The British Medical Association has called for action over alcohol and drug abuse among medics after a BBC survey showed the problem was widespread.
Dr Thomas Kenny is a recovering alcoholic
BBC One's Real Story found over the last 10 years 750 hospital staff in England had been disciplined over alcohol and drug-related incidents.
The BMA estimates one in 15 medics have a problem with drugs or alcohol at some point in their life-time.
Ethics Committee chairman Michael Wilks said the profession was in denial.
Doctors are known to be at least three times as likely to have cirrhosis of the liver - a sign of alcohol damage - than the rest of the population.
This is second only to publicans and bar staff.
Dr Wilks said: "You've got a profession that doesn't want to face up to the fact that it's got a problem in the ranks.
"You've got levels of denial that make it virtually impossible for an alcoholic doctor to be helped.
"With a fairly modest investment we could set up a programme that could intervene effectively, train people to buy the right treatment and set up a monitoring system," he said.
He estimates this would cost government £10million and would save money in the long run.
The BBC figures are based on replies from one in three hospital trusts in the UK and reflect only those cases that the employers knew about.
NHS Employers said the figures were probably an underestimate.
At Maidstone and Tunbridge Wells NHS Trust, three consultants in three years had been referred to the General Medical Council for alcohol problems.
At East Kent NHS Trust, seven doctors and two nurses had been disciplined over drink and drugs in the last 10 years.
The biggest figure came from the University of Leicester NHS Trust where 17 clinical staff, including one consultant, four nurses and two operating theatre practitioners were disciplined over the past decade.
The British Association of Oral and Maxillofacial Surgeons said a survey of 150 consultant surgeons revealed more than a fifth said they knew a colleague who they believed to be impaired by alcohol while on call.
Yet unlike other professions responsible for public safety, such as airline pilots and tube drivers, the NHS does not have strict rules on drinking before duty.
Newcastle Upon Tyne NHS Trust has guidance that staff should not drink up to eight hours before they are on duty. None of the others in the BBC survey had such rules.
Alistair Henderson, director of operations for NHS Employers, said even when policy was in place it did not always safeguard against the problem.
"Sometimes it is easy to assume that having a policy is the same as dealing with it.
"I would hope and expect that all organisations are able to deal effectively with drug and alcohol abuse."
He said random alcohol and drugs testing of staff, which has been suggested by some as a solution, would not solve the problem.
Dr Vivienne Nathanson, the BMA's Head of Science and Ethics, said: "Doctors respond extremely well to treatment when they have the appropriate services available to them. Research has shown that the vast majority of doctors will make a full recovery."
She also called for more government investment for such services.
A Department of Health spokeswoman said: "We expect all NHS Trusts to have in place drug and alcohol misuse policies."
She added that all trusts were required to provide access to occupational health services for staff and that NHS Employers had made good progress to ensure staff were being provided with appropriate support.
The Medical Defence Union, which provides medico-legal support and advice to UK doctors, said those with drug and alcohol problems should seek help early.
Dr Thomas Kenny, a surgeon who is recovering from alcohol addiction, said: "Patients have suffered and it's something I have to put up with every day of my life."
Natasza Lambert from Folkestone told Real Story she had been seen by a doctor who was under the influence of alcohol.
"He had come in straight from riding. He was absolutely paralytic. He was all over the place, stuttering and slurring."
Real Story: - BBC ONE, Monday 13 June, 2005 at 19OO BST.
This debate is now closed. Thank you for your comments.
People are forever trying to blame their own failings on their circumstances, but that simply won't wash. Medical students and doctors knew what they were signing up for when they chose a career in medicine. They knew it would be stressful. They knew it would involve long hours and difficult decisions; but since when has alcohol solved anyone's problems or enhanced their ability to cope with stress? It never has and it never will. It causes only problems. More to the point, when the health and lives of patients is put at risk by the irresponsible behaviour of those who are supposed to be health 'professionals' clearly some action needs to be taken.
Medical student, Norwich, England
I know many doctors and come from a medical background and this is not at all surprising. What is however a surprise is the lack of help that is out there for these doctors. The GMC would rather wash their hands of them which inadvertently makes the situation worse and the doctor is hence caught in a Catch 22 situation. One of my friends was actually reported to the GMC not that he ever came to work drunk or anything but had taken days off. Instead of getting proper help with his alcohol problems the GMC preferred to put restrictions on him which inherently made it impossible for him to get a job. I find it unbelievable that a profession which is supposed to be looking after the welfare of others cannot look after their own members.
Doctor's have never had it so easy! In this part of the world they barely work a 9-5 Mon-Fri shift (much less than most people), they refuse to do out of hours work and still demand large salaries from the taxpayer. A few weeks ago a tourist died in our village because no doctor could be found on a Thursday afternoon, a very sad situation. Doctor's are becoming over pampered - this is a 24/7 world and doctors should have to work like the rest of us. It might keep them away from the booze, drugs and golf courses!
John MacDougall, Loch Tay, Scotland
I come from a medical family, and have always appreciated the stressful environment that doctors and nurses work in, especially in this day and age. My upstairs neighbour is training to be an ENT consultant, and judging by the drunken/drug induced ribaldry emanating from his home every other night, I certainly would not wish to be one of his patients. The problem lies with the total acceptance by medical schools of this alcohol culture that has always existed in this particular profession, and can only be getting presently worse. What is acceptable as a student, is not going to change once you are qualified.
D, Epping, Essex
As a second year medical student, I would agree that the problem with alcohol very much begins at medical school. Medical student societies seem to exist with the sole purpose of getting their members into a state of oblivion. With this ingrained so firmly into medical students, and with the supposedly "proud history" of drunken medics, is it any wonder that there is trouble later on? Yet, I think it important to be sensitive about this. It is all very well for non-doctors to whine incessantly about how easy doctors have it, and how much they get paid. My advice: experience it for yourselves. Tired, stressed doctors need help to get through their addiction, not recrimination. That help should begin at medical school, and extend upwards.
John, Edinburgh, Scotland
Apart from the obvious concern regarding the problem of alcohol abuse, the bigger question to be addressed is why the medical profession (doctors in particular) are prone to alcohol dependency. Could it have something to do with stress caused by: the management structure (e.g. no line responsibility for nursing staff, management by administrators not medical professionals) anti-social shift patterns, beligerent patients (e.g. in A&E), stop-go policies (e.g. targets) and more. Did I hear recently that about 2/3rds of junior doctors are leaving for jobs outside medicine - while we recruit from developing countries? This alcohol problem is but just one symptom of a much much larger crisis in medicine.
Jeremy Lumbers, Wimbledon
Doctors have feelings and emotions, just like any other person. They take on enormous responsibility and have to cope with horrific cases and feelings of guilt when they (as high achievers throughout childhood), feel they should have been able to do more every time. There are so many people around who have the unspoken feeling of never being quite good enough. Like many other addicts, the socially acceptable bottle provides self medication to try and numb doubt and pain and guilt. Even if they come to acknowledge they have a problem, anyone working in healthcare stands to lose their livelihood with just three words on a sickness certificate - alcohol withdrawal syndrome.
My other half has nursed me through tremors, hallucinations, nightmares and deep, deep depression because we both know the consequences of seeking help. I just have to keep things going for another 10 years until my youngest is an adult. If I can keep relapses down to a minimum and keep it as it is now, where I never ever go to work with alcohol in my system, perhaps I can make it. But it's a creeping, progressive disease and it's going to be hard fighting it all alone for another decade. Then one day I will finally be able to say out loud what I know already in my heart - that I am an alcoholic.
It is not just Doctors and nurses who drink too much or take drugs, many responsible professional people do it too. The reason this is so controversial is they are directly responsible for people's lives, I think a zero tolerance policy with random testing should be implemented so that medical staff who are over the limit at work are sent home, I work in civil engineering and this applies to us. However this could prove costly, especially when our wards are so short staffed, it will also tie the medical staff up with more and more red tape. This will only work if the cause of the problem is also treated and Medical staff are under a huge amount of pressure due to mismanagement and insufficient funding. Not to mention the emotional stress and trauma of suffering patients, abuse from patients and the constant threat of legal action.
Brian Shoelace, Partick Thistle
Where this figure from the BMA has come from I do not know. I know no doctors who are addicted to drink or drugs. I know lots and lots of very hard working doctors who are utterly sick and tired of this media bashing that we get constantly and just want to get on with our jobs. Even if this number was somehow based in fact, the vast majority of medics are not affected by these problems, and continue to try and do their best day in day out, week after week.
Over twenty years ago I witnessed an organised drinking contest at a famed medical school in London. It went way beyond any other student high jinks I have ever witnessed, and disturbs me to this day. I think the problems are that medics are assumed by all of us and by themselves to be God-like in their power, abilities and responsibilities, when obviously they are not. But medical school breeds in them arrogance, an inability to relate to the real world and a very unhealthy attitude to their own position in it. Solutions? Certainly a rule against drinking 12 hours before going on duty or while on call. More importantly a mission in medical schools to train fully rounded human beings who are skilled in medicine - not 'doctors' for whom human frailties are an embarrassment that they try to deny.
I think it is necessary to separate GPs from truly hardworking doctors (at least in Scotland). Although many working people have to work long hours GPs now have an easy 9:00 - 5:00, Monday - Friday job. And they still moan! If they spent more time dealing with patients they wouldn't have the time to get stoned!
Anon, Central Scotland
And they have the nerve to tell the rest of the population that they should drink less, smoke less, eat more healthy food, eat less unhealthy food etc. Doctors are the biggest hypocrites in the country.
Hold on a minute! Drink to unwind after the stresses of their days/nights...! I've lived with junior doctors - yes, they do a tremendously difficult job at times but their hours are no longer than the average white collar worker who has other stresses and strains (such as job security) that doctors don't have. Doctors drink heavily because they can get away with it. Also drinking Doctors form the last male bastion (just as boozy lunches used to be the norm amongst stockbrokers in the City of London)
D, Dorchester, Dorset has not got a clue in regards to what the doctors have to work through. I would like see D, work an 18 hour day 10 days straight have 1 day off and continue again. The so called limit of hours for a working doctor is ignored by most hospitals in the UK, there is NO support from the medical association, add to that the doctors are still studying for further qualifications, then there is the added stress of the making a mistake which could cost your career, and someone's life. The Doctors in the UK are expected to work with no support, ridiculous hours, and the pay is not as good as most people think.
When a patient has an alcohol or drugs problem, they go see their local GP for help. They are provided with support and guidance from someone they trust and all in perfect confidence. Who should a doctor go to when he or she has such a problem? Most likely they know all the doctors they might be referred to - how many of us would feel comfortable talking to a colleague about something so deeply personal and difficult? When a doctor essentially takes on the role of a patient, they should be given as much help and support as they would be expected to give their own patients. The first step is surely to give them somewhere they can go themselves with access to someone they feel comfortable talking to in confidence. They too should have the opportunity to receive as much help and guidance as any other patient would get.
I don't think the general population really understand the constant pressure doctors are under. A slight mistake and you'll kill somebody. The only thing that surprises me is that more doctors don't turn to alcohol and drugs. Most people in this country don't know they're born.
A, Sheffield, UK
Please. Doctors are people aren't they? Sure enough they should not be drunk when they are treating people but what they do in their own time is entirely up to them. As someone has already said they drink to unwind from a stressful job: being a doctor has to be one of the most stressful jobs - deadlines to keep to, on top of the constant media barrage about hospital waiting times and meeting targets. At the end of the day doctors are just normal people too - it does not mean that they are not allowed to drink but it also does not mean they can flout the rules and jeopardize somebody's life.
Matthew, Norfolk, UK
I fully appreciate that doctors and nurses have stressful jobs and quite often work longer hours than the majority of people. That said this is true of a large number of professionals! I can not go out and drink the night before I drive 100 miles to an appointment. Even with a low level of alcohol in my system it is deemed unsafe for me to drive. How on earth can the nurses and doctors who do drink and consume drugs, prior to duty (even 8 hours before) justify their actions, when the very essence of their profession is to preserve life and promote recovery, not put people in grave danger. In my humble opinion, testing for drugs and drink should be introduced, not only to force those with addictions to seek help but to head of the stereotypical behaviour of junior staff who drink heavily and turn up for duty. Finally, after hearing that my local GPs were being paid £1000 per night to be on call as a duty GP often without minor or major incident, in addition of their salary of 100k+, I personally feel their salary alone is recompense for the long, possibly unsociable hours, and sufficiently high to demand high standards of professionalism.
D, Dorchester, Dorset
I have run a longitudinal study of doctors over the last 20 years, including questions about their alcohol use. There has been a consistent 5% of them signing up to the top of the alcohol use scale at each 5 year assessment since medical school. As the questionnaires are not anonymous, this is bound to be a large under-estimation. Another 7% sign up to the score below the maximum, which means that at least one in ten know they have a problem with alcohol. In the States this is treated fast and effectively - zero-tolerance but good clinical help on hand - paid for by the doctor - using the AA 12-steps method at its core. Here we ignore it from medical school on.
Women medical students are the only group to increase their drinking over their student years and alcohol abuse is a particular problem with women doctors and probably linked to their higher suicide rates as well. British doctors take a laissez-faire attitude to alcohol abuse in their colleagues - partly to do with inherent politeness - and their patients - partly, I suspect, to do with wondering whether they too have a problem and so denying it in both. I was on the Board of Alcoholics Anonymous for some years and many recovering alcoholics on the board talked about going to their GP with "depression" and being told to go and have a drink. Perhaps what we are seeing is part of the British love affair with alcohol that infects our young but that is shrugged off as in some way normal. The sooner we work to get over this strange folie a deux the better!
Professor Jenny Firth-Cozens, Kendal, UK
Brilliant! Just what the country needs - more fear-mongering about how 'evil' doctors are. Doctors are real people, believe it or not. And as such they have real problems. Perhaps we should be looking at why they have to resort to drink to calm themselves - abuse by ungrateful whining patients who feel the world owes them treatment seconds after they enter the A&E for a bruised knee, drunkards, thugs off the street, druggies and screaming brats. Who can blame the doctors for taking to drink?! I honestly hope this program by the BBC takes some responsibility for a change and looks at why the problem exists.
Bob, Reading, UK
A friend of mine was once placed in the residential accommodation for a hospital when he needed somewhere to live. Many of the doctors and nurses that stayed there were in the A&E department of the hospital. They spent much of their spare time getting drunk and taking drugs and I am glad I never had to attend that A&E department. At the time, my friend and I agreed that the doctors and nurses used alcohol and drugs so much because they needed to escape from a very lonely, stressful and depressing job.
It's hardly surprising given the hours that our NHS doctors and nurses are expected to work and the pressures of their jobs. I think the employers should shoulder a good proportion of the blame for this problem, and seek to address it through identification and support of those in need, and also to reduce the conditions that provoke these problems in the first place. It seems that the NHS is not only in denial of the drug and alcohol abuse problems it's staff have, but also of the abuse of the staff by the employers.
Sean Ellis, York, England
Surely part of the problem is that young doctors and nurses have to lead extended periods living a student-like lifestyle of long, stressful hours with little opportunity for socialising in less intense ways? Find a way of giving them a more relaxed lifestyle and less of them will end up drinking unhealthily.
Daniel, Cambridge, UK
I think this is appalling. Doctors are supposed to be helping patients and setting an example to the people of Britain because they are thought to look after their health because of their profession. In my opinion, the government needs to act fast and as for the doctors, they should face some kind of punishment.
Rizwan Khan, Rochdale England
With the NHS in the mess that it is, we should not be surprised that this is happening. Doctors are only people, not superhuman, and seem to be expected by the general public to be able to cope with work and stress loads that most people would find unbearable. So this problem does not lie with the individuals, but the pressures put upon them by public and government expectations.
Medical student, Oxford, Oxfordshire
Surely we have to ask why? It's clear that they are working under increasing pressure, and are getting no support. The help they would receive if they were to admit to a drink or drugs problem would be from someone in their own line of work which would be embarrassing and would make them feel at risk of putting their own jobs on the line. Give them a break, literally and let them work more normal hours. Get their management off their back, get the government to support them rather than beat them with a stick to make them work harder.
Hold on, what's driving the poor doctor into this state? When you are dealing with hundreds of patients a day, all with different complaints, moaning, screaming and all other things the human race can muster - it's a wonder the medical profession takes to drink. "Treating illnesses is why we become doctors. Treating patients is what makes most doctors miserable" - a quote from the TV series House. How right they are.
Horace Ward, Feltham, Middx
I am appalled at this revelation. How can I trust a doctor in future to guide an alcoholic to the path of recovery, when he is in denial about his own problems? I do think NHS should issue guidelines to staff about drinking before duty, but also the onus should be on staff to admit they have a real problem. Only then this problem can be resolved.
Devinder Singh, Loughborough
There has been folklore about this problem for decades. I was once told, only half jokingly: "You're only an alcoholic if you drink more than your doctor."
Graham, Oxford, UK
The problem always has been that the BMA is a trade union looking after its members and not the patients. Until doctors are subject to the same rules as everyone else i.e. governmental control rather than the rules of an old boys club we will always have incompetence in that so-called profession. Drink and drugs are the least of the medical professions' problems, incompetence is rife at every level.
John Sinclair, Dundee, UK
Alcohol related disease costs in terms of human suffering and the economy are astronomical and probably exceed those of smoking. So I pose a question. Should alcoholic beverages carry a similar warning to smoking?
Stuart Jones, Aberarth, Wales
Why should the tax payer pay for their treatment? Let them be tested by all means but treatment, especially priority treatment, should be the same as that for any other member of the public - wait while suspended or non-contact duties, or go private.
M Durrant, UK
What the doctors get up to in their private off duty time is entirely up to them. However while dealing with patients it is essential that the NHS must have a zero alcohol level policy. Especially in the acute intervention areas such as casualty, operating theatres, interventional radiology etc. where a second chance or second opinion may not be available. It is quite cheap to make available breath analysers around acute areas and have either a compulsory or voluntary tests with appropriate policies to support the tests.
It should not be made a privacy issue of the NHS staff since there is a public safety issue of possible harm to patients who have already had the misfortune of being ill. The very high pressures of dealing and being responsible for others health, life and death could account for the high prevalence of alcoholism in the medical profession. Existing policies are quite sympathetic and supportive. They should be strengthened by proactive identification and rehabilitation of affected staff who are extremely valuable to the society.
Mr M Hemadri, FRCS Edin, Scunthorpe, UK
I'm not at all surprised by this report. I'm a final year medical student at one of Britain's largest medical schools, and in my view one key contributor to this rampant substance abuse problem amongst doctors is the uncontrolled hedonism fostered in on campuses and in medical student bars and clubs up and down the country. I'm no killjoy, but I'm amazed at some of my colleagues who think it perfectly alright to stay out drinking till dawn and then arrive a few hours later on hospital wards for teaching, where they will interact with senior doctors, nurses and patients often obviously hung-over and sometimes incapable.
No-one says anything by way of admonishment to them - in fact the "10 pints, a curry, a fight and then steal a traffic cone" lifestyle is unconsciously patted on the back by consultants who did it themselves and find "high jinks" positively admirable and character building. One can only conclude that this lax attitude (to alcohol in particular), common to all groups of students, spills over into many medical careers, and puts patients at direct risk of harm from doctors more interested in organising their next big night out than on handling the patient in a professional manner. Everyone, particularly hardworking medics deserves some relaxation, but society surely expects doctors and would-be-doctors to behave a little more responsibly than your average lager lout?
When doctors have the nerve to preach on the perils of alcohol and drug abuse this news is particularly galling. As for spending more money on helping them get over the problem - no way! They get paid enough already and if they can spend their money on intoxicating themselves, they can pay for their own therapy.
Georgia McDonald, Portsmouth
They drink to unwind. They are stressed out due to the extreme pressures of the job, bought on by long hours, victimisation, and bad management. My wife is an ex-nurse. Many of our friends are nurses and on some nights here in Brighton, especially at the weekend, they unwind in the night clubs and let off steam. It is the only way to remain sane. Who can blame them? The more they do the less appreciated they are, especially by middle management in the local hospitals.
Jim Evans, Brighton, UK
Alcohol and drug use among the medical profession is a symptom of a bigger problem. The profession also has the highest suicide rate of all professions. Part of the problem is the high level of occupational stress, coupled to a macho culture that doesn't acknowledge emotional distress. Part of the problem is typical of all occupations that require individuals to work and take responsibility for their actions individually. The danger is that we will see measures such as random drug testing introduced, without any serious attempts to address the underlying problems.
Tim Watkins, Cardiff, Wales
There are many professions out there where any amount of drinking is prohibited prior to going to work (e.g. airline pilots, train drivers). Isn't it about time that surgeons and doctors were asked to do the same thing.
Andy, Brighton, UK
At the end of the day these problems exist in all sections of the community and need to be tackled from grassroots level.
Rob Day, Immingham, UK
Doctors are like you and me. They all have their issues. They need to admit they have got excesses and get help. They are not super humans and they definitely don't have all the answers. I was once married to a GP and was abused by him but he also has the calm demeanour, that makes people trust him too quickly.
His patients think he is the most terrific person they have ever met, but at home he is completely different. I find it hard to trust even my own GP now as I always wonder what he is like really at home with his family. I am not writing off all doctors, but, in my view, most of them have serious problems including this topic that is being discussed.
Z, London, UK