Doctors Facing Physical, Mental Challenges – Including Suicide

Physicians are good at telling their patients how to take care of themselves, but do doctors follow their own advice? Not nearly as much as they should, according to Michael F. Myers, MD, a specialist in the health of physicians.

In fact, the state of physicians’ health is so concerning that the American Medical Association, the Canadian Medical Association and the British Medical Association teamed up in October to sponsor an international conference in Chicago to examine the latest thinking and research on the subject. Conference focuses were:

• burnout and peer support,
• physician health and its link to quality and patient safety,
• workplace wellness and
• physical and mental health and well-being, including residents and medical students.

Myers was one of the plenary speakers, and his topic was a somber one – physician suicide. Myers is a professor of clinical psychiatry at the State University of New York-Downstate Medical Center in Brooklyn, where he is vice chair of education and director of training in the Department of Psychiatry. Myers is the author of seven books, including The Physician as Patient: A Clinical Handbook for Mental Health Professionals (with Glen Gabbard); Touched by Suicide: Hope and Healing After Loss (with Carla Fine); and The Handbook of Physician Health (with Larry Goldman and Leah Dickstein), published by the AMA. Medical News talked to Myers about the challenge of keeping physicians healthy and the heartbreaking reality of physician suicide today.

Physicians should know more than most how to stay healthy and take care of themselves. Why don’t they do it?

That’s a very common question. It would seem like a no-brainer, wouldn’t it? Yet, despite the fact that we do have varying amounts of medical information about illnesses that could be going on with ourselves, we don’t come forward very easily for help. I’m not just restricting that to psychiatry now; I’m restricting that to just about anything. It’s well known that not enough practicing physicians have primary-care doctors. That should be a given, and in fact we call that Physician Health 101. When I lecture medical students and residents, I tell them, “If you’re not feeling well and you’ve developed some symptoms, you might have some idea as to what’s going on with yourself, but go to your doctor and let him or her sort that out.” Some do that, but many don’t.

There is a gender difference. Women physicians are much better about seeing a primary-care doc. We think that has something to do with just their openness toward getting care, because of things like pap smears and mammograms. Even men who are approaching that age when they should be getting their cholesterol checked and digital exams for prostate, even then there seems to be some delay in their going to a doctor.

Is it that wait-and-see attitude?

There’s nothing wrong with wait and see, but if you’re waiting and seeing and not getting any better, then you need to go see someone.

When it comes to physicians’ mental health, are they even less likely to seek care?

Anxiety disorders, depression, alcohol and drug use – they all occur in doctors. There is a sense of stigma. I’ve been working in my field for almost 40 years, and I certainly have seen a lessening of stigma, but we’ve still got a long ways to go. … Almost the first thing that a doctor concludes about himself or herself if they’re getting depressed is that they’re weak, that they can’t cut it, that they’re embarrassed. They should be able to work as hard or function as well as they perceive their colleagues to do. One of the words that I’ve been struck with when I’m assessing a physician for something like depression is the number who refer to themselves as “pathetic.” When I suggest that this assessment could actually be part of their depression, they say, “No, I am pathetic because I’m a doctor with depression.” Even my psychiatrist patients will sometimes say that. And those are the ones who come forward. Plenty of other people don’t come forward – they just keep treating themselves and carrying on.

Is the stress of being a physician a cause of this anxiety and depression?

I’m of the belief that we physicians don’t have a monopoly on stress. I would never say that my job is more stressful than yours, and I don’t care if I’m working nights, weekends, whatever. Is our work or can our work be stressful? Sure. Taking that as a given, it is clear that some doctors work way too hard. Sometimes it’s altruism. Sometimes it’s got to do with keeping up with the Joneses. They want to make a lot of money, and they compare themselves with somebody they graduated with – “If they have a house in the Hamptons, then I want a house in the Hamptons” – as silly as that is.

We know now the risk of depression is a bit higher in doctors, both men and women, than it is in the general public. Why could that be? I don’t think it’s all just stress. We also know that many of us who are physicians have come from families where there’s a family history of mental illness. It can be deceiving, because doctors can appear to have it all. They’ve got intelligence, they’ve gotten good grades, they’re professionals, they usually have good job security, they’ve got some status in the community. Therefore, it’s hard for lay people often to believe that doctors too could suffer from things like depression, alcoholism, drug use and then even suicide.

What goes through someone’s mind when they consider suicide as an option?

In the world of suicidology, because I’m very involved in that as a researcher and as a teacher, what we believe happens toward the end is people develop what we call tunnel vision or constricted thinking. They aren’t rational anymore. They don’t necessarily share that, but all they can see is suicide as the only way out. They no longer believe that they are going to get well. It’s all gray, it’s all bleak, even in the face of reassurance. Also inside is something that we call “psych ache.” It’s terrible anguish, terrible restlessness, terrible agitation, awful ugliness that they just can’t shake off. It’s very, very painful. I’ve heard people say, “I’d rather have cancer.”

I would think when a physician sets his or her mind to suicide, the odds of succeeding are great.

You took the words right out of my mouth. I’ve heard so many doctors say this: “Look, if I do it, I’m going to do it right. I’m not going to botch it. I’ve seen too many botched suicide attempts in my work.” My colleague and co-author Carla Fine wrote the story of her physician husband’s death by suicide in her great book No Time to Say Goodbye. After Harry killed himself, she got on his computer, and he had been researching how to kill himself for weeks – even ordered the Sodium Pentothol online. It was eerie, and the coroner told her afterwards that her husband really knew what he was doing.

Carla’s husband had hospital privileges at two Manhattan hospitals, but only one of his colleagues came to his funeral. She knows that if he had died of a heart attack or cancer that the whole Department of Urology would have been there. That was back in 1989, but we’re still fighting that.

Tags:

Bookmark:

Digg

Facebook

Technorati

Newsvine

Google

Related: