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Physicians often fail to recognize symptoms of depression, delay seeking treatment
Professional attitudes and institutional policies must change to encourage physicians to get help.
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Physicians overwhelmed with stress, depression and anxiety are seeking help, and they are doing it at an earlier point in their illnesses. But too many struggle alone, not getting help until they are very ill.
“I feel like we’re getting the message out there that doctors are human, too, and if you’re not feeling well to get help. We’re teaching this stuff at medical school and every state has a physician health program,” Michael F. Myers, MD, a psychiatrist of the University of British Columbia Faculty of Medicine, Vancouver, told Orthopedics Today.
“The bad news is that physicians are still falling through the cracks. Despite all of this progress, I continue to see doctors who are very ill by the time they come for help or are brought into the hospital because they’ve already tried to commit suicide. They were ailing for a long time and did not avail themselves of help.”
Studies have found a higher suicide rate among physicians than the general population and have identified depression as a risk factor. While depression may be genetically or biologically driven, the stress physicians face — coupled with isolation — can leave them especially vulnerable.
Life-threatening illnesses
Myers compares his work as a psychiatrist to that of an oncologist. “Psychiatric disorders are serious, painful, ugly, life-threatening illnesses,” he said. “Just as some patients will die from cancer, a certain percentage of depressed and suicidal patients are going to kill themselves, including physicians.”
While he understands that some of his patients will commit suicide regardless of treatment, he is most troubled by those physicians who have committed suicide because they did not receive treatment.
“I can come to terms with a physician who kills himself or herself after a long and painful journey in and out of the hospital, after they’ve lost professional ability and are no longer able to work. I still mourn their deaths, but like an oncologist or a family doctor who has looked after them for a long time, there is a sense that they’ve had enough suffering and are now at peace.
“It’s the doctors who fall through the cracks who are my concern, those who have never sought treatment, who have never been diagnosed, or the only person who has treated them has been themselves — that’s a dangerous prescription — who subsequently die by suicide,” Myers said.
Another problem is that sometimes physicians receive some treatment, but it is inadequate; it should have been in a hospital, or they should have been treated more aggressively or diagnosed as having a mood disorder, Myers said.
Stigma remains
While the stigma of depression and mental illness is less in the general public than in the past, it remains a significant barrier to physicians’ seeking help. It may be the most significant reason physicians who are experiencing the symptoms of a psychiatric illness fail to seek help.
“In contrast, doctors who have a lump in their breast or blood in their stool will seek medical care in a fairly timely manner,” Myers said, pointing to data that show physicians face lower mortality risks for cancer and heart disease compared to the general population yet a higher risk for suicide.
Physicians who struggle with depression or thoughts of suicide often fear that they may lose their license to practice medicine. A consensus statement published last summer by the American Foundation for Suicide Prevention called on state licensing boards to ensure that licensure regulations, policies and practices are nondiscriminatory and require disclosure of misconduct, malpractice or impaired professional abilities rather than mental or physical diagnosis.
“These groups have to be increasingly more humane so that doctors who are concerned about their mental health are going to get treatment rather than the axe,” Myers said. “I look after many doctors who are fairly symptomatic, but they are not impaired.”
If he is concerned that his physician-patients may be impaired, Myers advises them to take a voluntary leave of absence, which does not require informing the licensing board.
“When any human being is ailing with a psychiatric illness, they are so nervous, their self esteem is so lousy and they feel so terrible. You have to be reassuring; you have to be compassionate and kind,” Myers added. “If we’re ever going to get doctors to go for help, they can’t be worrying about the consequences.”
An orthopedic surgeon struggling with depression or thoughts of suicide who seeks the help of a psychiatrist should expect a biomedical psychosocial assessment, Myers said.
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Recommendations for physicians: |
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Source: American Foundation for Suicide Prevention. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289;3161-3166. |
Physicians should not be referred to physician health programs, however, simply because they have a psychiatric diagnosis or are receiving mental health treatment. The American Foundation for Suicide Prevention is creating a Web site to inform physicians about diagnosing depression in themselves and their legal rights if engaged in psychiatric treatment (www.afsp.org/physician).  |
Seeking help
“So much of psychiatry has been reduced to pharmacology,” Myers said. “Any symptomatic doctor has a right to a thorough assessment. If medication is recommended, the psychiatrist should explain why, but there should be a menu of psychotherapy options.”
These options may include supportive counseling during difficult times, but there may be deeper issues: an abusive childhood, professional isolation because the physician-patient is the only African American in an all-white environment or the only woman in an all-male practice. Such issues can be addressed through cognitive behavioral, interpersonal, psychodynamic, marriage and family, or group therapies, Myers said.
“So many doctors are afraid the psychiatrist will put them on a pill and forget about them. Others — such as those going through a painful divorce — will say ‘Can’t you just give me a pill?’ when what the physician really needs is to work through his grief because his wife has just moved in with her Pilates instructor,” Myers said.
Most important, Myers stressed, is the treatment plan must meet with the physician-patient’s approval.
Physicians who are referred
Myers works with physicians who voluntarily seek treatment as well as those who are sent to him for treatment. For example, a residency director or chief of staff may diagnose a physician as disruptive and refer him or her to Myers because he or she is late for the OR, is throwing instruments or is the subject of patients’ complaints.
“Sometimes I get a phone call from the spouse, who will say, ‘My husband is an orthopedic surgeon, and he’s just not himself. He’s drinking more than usual. His mother committed suicide when she was 52 and he’s 50, and I’m really worried about him.’
“When I get a call like that, I thank them for calling and tell them, ‘Please tell your spouse that you called me, that I would like to see him, and to please call me.’ If the physician’s spouse refuses, I will call them directly and invite them to come see me,” Myers said.
While some of Myers’ colleagues in physician health think his approach is “a bit over the top,” many psychiatrists take the same approach with their depressed patients in the general population.
Myers said he works hard to make the first appointment with a new patient go well.
“I want them to feel welcome, respected and safe, and I want them to feel that I am completely committed to and vigilant about confidentiality. I want them to see me as thorough and up-to-date, and that I’m prepared to help treat them and get them better. I hope that by the end of that first visit they are open to coming back to see me,” he said.
“I’ve looked after so many doctors who say, ‘I was unraveling, and I couldn’t see it, and I was so paranoid about seeing anyone there’s no way I could have made that call myself. I was pissed off, but I realize now that I was really, really sick.’
“They are grateful that their wife or their residency director or colleague recognized what was happening. It isn’t easy for many physicians, or for many men, to ask for help,” Myers said.
Last summer, the Journal of the American Medical Association published a consensus statement from the American Foundation for Suicide Prevention. Its authors called for the transformation of professional attitudes and new institutional policies to encourage physicians to seek help.
“As barriers are removed and physicians see depression and suicidality in their peers, they are more likely to recognize and treat these conditions in their patients, including colleagues and medical students,” according to the statement.
For more information:
- Michael F. Myers, MD, is the author of five books including Doctors’ Marriages: A Look at the Problems and Their Solutions, How’s Your Marriage? A Book for Men and Women, and Intimate Relationships in Medical School: How to Make Them Work. He is a co-author of the American Medical Association’s Handbook of Physician Health.
- Confronting depression and suicide in physicians: A consensus statement, abstract, JAMA, June 18, 2003.
- American Foundation for Suicide Prevention’s Depression and Suicide Prevention Project. Available at: www.afsp.org/index-1.htm.
- Canadian Medical Association Centre for Physician Health and Well-Being. Available at: www.cma.ca.