NEW YORK – The adage that physicians are the worst patients has more than a grain of truth to it when it comes to mental health issues, psychiatrists said at a workshop on physician mental health presented at the American Psychiatric Association’s Institute on Psychiatric Services.
"Why is it so hard for doctors to seek help?" asked Dr. Michael Myers, of the department of psychiatry and behavioral sciences at the State University of New York in Brooklyn.
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Dr. Michael Myers
The stigma of mental illness as perceived by physicians themselves is often a barrier to seeking mental health services. In addition, there is often stigma within the helping professions, and an institutional denial that even physicians might be subject to the thousand natural shocks that other humans are heir to, Dr. Myers said.
"Not all doctors are comfortable looking after other physicians, and it makes them a little squeamish," he said.
Many patients also are ambivalent about being treated by a physician with health issues, making the impaired physician even more leery about getting help, he added.
Stigma reinforces denial and delay in getting help, compounds symptoms, increases refractoriness to treatment, and contributes to strains in personal relationships. Stigma also affects medication adherence, because physicians might think they know better than anyone else what drugs they need.
"Stigma kills," Dr. Myers said, noting that deeply depressed physicians or those who feel very isolated and alienated have increased symptoms of melancholia, guilt, shame, cognitive distortion, and suicidality that can lead to suicidal actions.
Additionally, some physicians with depression or bipolar disorder might have comorbid cocaine, opiate, or alcohol dependence, increasing their risk for death from unintentional overdose or from a cascade of problems associated with substance abuse, such as marital breakups, economic threats to their practices, or scrutiny from medical boards.
At-risk physicians also might hesitate to seek care because they don’t want to impose on others, they have a tendency toward self-reliance, or they are too wrapped up in their work to pay attention to their own needs. Physicians also might worry that breaches in confidentiality could harm their careers, Dr. Myers said.
Code of Conduct
Dr. Linda M. Worley noted that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited facilities to have a code of conduct defining acceptable behavior and specifying which behaviors are disruptive and inappropriate, and to have a process or action plan for managing disruptive staff members.
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Dr. Linda Worley
She teaches a distressed physicians’ course at Vanderbilt University in Nashville, Tenn., where she is an adjunct clinical professor of medicine. A maximum of six physicians take the 6-month CME course at one time; many are there as condition of their continued employment. There are four faculty members, including a physician, social worker, psychologist, and addiction/assessment counselor. One observer is also allowed for each session, but the rules specify that he or she must take part in the exercises.
Physicians who are referred to the course are first interviewed by telephone to make sure that the program is a good fit and that the participants are not currently substance abusers, and course staff also conduct collateral interviews to determine the mental health needs of prospective participants.
The participants engage in an initial 3-day session at Vanderbilt and have three subsequent 1-day sessions over the ensuing 6 months.