Part of the culture of medical professionalism is that physicians are always capable of making sound decisions for themselves. This includes decisions about their own self-care and well-being. Sadly, however, when physicians experience serious depression and or high levels of stress they are too often reluctant to seek care for themselves. Often they fear the results of coming forward in terms of career repercussions, or possibly being regarded as less competent by their peers. The statistics on physician suicide1 are disturbing and merit consideration of the causative factors involved. Each highly trained physician is too precious to be lost as a result of shame, ignorance or neglect.
It is well known that physicians often neglect medical care for themselves. What is not is that they often neglect seeking treatment for depression. Hotchkiss and Early2 assert that men especially would benefit from encouragement to seek appropriate help early. “Efforts to normalize help-seeking behavior must be addressed... from first year in medical school forward. Particularly important is modeling good self-care by male superiors, which is not the case currently, where asking for help is discouraged, disgraced, and considered pejoratively.”
Furthermore, the authors state that “the quality of patient care is closely linked to the well-being of the physician. Studies have repeatedly demonstrated that physicians’ poor health may seriously impact the quality of care they provide their patients.”
Physicians have similar rates of depression as others, but physicians are more likely to commit suicide. Physicians have heeded their own recommendations regarding smoking cessation and other risk factors for early mortality, but are “decidedly reluctant to address a significant risk of both morbidity and mortality that disportionately affects them....Depression is a major risk factor for myocardial infarction in male physicians”3
Completed suicide is more likely among physicians, partly due to their medical expertise as well as ready access to lethal means. Estimates range from 1.4-2.3 times the rate of suicide in the general population. Female physicians attempt suicide less often than non-physicians, but are far more likely to complete the act. Completion rates equal those of male physicians.4 Further, Andrew believes that suicide statistics are most likely conservative, as compassionate colleagues may wish to protect physicians’ reputations by under-reporting.
Additionally, suicide is the second most common cause of death among medical students, following death by accidents. In a study of depression and suicidal thoughts among medical students, 14.3% reported moderate to severe depression.5 Women students were twice as likely as men to have moderate to severe depression. Students who acknowledged depression reported thinking that fellow students would respect their opinions less and that faculty members would regard them as less able to manage their responsibilities. Depressed students were more cognizant of the stigma of depression, than students who were not depressed, and thus strive to avoid revealing their depression to others.
Andrew relates that a physician suffering with depression may encounter little understanding or sympathy from his or her colleagues. When early physical symptoms of depression occur, there may be an inability to self-diagnose, which can lead to feelings of incompetence. “To admit inability to diagnose oneself to another colleague is an admission of failure. When such tacit confession is met with avoidance, disbelief, or derision by a reluctant treating physician, it can only reinforce a depressed physician’s feelings of worthlessness and hopelessness.”6
A possible model that could be replicated by hospitals, and other medical facilities is a very successful intervention program which was initiated by the U.S. Air Force as concerns developed over the increasing rates of suicide among pilots . A 50% reduction in suicide rates resulted over a two year period with a focus on available assistance and timely intervention.7
The MPHP often observes a tendency to refer a physician only after egregious violations of standards, and an avoidance of confronting lesser concerns. The MPHP is available for help no matter the severity of the problem. The MPHP believes it is imperative to salvage the lives of well trained and valued medical professionals, particularly in this era of acute physician shortages with prospects of this trend to be exacerbated by an aging population. As Hotchkiss and Early assert “it is in the best interest of training facilities to educate their students and residents [and medical staffs] as to the imperative nature of employing self-care practices, awareness of common physician illnesses and resources available to assist in preserving wellness and practice safety. Curriculum development that includes physician health and partnering with Physician Health Programs is an avenue to this end”.8 Destigmatizing mental illness would encourage physicians to seek help when needed.
JAMA recently published a consensus statement on the subject and advocated better treatment of depression and prevention of suicide by changes in professional attitudes and policies to support physicians seeking help for depression. “Barriers to physicians in seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.”9 Studies indicate that physicians often miss the detection of depression in their own patients. 40% of those who commit suicide have seen their primary care physician the month prior to killing themselves.10
The MPHP stands ready to assist any physician, resident or student with this issue. We will gladly help any associate or employer who has concerns about a colleague. Our 24-hour confidential hotline can be utilized by anyone. The caller can be a relative, friend, supervisor or colleague. Our failure to act may result in the permanent loss of a valued physician.
l The United States loses the equivalent of at least one medical school class to suicide each year.
2 Hotchkiss and Early, “The Differences in Keeping both Male and Female Physicians Healthy”, The Health Care Manager, Vol.28, No.4, pp 299-310.
3,4, Louise B. Andrew, MD, JD, “Physician Suicide, Medscape, March 29, 2010.
5 Thomas L. Schwenk, MD, Lindsay Davis, BS, Leslie A. Wimsatt, PhD, “Depression, Stigma, and Suicidal Ideation in Medical Students, JAMA, 2010; 304 (11) 1181-1190.
6 Louise B. Andrew, MD, JD, “Physician Suicide”, Medscape, March 29, 2010.
7,8 Hotchkiss and Early, “The Differences in Keeping both Male and Female Physicians Healthy”, The Health Care Manager, Vol.28, No.4, pp 299-310.
9,10 Claudia Center, JD, et.al. “Confronting Depression and Suicide in Physicians: A Consensus Statement, JAMA, June 18, 2003, Vol. 289, pp. 3161-3166.