Getting Started

My biggest fear when applying for work, and this seems to be the case for just about everyone in recovery, was how my potential employer would react when he found out that I am an addict. I imagined a disappointed, pained expression followed by a stuttering attempt elicit details about my use, and finally an awkward silence. Then the door. So I did what a lot of addicts do: I kept my past secret until I was asked a direct question. In my case, this question came in the form of an item on a malpractice insurance questionnaire. "Have you ever had a problem with alcohol or drug addiction or been enrolled in a formal program of treatment or addiction?" or something like that. So I let my written response do the heavy lifting of disclosure. I wrote that I had attended a formal treatment program, was now in aftercare, was being randomly drug tested by a professional monitoring organization, etc, etc. A few days later, the office manager and I sat down together. He had my answers in front of him, so I made some breezy statement, something like: "So, you read that I am in recovery?" And he said something like: "Oh...yeah, yeah. I saw that. That's okay." And that was it! All that anxiety and my addiction barely seemed to register as a blip on his radar. I would soon discover why.

Before I get into that, a little bit about what I do. I was trained as a general internist, which means a primary care doctor for adults. The practice where I now work, which for the sake of anonymity I will call The Company, employs physicians to visit patients in their homes. Most of our patients are elderly and all are covered by Medicare. The Company supplies the car, the patients, assembles and stores the charts, and does the billing. Each morning the physicians arrive, review the schedule and the route, prime the charts, and head out. We each even have a medical assistant to drive us around, take vitals, prick fingers, and draw blood when necessary. In a way, the set-up is pretty cush. On the other hand, it can feel like we are just playing a prescribed roll, and in a way we are. It can be pretty monotonous. And having supplied none of the capital, we have no say in how the place is run.

As I mentioned in the previous post, The Company is growing and growing fast. Chicago is the largest though only one of four branches. There are plans for at least six more. Our branch employs 10 doctors, some full time and some part time. Because the pay is so low, it can be hard to recruit. When I took the job, I assumed that I was the only one with a checkered past working there. I thought that I was lucky to have been hired. As it turns out, virtually every doctor at The Company has something of a past. Of the ten now working, there are three (including me) with a history of addiction, one surgeon who lost a big law suit, another who is in the process of being sued and is actively avoiding a summons (more on that later), one who had a sexual relationship with one of his patients, and another surgeon who has advancing Parkinson's and can no longer operate. Another physician recently left who was suspended for fondling one of his patients. It's an interesting crew.

Now I am all for second chances; for selfish reasons, but also because I think that forgiveness makes the world a much more tolerable place to live. However, I think that if you make it a policy to employ people in positions of high responsibility who have made mistakes in the past, you should put in place some system of oversight, or at the very least take advantage of oversight that already exists. When there was a question as to whether one of the formerly addicted physicians was using again, I sat down to speak with the office manager about what should be done. This man certainly did not seek out my advice. Apparently, the doc in question was nodding off during patient interviews and otherwise acting strangely and the whole office was talking about it. The issue seemed pretty straight-forward to me: confront him about your concerns; demand a urine tox immediately, then contact the professional monitoring organization and see how he has been doing. As it turned out, neither the office manager nor the owner of The Company had any idea that such an organization existed. And rather than getting a urine drop and a written consent for release of information from the monitors, they pulled my medical assistant, a rather burly and assertive sort, to "keep an eye" on the doc in question. What it must have come down do is that The Company did not want to risk any sort of legal culpability that knowledge of his addiction might bring and they also did not want to contend with the lost income that firing him would entail.

So, I can tell that I am coming off as bitter. Really, I shouldn't be bitter or harbor resentments. Nothing is more toxic to recovery. Plus I have a job. It may not be perfect, but it keeps me busy and out of trouble for the most part. And as long as I endeavor to take care of my patients as best as I can, I am holding up my end of things, which is all that any of us can do. And not all of the stories that come out of The Company are anger-provoking. A lot of them are very funny. And not funny in a "boy, that's really terrible, how come I can't help but laugh" sort of funny. But genuinely silly and enjoyable to reflect on. I will try to get to some of those soon.