Wednesday, July 9, 2014
Inquirer Daily News

Doctors are human, too

Your psychiatrist must be intelligent and motivated to have made it through four years of undergrad, four years of medical school, and four years of residency. However, she has a secret that she hasn't told anyone.

Doctors are human, too

(AP Photo/Ric Feld)
(AP Photo/Ric Feld)

by Erica Cohen

Your psychiatrist must be intelligent and motivated to have made it through four years of undergrad, four years of medical school, and four years of residency. However, she has a secret that she hasn’t told anyone. She has severe depression, just like you. But unlike you, she hasn’t sought treatment, and it haunts her every day.

Medical students and residents suffer from mental illness, particularly depression and burnout, at a higher rate than the general population. One potential explanation for this disparity is that medical training is rigorous; medical students and physicians often do not have the time to get the help and treatment they need, so their mental health deteriorates.

Additionally, physicians are significantly more likely to commit suicide than their counterparts in the general population; male physicians have a 70 percent higher suicide rate, and female physicians have as much as a 400 percent higher suicide rate.

According to a 2003 study, only 22 percent of medical students who screened positive for depression and only 42 percent of those with suicidal ideation sought treatment. Study participants cited lack of time (48 percent), lack of confidentiality (37 percent), stigma associated with using mental health services (30 percent), cost (28 percent), fear of documentation on their academic record (24 percent), and fear of an unwanted intervention (26 percent) as reasons for not seeking treatment.

Physicians are cultured to show no weakness, that vulnerability is a sign of medical incompetence. Although medical professionals encourage patients to seek help for their problems, admitting that the professionals themselves suffer from emotional or mental issues is often seen as a character flaw.

The culture among physicians is to place little emphasis on their own health. Many medical residency programs do not offer sick or personal days, and residents therefore come to work so sick they run to the restroom to vomit in between seeing patients. This cannot be healthy for the physicians or their patients. They work excruciatingly long hours with little sleep, which often results in burnout and depression.

A 2009 study found that physicians who sought help for mental illness “reported being ostracized by their colleagues, being seen as weak, incapable or lazy or no longer being seen as a ‘proper doctor.’” Only 40 percent reported receiving sympathy from colleagues, and only 11 percent reported that their colleagues had offered to help.

Traditionally, concerns about physician mental health issues have focused on risks to patient safety and resulted in punishment and stigmatization rather than compassion. Although patient safety is of paramount concern, not all physicians who are ill are impaired and a risk to patient safety.

In a 2007 survey of U.S. State Medical Board executive directors, 37 percent indicated that mental illness diagnosis alone, without any evidence of impairment, was sufficient for sanctioning a physician. Additionally, career obstacles are prevalent; studies show that “medical students who received psychological counseling were less likely to secure residency positions.” And "[p]racticing physicians with psychiatric disorders often encounter overt or covert discrimination in medical licensing, hospital privileges, health insurance, and/or malpractice insurance.”

How can we encourage a physician to get treatment if mere diagnosis could be professional suicide?

Medical schools and health care employers must be on high alert for issues related to medical professional mental health issues. They must work to provide the maximum possible resources to health care providers in need of mental health assistance. And it is essential to educate future doctors from the first day of medical school about the necessity of self-care and seeking help. We cannot expect our physicians to adequately care for us if they cannot take care of themselves.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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