Do you know which professional group in the United States experiences the highest rate of suicide? According to the most recent edition of Newsweek magazine, the highest rate of suicide in our country, higher than among any other professional group, occurs among doctors.
This startling assertion is the theme of an upcoming public television documentary entitled, “Struggling in Silence.” According to the producers 300 to 400 doctors in America commit suicide every year. That’s one every day.
Dr. Charles Reynolds, professor of psychiatry at the University of Pittsburgh School of Medicine, has done extensive research into physician suicide. Interviewed for the documentary, Reynolds offers a stark assessment of the problem. “Undiagnosed and untreated depression is the culprit here.”
But why? Why would doctors suffering from depression not seek treatment for it? Who else would be in a better position to understand the physiology of the disease and the consequences for not dealing with it?
The problem, according to one doctor who actually suffers with depression, is the stigma associated with mental illness.
It is not just the matter of “stigma”. If you are a physician, and were to go to a shrink or an ER and say that you are seriously considering suicide, this has serious professional risk. If the psychiatrist/psychologist wishes to be an a-hole, (or simply wishes to engage in a little professional derriere covering, so that he would be “protected” if the doc were to actually commit suicide, the shrink will admit the doc overnight for “observation”. This is done for most depressed folks who seriously contemplate suicide, and most of them benefit from having 24 hours of “space”.
If you are a physician, however, such an admission automatically generates a note to the friendly local medical board as an “impaired physician” and you will automatically lose your license for the next 6 months and be on the “LIST” with the sex offenders, drug abusers and the others. This in turn automatically generates your being thrown off all insurance panels (as you have now “lost your license for cause”), and automatically results in the revocation of your hospital priviledges. These in turn will automaticaly generate a note to the physicians’ national database, where any Tom Dick or Harry trolling the internet can learn that you had lost your license and was an IMPAIRED PHYSICIAN.
If you lose your ability to practice for six months you may well lose all your assets and your home.
The above scenario happened to a young physician whom I know well. She was out of medicine for six months, and worked as a phlebotomist while living with family for the next couple of years. She made the mistake of telling the head of her residency program (after not having had any sleep for almost 3 days) “I think I’m going crazy, I just feel it would be better to die than to go on like this”.
For a doctor, going to a shrink and saying “I need help” means that you plan to leave medicine. Because there is an enormous chance that you will be drummed out of medicine if you do so.
Physicians know the consequences of admitting to mental illness a good deal better than lay folk. Given a choice between suicide and living with IMPAIRED PHYSICIAN on their records for the rest of their lives most physicians prefer to simply commit suicide. And since they have both means, knowledge and access, they can do so efficiently with near 100% success rates.
This is very sad, and Clueless’ comment makes it all the more poignant.
What would be the prospects for changing professional culture enough so that physicians would seek help before becoming desperate?
I am a physician and have served on a state medical board. The statistic is absolutely true. While I agree with some of Clueless’ comments, I don’t agree entirely. Every state medical board (which gives – and occasionally revokes – physician licenses) has a program for physicians with various illnesses – and depression is amongst them. The programs are designed to take these highly-trained and dedicated individuals and preserve their usefulness to, as well as assure the safety of, their patients and communities. We (physicians) are a headstrong lot – we are selected for medical school because and receive LOTS of reinforcement in medical school and residency training/abuse that we are of value because we take responsibility, because we are ‘do-it-yourself, pull-yourself-up-by-the-bootstraps’ people. Sadly, this doesn’t translate well to reaching out and asking for mental health help. Additionally, while physicians were once well-paid and given high regard, we now hear daily of the failings of the profession, face marked declines in income and receive little respect from a substantial number of patients who view us more from the perspective of consumers than of patients.
The problem is not physicians “culture”. The problem is the law.
1. If a patient is suicidal and informs a practitioner of this, and the practitioner fails to ensure the patient’s safety, that practitioner is liable for malpractice, and will certainly be sued. Thus, the need to commit folks who are suicidal in order to protect not only them, but the committing psychiatrist. If the physician were to die, or if the physician were to make an error, the psychiatrist would be held liable.
2. This reality collides with the law regarding physician “impairment”. Any impairment must be reported. It is a state and federal requirement, and failure to do so will subject the hospital/admitting psychiatrist to heavy fines.
3. Then there is the medical board. The medical board’s first duty is to protect the public, and federal and state law has decreed that all its doings be published. Thus the automatic loss of license and the publishing of the same in web and paper journals.
4. Then there is the Physician’s National Database. Every event must be tracked, failure to do so is considered “fraud”. Thus the immediate exposure which lasts for ever. (The physician is permitted to post an “explanation” next to this note (I believe).
I don’t know any physician more than 5 years out of residency training who is stupid enough to see a shrink without already having been exposed.
The best thing that a physician can do is to have a close knit family in whom to confide, and a confessional church with a good pastor who reinforces the Church’s prohibition against despair as mortal sin.
Doesn’t Montana report “impaired physicians” with depression to the National Database? I believe it is required to do so. (I may be wrong).
How can we change the culture such that physicians seek help before they get to the “impaired” stage? During CPE, I always made it a point to chat with the doctors and nurses and let them know I was there for them as well. A few nurses did talk with me, but no doctors that I remember.
YBIC,
Phil Snyder
#6 Define “impaired”.
Unfortunately, like most things in psychiatry the definition is fuzzy. A depressed physician might see himself “blowing off steam” in private to a shrink or CPE. A shrink might see an opportunity to make a well insured admission, and the CPE may see the opportunity to indulge his/her rescuer fantasies.
The only safe confessions are made in the confessional to a priest who takes confessions seriously.
The “I’m here for you” bit works only when it is a teenager sobbing about her boyfriend.
In addition to the stigma surrounding the disease of depression
(especially in the medical community), I think that it’s important to recognize that the very symptoms of depression can make it difficult for an individual to ask for help…feelings of hopelessness and
worthlessness…less of a desire to interact with others…These make it so hard to reach out, even without the stigma.
Also, we may assume that members of the medical community would understand mental illness and, therefore, seek appropriate treatment but I don’t believe that this is often the case. In med school curriculums, psychiatry and addiction are often issues that are just glossed over. Med students and doctors can have just as little understanding of the complexity of this illness as the community at large. I think that’s also something that needs to change if folks are going to get the help that they need.
#’s 5 & 7 (Clueless):
Suicidal depression would require intervention by a state medical board (being listed as “impaired”); depression [i]per se[/i] would not. Being “impaired” or simply requesting the help of the Board would make someone eligible for a Physicians’ Assistance Program (which all states have, though maybe with different names) – this would not go to the Board unless the physician did not comply with treatment and monitoring or became dangerous to patients. These programs all assure confidentiality. States do require the actions of their medical boards to be public record – except that which is done in executive session, which can be done if the exposure of someone’s name would result in harm to an individual and the process of listing it would not serve to protect the public. Therefore, the PAP’s in each state are conducted in executive sessions. Revocation or limitation of a license is reportable to the National Practitioner Data Bank; being in a PAP is not.
#8 (writingmom):
Depression is seen in the office all the time. Even specialists see it, though they may not recognize it very often. Education on depression has come a very long way – even when I was in med school (in the 80’s), we received a reasonable didactic on it. I cannot imagine someone coming out of school or residency not having some degree of increased knowledge about depression as opposed to the general public (though not some members of the public, to be sure).