Physicians at Andrews Air Force Base in Maryland pulled MOD (medical officer of the day) about once a month. It was a 24-hour shift. During the day, instead of seeing his or her own scheduled patients, the MOD cared for walk-ins. Then, from 5 PM to 8 AM the next morning, the MOD saw all adult patients in the emergency room.

One morning near the end of my MOD shift, a senior non-commissioned officer presented with complaints of abdominal pain. He was the crew chief for Air Force One, the plane that carried the President of the United States. As I prepared to examine the patient, I detected alcohol on his breath. The abdominal examination showed that he had an enlarged, slightly tender liver. He also had a few spiders on his face and upper chest, red lines radiating out a few millimeters from a small red dot.

I told the patient that his abdominal pain was due to an enlarged liver. I commented about the odor of alcohol on his breath. I indicated that the two were almost certainly connected and that continued drinking would be a risk to his life. I suggested that he seek help through Alcoholics Anonymous. He immediately denied the problem and would entertain no further discussion of the issue.

The patient was not sufficiently ill to warrant removing him from flying status on medical grounds. Yet, he was in a position that called for alertness and good judgment.

I was faced with a difficult choice.

Physicians are expected to maintain the confidentiality of their patient findings; if I shared my findings with his superior, I would be breaching that confidentiality.

QUESTION:

How would you handle the situation? Would you inform the pilot's superior? Would discussing the problem with his wife be a first consideration?