Welcome to Charity Hospital in New Orleans in the late 1980s. Gunshot and stab wounds are common, and doctors face the kind of life-and-death pressures — and personal problems — depicted on TV shows like ER.On site is Martha E. Brown, MD, fresh from the Medical University of South Carolina, where she had been a medical student, intern, clinical chief resident and, finally, an addiction psychiatry fellow.
Present day, she is a new associate professor with the department of psychiatry at the UF College of Medicine, working alongside colleagues from the Addiction Medicine Group at Springhill and the Florida Recovery Center.
But in the 1980s, Brown was in new territory — a doctor charged with helping addicted doctors in the Big Easy. In the home of Cajun music, strong coffee and deceptively potent drinks called “Hurricanes,” opportunities to stray were never far. At Charity Hospital, temptation was right across the street.
“Remember that this is New Orleans in the 1980s,” said Brown, who at the time was an assistant professor at the Louisiana State University Medical School. “My surgery residents would take their breaks at bars. They would make bets. The ones who lost would have to go back to work and the winners could stay at the bar.”
Sound like good times?
“I think professionals in general have special issues that make them different. I’ve worked with everyone from airplane pilots to dentists to doctors to nurses to veterinarians to professional athletes — people at the top of their field, many of them with issues that make them prone to substance abuse, or family histories that may have preselected them at some level. And there are ego issues within all of those categories. They have so much drive and such great denial about what goes wrong.”
Martha E. Brown, M.D.
Doctors paid high personal premiums for substance abuse, yet, most of them denied that they even had a problem. And Brown, who was responsible for getting them to own up to their indiscretions, was not a smash hit.
“LSU was one of the first institutions to implement drug testing for medical students, faculty and staff,” Brown said. “It was a policy that did not make me popular. In fact, there were flaming letters to the editor condemning drug testing and the people responsible. Forget about impairment issues. New Orleans, remember? It was like being at Cook County Hospital (the real-life basis for the fictional ER TV series). At Charity, you would see some amazing things.”
Today, problems of physician impairment are no less serious, but awareness is higher and the stigma has lessened. Programs like the ones offered at the Florida Recovery Center under chief of addiction medicine and FRC medical director Scott Teitelbaum, MD, help professionals from throughout the country deal with their addictions.
“We are very excited to have Dr. Brown here,” said Mark Gold, MD ’75, chairman of the department of psychiatry. “She is a well-known mentor, a national expert who from day one adds considerable addiction psychiatry training and experience as well as the ability to develop prevention, early intervention and recovery programs.”
After their medical issues are resolved, physicians need to get their professional lives back in order. That’s where Brown comes in.
Previously the medical director of Louisiana’s Physician Health Program, Brown is now the assistant medical director of Florida’s Professional Resource Network, an organization that by statute coordinates evaluations, treatment, case management and advocacy for all licensed physicians and health care professionals except nurses who have had problems, but are now in compliance and receive treatment.
“I think professionals in general have special issues that make them different,” Brown said. “I’ve worked with everyone from airplane pilots to dentists to doctors to nurses to veterinarians to professional athletes — people at the top of their field, many of them with issues that make them prone to substance abuse, or family histories that may have preselected them at some level. And there are ego issues within all of those categories. They have so much drive and such great denial about what goes wrong.”
But not every situation is clear-cut. Take, for example, an athlete with attention deficit hyperactive disorder. The typical treatment could require stimulants that are also considered performance-enhancing substances. Brown, who also works as a clinician with programs in the National Football League and Major League Baseball, helps make those clinical decisions.
As for her methods of intervening with impaired health professionals through continuing education, Brown learned many of her techniques from Anderson Spickard Jr., MD, the past medical director of the Center for Professional Health at Vanderbilt University. Tracing the origin of those methods even further, Spickard says his medical career turned on a fateful day in the 1970s when a colleague, an alcoholic, took his own life.
Spickard was stunned. He realized he knew about the physical effects of alcoholism but much less about the associated behavior. Problems of substance abuse are often unrecognized or misunderstood by the medical profession, and denial and fear strongly influence whether physicians seek help for themselves, or intervene to help colleagues.
Spickard went to Saint Mary’s University of Minnesota to learn more. He participated in group therapy sessions and brought concepts home to Vanderbilt, where he started the Center for Professional Health. Brown, in turn, has carried some of his curriculum to Florida in the form of continuing medical education, trying to offer educational seminars before serious problems develop.
“Martha is the best in the business,” said Spickard, now a professor emeritus at Vanderbilt Medical Center. “Her teeth were cut dealing with impairment in Louisiana. She is as seasoned as a veteran that there is at teaching the behavioral principles that physicians need to abide by, but have not learned.”
Brown says professionals may come to her because they were ordered to by a medical board or hospital. Many of them have misprescribed drugs, or have acted unprofessionally, or have had substance abuse problems that they resolved at the Florida Recovery Center. Some are self-referring who recognize that they are having problems.
“Andy (Spickard) did a fabulous job of designing educational materials that allow people to learn in a nonthreatening way,” Brown said. “The majority of people walk away with knowledge that will help them.”
Within the psychiatry department, Brown will work alongside clinical faculty, including Teitelbaum, Michael Herkov, PhD, William Greene, MD, and Daniel Logan, MD.
“Our clinical programs for impaired professionals will now be able to cover the entire range of impaired professional evaluation services as well as all areas of treatment, with faculty trained experts in both addiction medicine and addiction psychiatry,” Gold said.
Brown’s research interests revolve around evidence-based treatment for impaired professionals, evaluation of national assistance programs for professionals, the impact of employee assistance programs and drug testing programs on health and wellness, and early intervention with educational courses on misprescribing and distruptive behaviors.
“With my arrival at the University of Florida, it is like I’ve come full circle,” Brown said. “I’ve always been an academic, wanting to educate young and older physicians as well as others about these problems.”