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Topic Overview: Substance abuse, and ultimately impairment while at work, is a significant problem for healthcare employers. Many institutions have implemented pre-employment and/or random drug testing programs in an effort to combat this problem. Unfortunately, even the most stringent testing programs don’t seem to be able to completely eliminate the problem of an employee coming to work impaired or becoming impaired while at work. This is especially concerning when a clinician is impaired and providing care to patients. Massachusetts General Hospital, a 900+ bed acute care hospital, has taken a multi-disciplinary approach to deciphering impairment versus poor practice, investigating potential diversions and determining the best course of action once a conclusion has been made. The role of the occupational health professional is paramount to this process. Occupational Health needs to be involved with the development of hospital policy, the selection of the drug testing method and panel development, and potentially development of a return to work and monitoring plan. This includes reporting to and working with the clinicians licensing board.
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