Founded in 1995, the Ontario Medical Association’s Physician Health Program, or PHP, helps doctors with alcohol and drug addictions.
Dr. Sam Smith, not his real name as we agreed to protect his identity, started attending the PHP in 2010 because of a marijuana addiction. A practicing family physician now, he celebrated six years of abstinence in February.
When Smith started residency in 2010, he was referred to the PHP because of a question on his application for licensure with the College about previous problems with alcohol, or drugs, which he answered ‘yes’ to.
In fact, Smith was given his medical license on the condition that he enrol with the PHP.
“Most people would just answer ‘no,’” he says. “All through medical school I evaded the truth about how much I was using when I was flagged for failing exams. That question about substance use on the residency application gave me a chance for a fresh start by being truthful. I was told by the PHP that it was ‘refreshingly honest’ [because most] people don’t come into recovery until they’re discovered,” says Smith.
“Either they’re caught taking drugs from work, or they’re hung over, or intoxicated, or they get a DUI, or a colleague will call the PHP, or the College, [to] make a complaint.”
Although a proactive process in the end, getting here has been a long journey for Smith.
“In Ontario, the usual [agreement] with the PHP is five years,” he says. “For most people, they recommend urine monitoring, seeing an addiction doctor and sometimes a psychiatrist as well. They also generally recommend an in-patient treatment program and attending Caduceus, a group of health-care professionals with addictions.”
Smith says it has been a positive experience. He has a new contract now, after moving to another province, and will be finished mandatory monitoring soon. As with many physicians in recovery, however, Smith intends to continue his addiction treatment afterwards.
“The overwhelming thing for me in my recovery was someone [who] said, ‘You have to give up control to get back control,’” he says. “Over time, I really learned what that meant, which was that when you’re in active addiction, or even recovering, but still trying to do everything on your own, or do things your own way, it can be really problematic.”
Smith considers the PHP’s support instrumental in his successful recovery.
“It’s been really helpful for me to have the PHP to say, ‘No. This is what we want you to do. We want you to have all these things in place to keep yourself and the public safe in case you relapse,’” he says.
Based on Smith’s experience, one has to buy into the program, by trusting the people who are there to help you.
“For the first time in my life, I had all these different areas of support and fail-safes to protect me from using, [which] really, really helped.”
The statement, “I wish I had cancer,” recently reminded me of the film Still Alice, based on Lisa Genova’s novel, and dementia’s lonely journey.
This is because these are also the words of Dr. Alice Howland (Julianne Moore), a linguistics professor at Columbia University, when her neurologist (Steven Kunken) diagnoses her with early-onset familial Alzheimer’s disease. She celebrates her 50th birthday with her physician husband, John (Alec Baldwin), and their three children. During a lecture, Alice forgets the word “lexicon.” Then, she gets lost on campus while jogging.
As her illness progresses, she becomes unable to deliver focused lectures and subsequently loses her job. Alice gets lost looking for the bathroom in her own house and soils herself. She fails to recognize her youngest daughter, Lydia (Kristen Stewart), after watching her play performance. Later, Alice visits her eldest daughter, Anna (Kate Bosworth), in the hospital to meet her newborn twin grandchildren, but doesn’t recognize her. Anna tests positive for the Alzheimer’s gene. Her unborn twins test negative, as does her brother, Tom (Hunter Parrish), a junior doctor. Lydia declines genetic testing.
Alzheimer’s is not only a disease of the elderly. The younger-, or early-onset type, affects those less than 65 years of age. In fact, up to five per cent of the over five million Americans with Alzheimer’s have the early-onset form, according to the Alzheimer’s Association. That’s about 200,000 Americans. Many are in their 40s and 50s. They may have careers, families, or even be caregivers when Alzheimer’s strikes.
Last week, one of my patients expressed memory concerns. After a series of other tests, I eventually asked him to draw a clock, a common method used to assess baseline cognitive function. When he tried, he realized he couldn’t do it. Then he said, “I wish I had cancer. People wear pink ribbons for you when that happens.”
A moment of realization for both of us, this reminded me how lonely illness is. Losing one’s mind is a journey we largely walk alone. Perhaps it’s because we’re often as afraid as our patients. Rarely do we ask, ‘What is it like?’ Or, ‘How does it feel?’ Questions considered common practice with cancer, diabetes, or heart disease.