title: Alcohol and drug testing of health professionals following preventable adverse events: a bad idea.
abstract: Various kinds of alcohol and drug testing, such as preemployment, routine, and for-cause testing, are commonly performed by employers. While healthcare organizations usually require preemployment drug testing, they vary on whether personnel will be subjected to further testing. Recently, a call has gone out for postincident testing among physicians who are involved in serious, preventable events, especially ones leading to a patient's death. This article will offer a number of counterarguments to that proposal and discuss an alternate approach: that health institutions can better improve patient safety and employees' well-being by implementing an organizational policy of "speaking up" when system operators notice work behaviors or environmental factors that threaten harm or peril. The article will conclude with a description of various strategies that facilitate speaking up, and why the practice constitutes a superior alternative to mandatory alcohol and drug testing in the wake of serious, harm-causing medical error.
authors.affiliation: a Emory University.
authors.forename: John
authors.initials: J
authors.lastname: Banja
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000534:rehabilitation; D003142:Communication; D003219:Confidentiality; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D016134:Organizational Policy; D010564:Personnel, Hospital / Q000592:standards*; D010815:Physician Impairment; D011363:Professional Impairment; D028743:Professional Misconduct; D015813:Substance Abuse Detection / Q000941:ethics* / Q000379:methods* / Q000523:psychology / Q000592:standards / Q000639:trends; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation; D013997:Time Factors; D035642:Whistleblowing / Q000523:psychology; D017132:Workplace / Q000592:standards*
keywords: confidentiality and privacy; health policy; mental illness; organizational ethics; professional ethics; regulatory issues