Ionce knew a doctor who was always a bit over-cheery, a little red-faced, sometimes just a touch off the subject.

I brought the matter up with a second doctor, who said: "Don't you know he's always in the bag a little?"

Could your doctor be an alcoholic? How can you tell? If you think so, what should you do?

Estimates, mainly unreliable, of physicians abusing either alcohol or drugs vary from less than one in 100 to one in 10. In Georgia, where the state medical society has been especially zealous in seeking out such physicians, 3.7 percent of the state's doctors entered the society's impaired physician program in a five-year period.

Health professionals, especially physicians and nurses, are under special stresses. Many have easy access to drugs.

Their decisions, or failure to make the right decisions, can imperil us. Addicted health professionals, says one authority, "are dangerous both to themselves and their patients."

Dr. Gordon Hyde of the University of Kentucky told a medical conference there last year of a surgeon who chewed out the people in his hospital "because someone {had} performed a tracheotomy on his patient" -- opened the patient's throat -- "when in fact he himself had done the tracheotomy perfectly, but could not remember it."

Dr. David Clark of the same university told of a physician who "would first drink a half pint or more of vodka with breakfast, then go to the office where he maintained an active practice" despite being thrown off a hospital staff. His wife and nurses help him keep up his practice by handling most of his phone calls and office routine.

But what if you're his patient? ::

Before abandoning a good doctor:

Ask, if you can find the courage, "Is there something wrong, doctor? You don't seem to be yourself." Strong, self-protective denial is one of the alcoholic's most common traits.

Doctors are as dependent on patients as patients are dependent on doctors, and a patient's saying "Is there something wrong?" may be the jolt that leads to some self-realization.

Coming from another doctor, such a question may be even more persuasive. Medical societies are now urging anyone who thinks a practicing doctor is impaired and unable to exercise sound judgment -- whether impaired by alcohol, drugs, illness or some other cause -- to phone the local or state medical society. It will then have some knowledgeable doctors investigate. The "anyone" may be a family member, friend, colleague -- or patient.

Many patients remain convinced that medical societies ignore such complaints. "Not true!" exclaims Dr. Sylvester Booker, vice chairman of the D.C. Medical Society's impaired physicians committee. "We look into every complaint."

Medical societies have aggressively tried to help doctors who have drinking or other problems. In 1972 the American Medical Association's House of Delegates said: "When exhortation by family and friends is ineffective and when the physician is unable to make a rational assessment of his ability to function professionally, it becomes essentially the responsibility of his colleagues to make that assessment for him, and to advise him whether he should obtain treatment and curtail or suspend his practice."

If there is real reason to believe that is the case -- and good evidence is not always easy to come by -- two fellow doctors, one a recovered or recovering alcoholic if alcoholism is the problem, will often call on the physician for a frank talk. Many impaired doctors agree to enter treatment programs. In one study, 76 percent of alcoholic doctors were abstinent for at least a year "with great improvement" in health, self-image, adjustment and medical performance.

"Most of these people are excellent physicians," Booker says. "It's a shame to lose their talent because of a disease that needs to be taken care of like any other disease . . . Sometimes there are relapses. But I've been pleasantly surprised with our results."

Treatment is difficult, says Dr. John Dawson of Seattle, an AMA trustee. But there are more successes than failures, in part, perhaps, because there is an implied threat. If the doctor remains impaired and patients are endangered, the medical society can refer the case to the state licensing board. In every state, some licenses are regularly suspended pending treatment. If treatment fails or a doctor refuses help, his or her license to practice medicine can be permanently revoked.

In physicians, as in others, says Dr. Martin Valaske, a former chairman of the District society's impaired physicians panel, alcoholism often becomes fatal alcohol syndrome. "Professional knowledge," he has written, "does not seem to protect against either succumbing to or dying of alcoholism."

In one study of alcoholic physicians, fatal outcomes over a recent 10-year period ranged from 8 to 20 percent. And in 1971, Valaske wrote, one authority described "treatment outcomes of 11 physician addicts personally known to him during the 1960s; all but one were dead. Treatment has improved; treatment outcomes have improved, especially for physicians. But chemical dependency remains a fatal disease. These are not good odds. The chemically dependent physician in denial needs your help." ::

Nurses, like doctors, are under the stress of caring for us. Many nurses spend more time with the sick than many doctors do.

Stress is not the simple "cause" of addiction, maintains Madeline Naegle, associate professor of nursing at New York University and chairman of the American Nurses' Association's task force on impaired nursing practice. But the person who is "predisposed to addiction," she adds -- whether because of genetics, family history or psychological conflicts -- "may abuse more when placed in highly stressful situations."

The nurse in an intensive care unit, the nurse treating threatened newborns, the nurse attending the dying -- these are among the frequent victims of stress and sometimes alcohol or drug use.

Yet nurses, like doctors, are "beginning to get a handle on the problem with a number of peer assistance programs," Naegle says. "We are beginning to realize that people . . . can be treated and can recover." ::

For doctors and nurses, hospitals are becoming more stressful. Fewer of the moderately sick are being hospitalized, so hospital patients are increasingly older and sicker, and, says Judith Ryan, executive director of the nurses' association, "we know that the stresses -- high-stress assignments, providing high-tech care, double or rotating shifts -- are increasing.

"It seems to me that the real heroes are those working under these increasingly stressful conditions and not relying on alcohol or drugs but hanging in there."

An experienced nurse herself, she also -- and understandingly -- refers to the recent words of a New York City nurse in the American Journal of Nursing: "I wouldn't hesitate to be a patient in {my hospital}. But this good patient care comes at the expense of ourselves. You work only so much overtime before you get sick yourself."