Physician, heal thyself?
When your friend comes to you complaining of unshakeable depression, your first instinct is probably to direct him to a friendly, caring doctor who will help him get started on his journey towards healing. That’s a great instinct! But what if your friend is a physician himself?
Depression among physicians and physicians-in-training (interns, residents, and the like) is disproportionately high, with male physicians being more likely to commit suicide than their non-M.D. professional counterparts. It’s also interesting to note that while in the general population, the suicide rate is about 4 times higher in men than in women, women who are also physicians have a suicide rate equal to that of men. This article from Hospital Physician goes into more detail.
Sounds sad, right? But you may be wondering why, unless you have personal friends who happen to be physicians, you need to be concerned. Well, recent research has revealed that depressed doctors, specifically depressed doctors-in-training, are over six times more likely to make medication errors than their non-depressed counterparts. In the U.S., about 98,000 patients die each year due to medication errors.
When I read this statistic, my first thought was: of course they’re making errors, those poor overworked burned-out residents… But that doesn’t seem to be the case. The study found that while there was a high rate of burnout among participants (74%!), burnout was not actually linked to a higher rate of medication errors.
So why aren’t all these depressed physicians seeking help? Evidence suggests that the biggest barriers depressed physicians face are: concerns about professional discrimination, loss of hospital privileges, and even potential loss of medical licensing. Physicians-in-training cited still another barrier to seeking help: lack of time to do so.
It may seem extreme, but the worry about loss of medical licensing is a legitimate one. Although most (but not all) states have shifted medical board licensing questions about diagnosis or treatment (of a mental disorder) to be more centered on impairment, there often isn’t a timeframe specified. (So, instead of being worded “Have you been impaired in the past 2 years…”, the question is often worded “Have you ever been impaired…”.) The Americans with Disabilities Act has successfully been used to challenge some discriminatory policies, but again, not all the time or in all states.
What’s being done to change things? Well, in order to help empower depressed physicians to seek help, the American Foundation for Suicide Prevention (AFSP) has been reaching out to the medical community, and organizing both workshops and working groups with the American Medical Association. AFSP has even teamed up with Wyeth and the American College of Psychiatrists to produce a documentary film, Struggling in Silence, set to air on PBS this May.
As the word gets out, the barriers to seeking help will likely start to lessen, and hopefully those medication error numbers will go down. In the meantime, if you’re not a medical professional you can help by refraining from judging a professional who has had to seek help him or herself. If you are a medical professional, you can help by knowing the profile of a physician at a higher risk for suicide (thanks to AFSP for the information):
Sex: Male or Female
Age: Women – 45 or over Men – 50 or over
Race: White
Marital Status: Divorced, separated, or currently having marital disruption
Risk Factors: Depression, alcohol or drug abuse, gambling, workaholic, excessive risk-taking behavior
Medical Symptoms: Psychiatric symptoms or history (especially depression or anxiety), physical symptoms (especially chronic pain or debilitating illness)
Professional: Recent changes in status, high work demands
Access: Access to legal medications, access to firearms
Physicians and other medical professionals, have you had a friend or colleague struggle with depression? Was it difficult for him or her to seek help?
Depression among physicians and physicians-in-training (interns, residents, and the like) is disproportionately high, with male physicians being more likely to commit suicide than their non-M.D. professional counterparts. It’s also interesting to note that while in the general population, the suicide rate is about 4 times higher in men than in women, women who are also physicians have a suicide rate equal to that of men. This article from Hospital Physician goes into more detail.
Sounds sad, right? But you may be wondering why, unless you have personal friends who happen to be physicians, you need to be concerned. Well, recent research has revealed that depressed doctors, specifically depressed doctors-in-training, are over six times more likely to make medication errors than their non-depressed counterparts. In the U.S., about 98,000 patients die each year due to medication errors.
When I read this statistic, my first thought was: of course they’re making errors, those poor overworked burned-out residents… But that doesn’t seem to be the case. The study found that while there was a high rate of burnout among participants (74%!), burnout was not actually linked to a higher rate of medication errors.
So why aren’t all these depressed physicians seeking help? Evidence suggests that the biggest barriers depressed physicians face are: concerns about professional discrimination, loss of hospital privileges, and even potential loss of medical licensing. Physicians-in-training cited still another barrier to seeking help: lack of time to do so.
It may seem extreme, but the worry about loss of medical licensing is a legitimate one. Although most (but not all) states have shifted medical board licensing questions about diagnosis or treatment (of a mental disorder) to be more centered on impairment, there often isn’t a timeframe specified. (So, instead of being worded “Have you been impaired in the past 2 years…”, the question is often worded “Have you ever been impaired…”.) The Americans with Disabilities Act has successfully been used to challenge some discriminatory policies, but again, not all the time or in all states.
What’s being done to change things? Well, in order to help empower depressed physicians to seek help, the American Foundation for Suicide Prevention (AFSP) has been reaching out to the medical community, and organizing both workshops and working groups with the American Medical Association. AFSP has even teamed up with Wyeth and the American College of Psychiatrists to produce a documentary film, Struggling in Silence, set to air on PBS this May.
As the word gets out, the barriers to seeking help will likely start to lessen, and hopefully those medication error numbers will go down. In the meantime, if you’re not a medical professional you can help by refraining from judging a professional who has had to seek help him or herself. If you are a medical professional, you can help by knowing the profile of a physician at a higher risk for suicide (thanks to AFSP for the information):
Sex: Male or Female
Age: Women – 45 or over Men – 50 or over
Race: White
Marital Status: Divorced, separated, or currently having marital disruption
Risk Factors: Depression, alcohol or drug abuse, gambling, workaholic, excessive risk-taking behavior
Medical Symptoms: Psychiatric symptoms or history (especially depression or anxiety), physical symptoms (especially chronic pain or debilitating illness)
Professional: Recent changes in status, high work demands
Access: Access to legal medications, access to firearms
Physicians and other medical professionals, have you had a friend or colleague struggle with depression? Was it difficult for him or her to seek help?
3 Comments
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Comment by Vincent J. Tamuzza, MD on April 14, 2008 at 1:11pm - Amanda, this is a great topic. The message we got in medical school was often contradictory, "Definitely get help if you need it, but beware that mental illness (and medication) is asked about in residency and licensing applications." Unfortunately, physicians hold themselves to a higher standard than they do their patients. Somehow healthcare professionals are supposed to be immune to mental illness, and even mild episodic emotional issues are viewed as a liability. I'm sure that most medical students and residents experience periods of anxiety/depression similar to dysthymia or adjustment disorder, but they never seek help in fear that it will hurt their career. It's impossible not to get depressed when it feels like every exam can make or break you, or when you're working 80-120 hours a week. These "feelings" should be categorized differently than debilitating mental illnesses like major depression, substance abuse, and schizophrenia. Doing so might eliminate the stigma attached specifically to mental illness in healthcare professionals, thereby encouraging phyiscians and physicians-in-training to get the help they often give others.
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Comment by Jolyn on April 14, 2008 at 1:55pm -
Amanda, I certainly agree that stigma concerning mental health issues among those in the medical field is partly responsible for doctors not seeking help as often as needed. I also agree with the statement; "Doctors are notoriously difficult patients, prone to avoiding the patient role by denial and self-neglect, or by self-diagnosis and treatment (McKevitt et al, 1996; Forsythe et al, 1999)," cited in Advances in Psychiatric Treatment. This source article points out that people in the helping professions often have some complex psychological reasons for entering their professions in the first place.
In other words, some have deep-seated motivations based on unresolved personal issues -- something I've long observed in the mental health field itself. One of my favorite books for explaining some of this to students is "Power in the Helping Professions," by Adolf Guggenbuhl-Craig. Misuses of power and control are often defenses against feeling vulnerable and dealing with our own issues.
The helping professions are becoming more aware of depression and other mental health issues among themselves. Many of their professional associations and medical centers now offer easy access to confidential treatment and therapy. I believe that the issue of stigma among the helping professions isn't so much one of lack of education about depression and other mental health disorders, but is still a realistic one of fear of discrimination -- and very importantly and commonly -- of admitting to being human like everyone else.
I think these professions need to become even more proactive in rooting out discrimination within their ranks, whether towards patients, clients and mental health consumer-survivors or among themselves. The battle against stigma concerning depression and other mental health disorders needs to be both broader and deeper. I also strongly believe that professional training programs for the helping fields must be much more proactive in helping their undergraduates, graduates and doctoral students understand and deal with their own motivations for wanting to enter practice.
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Comment by Amanda on April 14, 2008 at 2:32pm -
Thanks for your thoughts, Vinnie and Jolyn! I was hoping I'd hear from you.
Vinnie--I completely agree with the stress-related side of depression in physicians. With such a rigorous schedule, and such an intense level of expertise being constantly called for, it's amazing that we don't see even higher numbers of depressed/suicidal residents! It seems like in recent years there has been more of a drive to limit the number of hours interns and residents are required to work, do you think this would help?
Jolyn--I was very interested in the nature vs. nurture (for lack of an easier oversimplification) aspect of this issue as well. It was noted that people with a certain amount of professional drive and aspiration tend to be harder on themselves, something that is perhaps a precursor to depression. Who is more ambitious than a medical student? I think you're right in that some required soul-searching could head off depression.
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