Doctors are human, too

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.