Mansky P A
Department of Psychiatry, Albany Medical College, NY, USA.
Psychiatr Q. 1999 Summer;70(2):107-22. doi: 10.1023/a:1022197218945.
The issues discussed in this article introduce and examine topics related to physicians' health which are salient in their clinical usefulness or their heuristic value in planning future research. Physicians in general possess physical, emotional and intellectual strengths that are needed to face high stress and low social support. Physicians are also less likely to seek routine medical care. With many illnesses physicians are inherently resistant but have higher risk factors. It is postulated that the opposing tendencies cancel each other. Physicians have better intrinsic physical and mental health but live under higher stress and get less routine preventive care. Physicians also may have a tendency to live healthy lives without addiction but have high risk factors for addiction. Adults who have grown up in families with addiction have a tendency to choose health care professions. Genetic composition may predispose to alcoholism and other chemical addictions. Taking into consideration inherent health and risk it is thought that physicians have a similar prevalence of alcoholism and drug dependence as compared to the general population. Physicians have higher access to pharmaceutical drugs but are less inclined to use street drugs. In the New York State Physicians' Health Program, 88% of the participants used alcohol or prescription drugs and only 12 percent used marihuana or Cocaine. Additional risk factors for Substance Use Disorders in Physicians have been postulated to be pharmaco-logical optimism, intellectual strength, strong will, love of challenges, instrumental use of medications and a daily need for denial. These factors require rigorous investigation to establish their role. Clinical approaches and techniques discussed include the incubation period for a Substance Use Disorder, initial high tolerance, state dependent learning, and the signal properties of drugs. As recovery progresses it is postulated that it becomes increasingly important to deal with substitute addictions and family of origin issues.
本文所讨论的问题介绍并审视了与医生健康相关的主题,这些主题在其临床实用性或对未来研究规划的启发价值方面颇为显著。一般而言,医生具备应对高压力和低社会支持所需的身体、情感和智力优势。医生也不太可能寻求常规医疗护理。对于许多疾病,医生本身具有抵抗力,但却有更高的风险因素。据推测,这些相反的倾向相互抵消。医生有较好的内在身心健康,但生活压力较大,接受的常规预防性护理较少。医生也可能有过健康生活且无成瘾问题的倾向,但有成瘾的高风险因素。在有成瘾问题的家庭中长大的成年人倾向于选择医疗保健职业。基因构成可能易患酗酒和其他药物成瘾。考虑到内在健康和风险,人们认为医生酗酒和药物依赖的患病率与普通人群相似。医生更容易获得药品,但不太倾向于使用街头毒品。在纽约州医生健康项目中,88%的参与者使用酒精或处方药,只有12%使用大麻或可卡因。医生物质使用障碍的其他风险因素被假定为药理学乐观主义、智力优势、坚强意志、热爱挑战、药物的工具性使用以及日常的否认需求。这些因素需要进行严格调查以确定其作用。所讨论的临床方法和技术包括物质使用障碍的潜伏期、最初的高耐受性、状态依赖学习以及药物的信号特性。随着康复的进展,据推测处理替代成瘾和原生家庭问题变得越来越重要。