Men's Health
15% of U.S. Surgeons Report Drinking Problems in Survey
MONDAY, Feb. 20 -- Alcohol use disorders are a significant issue among U.S. surgeons, a new national survey reveals.
The online, anonymous poll indicated that 15 percent of surgeons appear to suffer from alcohol abuse or dependence: nearly 14 percent of male surgeons and 26 percent of female surgeons.
Those figures exceed the 8 percent to 12 percent figure typically cited for alcohol abuse rates among the public at large, according to background information in the study published in the February issue of Archives of Surgery.
"But it should be said that a number of studies have shown that direct patient harm associated with impairment due to chemical dependency is very, very rare," said survey lead author Dr. Michael Oreskovich, a clinical associate professor of psychiatry and behavioral sciences at the University of Washington in Seattle.
"The chance of a patient being injured by an impaired surgeon is really very uncommon. Something like one in 10,000. So it just doesn't happen very much," he noted.
"However, the findings do beg the question as to why it is that every other safety-sensitive profession has random drug screenings, while surgeons do not," Oreskovich added. "Some anesthesiologists are finally undergoing this -- pre-employment drug screens, for-cause drug screens and random drug screens -- for the same reasons. And although it may not be a popular statement, there's no reason other interventionists involved in a high-risk practice should not be tested. And I think eventually we'll get there with surgeons."
In the study, the investigators analyzed surveys completed in 2010 by physicians from all across the United States, who were members of the American College of Surgeons.
All of the surveys were administered online and processed anonymously. However, less than one-third of the more than 25,000 surgeons to whom they were emailed actually responded.
Among the nearly 7,200 respondents (29 percent response rate), the team focused solely on the 1,112 surgeons (15 percent) who reported drinking behaviors that amounted to full-fledged abuse or dependence. Completed surveys that demonstrated an unhealthy, and perhaps even risky, pattern of drinking that did not amount to a diagnosis requiring treatment were not included in the final tally.
Surgeons who said they had made a major medical mistake over the previous three months were more likely to be struggling with alcohol abuse or dependence, as were those who were either depressed, emotionally exhausted, suicidal, "distressed" or "burned out."
Overall, alcohol issues were less prevalent among male surgeons, as well as among those who were older, had children, worked longer hours, were more often "on call" or were employed by the U.S. Department of Veterans Affairs.
"Doing this study to find out where we're at is truly remarkable for an organization like the American College of Surgeons," Oreskovich said. "But the idea is let's shine a light on it and get on with it. Because this may very well be an even bigger problem than the numbers now indicate, because many surgeons may not have completed the survey or [not] completed it honestly out of shame, guilt and fear," he added.
"But actually publishing this survey, and showing the high percentage of those who have a problem, we think is actually destigmatizing by its very nature. It kind of sets a precedent that it's OK to be ill," Oreskovich said. "And, hopefully, next time we do a poll more surgeons will come forward."
Dr. John Fromson, a co-director of postgraduate medical education at Massachusetts General Hospital, and an assistant clinical professor of psychiatry at Harvard Medical School, wrote a critique of the study in the journal.
"The most important thing here is to note that physicians are not immune from these kinds of problems. And I think it's quite courageous on the part of the journal to actually publish this information, because there are not many studies that take a kind of a fearless look at this profession," Fromson said.
"And even if you help just one surgeon in terms of this identification, you've done a good thing," he added. "I don't think patients and their families need to be alarmed. But the reality is that the more we talk about it, the greater the chances of recognizing the factors and stressors that contribute to it among those who need help."
In an editorial also accompanying the study, Dr. Edward Livingston, a professor of surgery at the University of Texas Southwestern Medical Center in Dallas, re-emphasized the reservations with survey accuracy addressed by the study authors.
"You really can't interpret too much from this," Livingston said. "The response rate was just really, really low. Most statisticians agree that out of 100 surveys you have to have 60 or more responses for the findings to be reliable. That's 60 percent. And here you have a 29 percent response. Which is understandable, since the ramifications are so great for a physician who is found to have a drinking problem," he pointed out.
"In fact," Livingston added, "one possibility is that the problem is even greater than they've found. So what we might have here is really an underreporting of the situation."
SOURCES: Michael R. Oreskovich, M.D., clinical professor of psychiatry and behavioral sciences, University of Washington, Seattle; Edward H. Livingston, M.D., professor of surgery, UT Southwestern Medical Center, Dallas, and contributing editor, JAMA; John A. Fromson, M.D., co-director of post-graduate medical education, Massachusetts General Hospital, Boston, and assistant clinical professor of psychiatry, Harvard Medical School; February 2012, Archives of Surgery
WEDNESDAY, Feb. 15 -- Scientists have long believed that urinary tract infections are typically caused by a person's own E. coli bacteria, but a new Canadian study suggests the bacteria may more often than not come from chickens.
Yes, chickens.
As many as 85 percent of urinary tract infections are caused by E. coli, according to the report in the March issue of Emerging Infectious Diseases, a publication of the U.S. Centers for Disease Control and Prevention.
Researchers compared the genetic fingerprints of E. coli from these infections to that of E. coli from chicken, beef and pork. And they found a match: chicken. What's more, they report that the infections probably came directly from the chickens, not from human contamination during food processing.
"Chicken may be a reservoir for the E. coli that cause infections like urinary tract infections," said study author Amee Manges, who is with the department of epidemiology, biostatistics and occupational health at McGill University in Montreal.
"We are also concerned about the selection and amplification of drug-resistant E. coli on the farms because of improper or overuse of antimicrobials during food animal production. It may be possible to reduce the level of drug-resistant infections in humans by encouraging rational and judicious use of antimicrobials on farms," Manges said.
"We just want to emphasize that it isn't just inappropriate use of antibiotics in human medicine that matters, but also the use of antibiotics in veterinary medicine and food production that leads to greater drug-resistant bugs," the study author added.
The U.S. Food and Drug Administration already advises against the overuse of antibiotics in livestock, because it can lead to resistant strains of bacteria.
Dr. Philip Tierno, director of clinical microbiology and immunology at NYU Langone Medical Center in New York City, said it is not surprising that the food supply, especially chicken, may play a role in causing urinary tract and other infections. He said the best protection begins with proper hygiene.
"If you practice good personal hygiene, good food hygiene and good home hygiene, we can reduce the number of infections," he suggested. Proper hand washing should last for 20 seconds. "Wash in between your [fingers] and under your nails," Tierno said. "When dealing with counter surfaces, use a product that can disinfect surfaces and prevent cross-contamination."
Cooking also helps kill disease-causing bugs. "Eat nothing raw. Cook it well, and if you are eating vegetables, make sure to soak them and wash them well," he said.
The solution is definitely not to throw more antibiotics at livestock, Tierno agreed. As far as preventing E. coli in chicken coops, "we need a better system developed to raise chickens so they are not raised in crowded conditions and prone to diseases like E. coli," he explained.
Good hygiene is never a bad idea, but the truth is that E. coli is everywhere, said Dr. Elizabeth Kavaler, a urologist at Lenox Hill Hospital in New York City. "The best defense against urinary tract infections is to exercise, eat well and get proper sleep so your immune system is strong and can fend off what you can't see, including E. coli," she said. "Be healthy, wash your hands, take care of yourself and when you have a urinary tract infection, see your doctor for an antibiotic to treat it."
SOURCES: Amee Manges, Ph.D., M.P.H., department of epidemiology, biostatistics and occupational health, McGill University, Montreal; Philip Tierno, Ph.D., director, clinical microbiology and immunology, NYU Langone Medical Center, New York City; Elizabeth Kavaler, M.D., urologist, Lenox Hill Hospital, New York City; Feb. 15, 2012, Emerging Infectious Diseases, online
- 
