Welcome to From the Ashes Recovery
This is a tiny practice for folks with safety sensitive jobs and addiction. I’m Dr. Trish Uniac, you can call me Dr. U or Dr. Uniac. My medical office assistant is Julie Clarke (she’s essentially my boss). While it’s true that we’re all health professionals, we are not colleagues when we are in group or in session, this is a doctor patient relationship. I find it’s important to remember this to prevent messiness with roles in the future.
As someone in a safety-sensitive position, you've been asked to be followed by a physician with a speciality in addiction.
A lot of what will be covered in this introductory letter is going to feel punitive. Please understand that it is not. The rules that are laid out here are to get rid of any ambiguity and to give you guidance on how to best enter a life of recovery. Everything in these pages are meant to be supportive of you, your health, and your sobriety.
You may find that some things about this are different than you are used to with other physicians. My role in your care is to ensure that you are safe to return to work, and remain safe while there. This safety includes to yourself, your patients, your colleagues, and the profession in general. While ensuring that you have a safe, permanent, and healthy return to work, I also have an obligation to your patients and colleagues to ensure you are ready to do this.
This means that I will occasionally need to disagree with what you want to do. When I am working with patients with addiction, I remind myself that I am helping who they will be in 5 years, not the person in front of me who is still unwell from their addiction. Addiction distorts our self perception and makes it necessary to rely on those who care about us to tell us what is and is not true.
I believe that part of going back to work safely is to grow the skills you will need to stay well and sober when you return. For everyone, these will be different, though most will benefit from burnout prevention work. The way you were working before has landed you in my practice, so finding a new way can only be helpful.
I do not work directly for the Nursing Health Program, the Physician Health Program, or any college. I provide reports to these bodies as requested, and as approved by you. I require your consent to share information with them and they will have you sign an agreement to that effect. If there is anything that you want me to hold back, please let me know. For the most part, I share your roadblocks, successes, and proof of sobriety in a way to get you support and let them know what our timeline for getting you back to work is.
Occasionally, I may need to speak out without your request. This will include when you do not respond to my emails/calls etc. and I am concerned for your well being, or when I worry about the safety of the public should you be working while intoxicated. As with every other helping profession, what we talk about is confidential unless there is a minor in danger, or if you are planning to harm yourself or others physically. Practicing medicine or mental health while intoxicated fits into this exception. Not surprisingly, I hate doing this.
Please don’t put me into this position.
Being in recovery is a complicated mix of therapy, self care, and reading. Everyone’s program will be different. I strongly recommend yours contain the following aspects: Mutual support groups including a sponsor (12 steps for example), a rehab program (in patient residential or out patient depending on your circumstances), weekly Caduceus meetings, 1:1 meetings with Dr. U (monthly to start), random urine drug screening, recovery reading, journaling, a meditation or mindfulness practice. I’ll go over these in more detail below.
Take a breath. This can feel overwhelming.
You’ve got it though.
Best way to contact me is through my medical office assistant (MOA) Julie Clarke through email@example.com. She is not in the office every day and will not always be able to respond immediately. You can also send me secure messages through the OWL portal that we book our appointments through if there is something that I need brought to my attention. If this is an “FYI” sort of thing, if it does not require a response from me I will put the info into your chart and discuss it with you at our next appointment rather than responding.
Please recognize that from time to time I will need to take time away from work so planning ahead will keep you out of a desperate situation.
In case of absolute emergency, it is ok to call my office in Clinton 519-482-3000. Please ask for Julie first, but if she is not available, it’s ok to speak to any of the staff that answers the phone. They are all amazing. Please identify yourself as a patient of mine. It is never acceptable to identify yourself in your professional capacity as this will trigger the staff to interrupt me with another patient.
Forms and Official Letters:
Forms require 3 weeks turnaround. I am usually able to do them more quickly, but please understand that sometimes they take much longer depending on what else is happening. Emailing a scanned format to Julie works well, or have them faxed to 519-482-7648. Same for required letters. Please provide the most amount of information that you can to prevent delays while I ask for more data. Include who the form/letter needs to be sent back to. I will keep a copy on your chart in my office in case we need to access it in the future.
Like every other MD in Ontario, I do not get paid by OHIP for this paperwork so I have a list of billing for forms that is attached. If you are not working, I do not expect you to pay for paperwork. I understand how stressful it is to cover expenses already without having to pay to be able to go back to work too. If your insurance will cover them, please let me know. Otherwise, if you are paying out of pocket, I’ll expect you to pay for your forms etc. when you’ve been back to work for 6 months. E-transfers to firstname.lastname@example.org works, or send a cheque to 105 Shipley St. Clinton ON N0M1L0 (my family practice office).
If you require refills on medications, please ask your pharmacy to send me a fax requesting it. I request a week’s notice for filling these. Again, I can usually do them much faster but appreciate the heads up.
How to Address Me:
The temptation when we are both a patient and a health care provider (HCP) is to identify as the HCP. In the relationship we are embarking on, you are a patient, and remembering this will allow you to embrace all that you need to do and allow you to grow in recovery. This stance comes from my and my colleagues’ decades of experience. In the same vein, please refer to me as Dr. Uniac or Dr. U. Using my first name is not appropriate. While group and our sessions get fairly fun and informal, this is an important distinction, and I promise it is in your best interest.
Vacations and time away:
Vacations are defined in our relationship as any overnight excursion away from your own home that is not something you do more than 4 times a year. E.g. going to your mom’s for the weekend like you do every month or so is not a vacation, but going to the cottage twice a year is. You need to inform me of these and discuss your plans with the Caduceus group to get feedback on staying well while away. The more you do this, the more you see others doing it, the more you will understand why.
Caduceus is a group of health professionals that meet regularly to hold themselves accountable. Health professionals have a different set of issues than folks that you will meet in 12 steps and other mutual support groups.
Sometimes folks decide to go to Caduceus groups that are not run by me. That’s just fine, but please know that your leader of Caduceus and I will need to be in contact.
If you are unable to make a meeting, please reach out by email ahead of time or send a message along with a group member. It is important to make as many of these as possible to keep in the flow of the group and also to stay accountable. Acceptable reasons for missing at the last minute are what you would likely expect (illness, work, family emergencies). If you know ahead of time that you will be away, family is coming from out of town, etc, please check it out ahead of time.
Random Urine Drug Screening:
1:1s with Dr. U:
for the first year, these will be monthly
Depending on your needs, she may also be your "mental health" physician
Contact with Your Case Manager:
Dr. U needs to know who your case manager is. You'll be in touch with them at least monthly. They're the liason between you and the NHP program.
Contact with Your Family Doctor:
Your physical health is a big part of your recovery. Expect to be seeing your family doctor every 3 months. Even though Dr. U is also a family doctor, she is not YOUR family doctor.
Return to work:
All of what we are doing together is preparing you to safely return to work. This return will often take a year (not always). Now is a good time to wrap your head around that.
I can help with the insurance forms etc. that are needed to sustain you financially.
It is sometimes reasonable to temporarily take a non-health care position, either for pay or volunteering. This is considered work hardening and will help us to see the parts of your program that need more work.
We will talk a lot about safety planning while in Caduceus.
The temptation may be to able to jump all over a new training program. Don’t. You need to take it slow. Just because you feel better doesn’t mean that you should break yourself.