Messages surrounding work-life balance, mental health awareness, and overall wellness flood our culture, but doctors are rarely the target of these health initiatives. Not only that, but doctors who seek treatment might be fearful for their careers: According to a recent report in Mayo Clinic Proceedings, medical licensure questions regarding physicians' previous mental health diagnoses and treatment may discourage them from seeking help. Doctors in some states are expected to answer questions likes these in order to renew their license and some of them are withholding information, and in some instances, failing to get the help they desperately need.
There isn't much information available on the mental health resources physicians use, but the report found that 40 percent of doctors said they would be hesitant to receive treatment for their mental health concerns out of fear. "Clearly, in some states, the questions physicians are required to answer to obtain or renew their license are keeping them from seeking the help they need to recover from burnout and other emotional or mental health issues," Liselotte Dyrbye, an internist at Mayo Clinic and the study's lead author, said in a press release.
The concern with asking doctors about their mental health on licensing applications is that the questions tend to be overly broad. Some state licensures ask about current mental conditions, previous mental health conditions and/or impairment from a mental health condition. "The implication is that there's a high prevalence of psychological distress in physicians. It often goes untreated, which contributes to a high prevalence of suicide in physicians than [in] other US workers and here we have a really clear barrier for physicians to seek care," Dyrbye tells Tonic. "Many of them are reluctant to seek care because they're concerned that doing so could negatively affect their medical license."
For many docs, the strains of medical school mark the beginning of mental health conditions. A 2016 analysis found that 27.2 percent of med students were depressed or had symptoms of depression, but only 15 percent of the students who were depressed reached out for psychiatric care. Those numbers increased during residency, with the prevalence of depression and depression symptoms rising to 28.8 percent, according to a 2015 report. And that distress only worsens with time.
A 2011 report found that suicidal ideations was 1.5 to 3.0 times more common among surgeons than the general population. Approximately 9 percent of those doctors, the report says, prescribed their own anti-depressants, while about 7 percent got them from a colleague as a favor.
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Michael Meyers, a psychiatrist and a professor of clinical psychiatry at State University of New York-Downstate Medical Center, acknowledges that physicians under these circumstances often feel like they're capable of handling their own treatment because they're so knowledgeable in medicine. But Myers says, "Under no circumstances should doctors be treating themselves or their family members unless it is an emergency."
A common misconception is that if a physician has a mental disorder, they might not be able to care for their patients. Yet, the American Psychiatric Association says (PDF) there's no connection between a physician's mental illness and their ability to care for patients. "There's no evidence at all that physicians who have ever been treated for a mental health problem or are currently being treated for a mental health problem, that that puts patients at risk," Dyrbye explains. "There's a moral and ethical barrier here to lower barriers to care here for everybody in the population, but here's a unique barrier for physicians that we need to work on eliminating."
When a doctor receives treatment for mental illness, it helps both the patient and the doctor. "When physicians aren't terrified to go for help, then they can get help, then that keeps them healthy," Myers says. "And we've always [believed], those of us in psychiatry and those of us who work in physician health, that the easier you make it for a symptomatic physician to go for a treatment that works, the better off the physician is and the better off his or her patients are," he explained.
Depending on how licensing questions are asked, they might actually violate federal law. The Federation of State Medical Boards advises against asking physicians about their mental health treatment because doing so might infringe the Americans with Disabilities Act, yet two-thirds of states still ask physicians questions regarding mental health.
But the American Psychiatric Association offers recommendations on how to ask these trickier questions in a way that doesn't violate the law and places more emphasis on the physician's ability to provide quality care. The organization advises asking the question: "Are currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner? (Yes/No)" Framing the question in this way gets to the more salient information.
Myers recommends that patients express concern for their doctors' mental health like they would for a friend. He says it's like the New York City subway mantra, "If you see something, say something." That may sound a little strange, but as Myers wrote in his book, Why Physicians Die by Suicide:
"If our doctor seems preoccupied, weary, downcast, or forgetful, we need to reach out, not intrusively but with affection. "Are you okay? You seem tired. Please take care of yourself. I care about you." This is no more than we would do for a friend or a colleague at work, and doesn't the physician who's been looking after our needs deserve the same kindness and courtesy?"
"I believe that very strongly," he says, "and I'm recommending to the general public out there if you are worried at all about your doctor say something."
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