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whether or not the participant is able to safely practice medicine. Documentation can be in the form of reports from worksite or behavioral monitoring reports assessing stability and reliability from worksite monitors, treatment providers, PHP consultants and appropriate others. 12. Forensic Monitoring – Random, routine utilization of appropriate frequency chain of custody forensic testing is critical. Witnessed collections are preferred. In other instances a ―dry room‖ collection procedure may be utilized. Selection of drugs/substances to be included in the screening panels should be carefully considered and varied as needed to include not only the drug of choice but also other drugs of abuse including alcohol. Case specific testing of appropriate biological specimens may include, but may not be limited to, urine, blood, saliva, hair, nails, etc., as deemed appropriate by the PHP medical director. Certified laboratory testing facilities should be utilized to perform and confirm specimen results. Certified Medical Review Officers (MRO) should be utilized when necessary. Costs for forensic testing are typically the responsibility of the program participant. 13. Advocacy – With appropriate documentation of objective recovery / illness stability and associated physician health status, PHPs should advocate for the participant. The PHP can play an important role in assisting the participant in maintaining or returning to professional practice, avoiding discrimination, and also assisting with the administrative process of the board. Appearances before the board, hospital committees, malpractice carriers, and other bodies are an important role of the PHP as part of advocacy for the licensee. 14. Education – PHPs should promote physician wellness and support the treatment and continuing care of physicians who have illnesses such as addictive, psychiatric, cognitive and physical illness. This can be accomplished by PHPs making presentations to students, professional associations, medical groups, hospitals, licensing authorities, treatment providers, family members, consumer groups, and the general public.Case Scenario Am Fam Physician. 2009 Nov 1;80(9):1007-1008 I recently joined a busy practice that includes a physician who is well-respected and almost revered by his patients. Over the past couple of months, the staff and I have noticed changes in his behavior. He has been more withdrawn, disengaged, and short-tempered. Also, he has been late for his office hours on many occasions, and has made untypical charting and prescribing errors. We are concerned that he may have a substance abuse problem, but want to protect him and his patients. How can I further identify if this is the cause and what can I do to help this situation? Commentary In 1973, the American Medical Association defined the impaired physician as one who is unable to fulfill professional and personal responsibilities because of a psychiatric illness, alcoholism, or drug dependency.1 Physicians face the challenge of being able to identify impairment in their colleagues and, most importantly, in themselves. In many cases, substance abuse problems can remain undetected for several years before being brought to attention and treatment undertaken. Impaired physicians can usually function at an adequate level until their problem becomes more advanced and their ability to care for their patients deteriorates. The prevalence of substance abuse and chemical dependence among physicians is difficult to ascertain. Conservative estimates are that 8 to 12 percent of physicians will develop a substance abuse problem at some point in their careers.2 Within the medical specialties, persons in anesthesiology and emergency medicine appear to be at the highest risk.3 It is unclear whether it is the particular specialty that increases the risk of abuse, or that the already at-risk physician is more likely to choose that specialty. Alcohol is the most commonly abused substance among physicians. Compared with the general population, physicians have higher rates of prescription drug abuse, particularly benzodiazepines and opioids.4 This is because of the common practice of self-treatment and the ease of access to many drugs. Most risk factors for abuse