four, were surveyed. Responses to the survey's attitudinal items were analyzed across years of training, looking for changes associated with time and experience.

Results: Fifty-seven percent of eligible participants anonymously completed the survey. There was general agreement across all years of training that health care professionals should be allowed continued employment in their professions when in recovery from alcohol abuse (P= 0.424) and drug abuse (P = 0.409). Across years of training there was agreement that patients can recuperate and provide meaningful contributions to society when recovering from alcohol (P = 0.847) and drug (P = 0.859) abuse. From medical school years through residency there were enhanced beliefs that alcohol-abusing patients (P = 0.027) and drug-abusing patients (P = 0.009) overutilize health care resources. Most trainees, despite year of education, believe patients who abuse alcohol (P = 0.521 and illegal drugs (P = 0.356) have challenging medical and social issues from which they can learn. There was consistency across years in the perception that providing care to alcohol-abusing patients (P = 0.679) and drug-abusing patients (P = 0.090) is repetitive and detracts from the care of others. All felt their training was adequate to care for alcohol (P = 0.628) and drug-abusing patients (P = 0.484). Satisfaction achieved in caring for alcohol (P = 0.017) and illegal drug-abusing patients (P = 0.015) consistently diminishes over years in training.

Conclusions: There are positive as well as negative aspects for physicians-in-training to caring for patients with alcohol and illegal drug abuse problems. Combining effective education strategies with the needs of physicians at specific points in their education may be effective in reversing the negative trends seen in attitudes toward caring for patients with substance abuse problems.

Key Points

* Physicians in all specialties and at all levels of training and experience commonly encounter and work with patients who have substance abuse problems.

* There are degradations in attitudes toward caring for substance abusing patients throughout the years of medical school and residency training.

* Combining effective education strategies with the needs of physicians at specific points in their education may be effective in reversing the negative trends seen in attitudes toward caring for patients with substance abuse problems.

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