Thinking Citizen Blog — Doctors and the Mental Health Stigma
Thinking Citizen Blog — Thursday is Health, Health Care, and Global Health Policy Day
Today’s Topic: Doctors and the Mental Health Stigma
In medicine in the United States there is a culture of “no sleeping, no crying, no asking for help.” Is this a bad thing? If so, how bad is it? What is to be done about it? How unusual is the situation in the United States relative to other countries? My general impression is that the United States is an outlier, but my knowledge base is very limited. Today, some excerpts from an article by Dr. Seema Jilani, published in the New York Times last week. Experts — please chime in. Correct, elaborate, elucidate.
SOME SOBERING STATISTICS (BEFORE COVID) 29% OF RESIDENTS “EXPERIENCED DEPRESSION OR DEPRESSIVE SYMPTOMS
1.“A systematic review and meta-analysis published in 2015 in The Journal of the American Medical Association found that roughly 29% of resident physicians experienced depression or depressive symptoms.”
2. “For context, from 2013 to 2016, 8% of Americans age 20 or older had depression in any given two weeks.”
3. “In a study published in August 2019, 16% of emergency room physicians met the criteria for a post-traumatic stress disorder diagnosis.”
NB: “ In a 2016 survey of female physicians close to half said they believed they had met the criteria for a mental illness but avoided care, in part for fear of licensing boards.”
THE PANDEMIC HAS JUST A BAD SITUATION A LOT WORSE
1. “A survey conducted in the fall of 2020 and presented at the American Psychiatric Association suggested that as many as 36% of frontline physicians suffered from PTSD.”
2. In the United States roughly a doctor a day commits suicide.
3. “The past two years have been characterized by violent attacks against doctors, accompanied by even longer hours, sicker patients, limited hazard pay, and family sacrifices.
NN: Perhaps the saddest part is that the doctors we are often losing are the very ones we need: the gentle ones who you want holding your mother’s hand, the thoughtful, meticulous ones who call you on their day off.”
THE DEMANDS OF RESIDENCY — is there any other profession that is allowed to do this within the law in the United States? I don’t think so. if you know of such, please enlighten us.
1. “Residency can consist of sleep deprivation, hunger, constantly being told you are not a good enough doctor and working a torturous 100-hour week, all while six figures in debt.”
2. “Resident physicians routinely work on weekends and holidays, often with only four days off per month.”
3. “Accreditation Council for Graduate Medical Education regulations generally do not allow resident physicians to work more than 80 hours a week averaged over four weeks, but some residents feel that they must lie on their time sheets to avoid scrutiny.”
NB: “The merciless culture of medical education can revel in publicly shaming students; the practice of peppering residents or medical students with rapid-fire questions in front of colleagues and patients is called pimping.”
SHOULD DISCLOSURE REQUIREMENTS BE ELIMINATED OR PARED BACK?
1. “Despite the grueling experiences, the medical profession often stigmatizes physicians who seek mental health care and erects barriers to such care.”
2. “As of last spring, medical boards in 37 US states and territories asked questions that could require a doctor seeking licensure to disclose any mental health treatments or conditions. These questions can be intrusive and overly general.”
3. “Ticking those boxes can feel like risking everything we have worked toward over years. It could result in the medical board reviewing our personal medical records, possibly in psychiatric and drug testing and perhaps even in having our medical license reviewed, suspended or revoked all under the guise of establishing our professional competence.”
NB: “The questions have a chilling effect on doctors. In a 2017 paper, nearly 40 percent of physicians reported being reluctant to seek mental health care because they worried it would jeopardize their chances of getting or renewing their medical licenses.”
AN UNDERGROUND MARKET FOR PHYSICIAN MENTAL HEALTH CARE
1. “One way doctors reach out for help is through a “curbside consult.” A friend can stop you in the hospital cafeteria and ask for a quick prescription for Prozac. Not only are doctors terrible patients, but we are often crunched for time and can give fellow physicians awful care, too.”
2. “This all has helped create an underground market of sorts for physician mental health care. An often unspoken rule: If you must seek mental health care, do it quietly.”
3. “Find a therapist outside your city who documents only the bare minimum in your chart, pay with cash only, don’t let it be billed to your insurance company. Make sure there’s no paper trail.”
CONCLUSION — do physicians deserve the same compassion as their patients?
1. “A former colleague has told me it is ill advised for me to even write this essay. I can feel my palms sweating as I type.”
2. “But I’d rather be the doctor who confesses all instead of the one who buries the memories of dead children in bottles of bourbon or syringes of fentanyl.”
3. “This essay is not brave; it is foolish but necessary. It is time we collectively agree that physicians are worthy of the same compassion we give our patients.”
LAST FOUR YEARS OF POSTS ORGANIZED THEMATICALLY
#2 “39 Songs, Prayers, and Poems: the Keys to the Hearts of Seven Billion People” — Adams House Senior Common Room Presentation, 11/17/20
Please share the most interesting thing you learned in the last week related to health, health care or health care policy — the ethics, economics, politics, history…. Or the coolest, most important thing you learned in your life related to health are or health care policy that the rest of us may have missed. Or just some random health-related fact that blew you away.
This is your chance to make some one’s day. Or to cement in your mind something really important you might otherwise forget. Or to think more deeply than you otherwise would about something that matters.