Dear All,
Not too long
ago the media was full with harrowing and tragic stories of health worker
suicides. It has gone quiet now but that does not mean that we know of
interventions going on to prevent, detect, manage and control the root causes.
As always our colleagues elsewhere have been giving serious reflective thoughts
on the preventable saga:
Read on
courtesy of Medscape:
Two sides of
the coin for doctors regarding ill health e.g. depression:
‘Physicians
face unique circumstances during their careers that may lead to depression;
these include bullying, hazing, sleep deprivation, overwork, and medical
board investigations—plus the repeated near-daily exposure to suffering and
death. However, doctors also experience depression for the same reasons the
general public does, says Pamela Wible, MD, Ideal Medical Care, Eugene,
Oregon.
Dr Wible
has been running a physician suicide hotline since 2012 and has had the
opportunity to help hundreds of depressed and suicidal doctors. She also
interviewed 200 physicians who have experienced depression during their
careers. She asked what treatment they pursued and found that 33% chose
professional help, 27% pursued self-care, 14% engaged in self-destructive
behaviors, 10% did nothing, 6% changed jobs, 5% self-prescribed medication,
and 5% chose other activities.
"Most
physicians tried multiple treatments. Sadly, the majority of doctors I spoke
with did nothing for months to years until they finally decided to take
action—sometimes self-harm. Professional help was not generally first-line
therapy,"
|
‘Still,
respondents noted that there are still ways to be happy as a physician.
"[T]here are plenty of physicians who have lives filled with joy,"
said an internist, who noted further:
Happiness
is fleeting, as the etymology of the word ascribes (happen). Depending on the
field you decide to specialize in, there will be varying constraints on your
scope of practice. But being an internal medicine guy with a Navy flight
background and some tough times therein, I found that a fellowship in
wilderness medicine helped to rejuvenate me, and that international and
disaster/humanitarian medicine fulfilled me. And teaching, my old profession
before med school, was something I needed to incorporate into my career again
to bring back that joy of work.’
|
Why Do
Depressed Doctors Suffer in Silence?
Sandra
Levy
June 27, 2017
Many
Depressed Doctors Avoid Professional Help
Physicians
face unique circumstances during their careers that may lead to depression;
these include bullying, hazing, sleep deprivation, overwork, and medical board
investigations—plus the repeated near-daily exposure to suffering and death.
However, doctors also experience depression for the same reasons the general
public does, says Pamela Wible, MD, Ideal Medical Care, Eugene, Oregon.
Dr Wible has
been running a physician suicide hotline since 2012 and has had the opportunity
to help hundreds of depressed and suicidal doctors. She also interviewed 200
physicians who have experienced depression during their careers. She asked what
treatment they pursued and found that 33% chose professional help, 27% pursued
self-care, 14% engaged in self-destructive behaviors, 10% did nothing, 6%
changed jobs, 5% self-prescribed medication, and 5% chose other activities.
"Most
physicians tried multiple treatments. Sadly, the majority of doctors I spoke
with did nothing for months to years until they finally decided to take
action—sometimes self-harm. Professional help was not generally first-line
therapy," said Dr Wible.
In a recent
Medscape article on physicians and depression (Doctors and
Depression: Suffering in Silence), Dr Wible described her findings. Her
article sparked about 100 emotional responses from physicians, many of whom
talked about their own struggles.
"Owing
to the punitive nature of physician treatment programs, such as physician
health programs (PHPs), and the prevalence of intrusive mental health questions
on physician licensing, hospital privilege, and insurance credentialing
applications, many doctors avoid seeking needed care," says Dr Wible.
Sadly, many
doctors continue to suffer with untreated or poorly treated depression.
Doctors Are
Afraid to Get Help
A family
physician pointed out that doctors are punished when they seek help for
depression, saying, "It is sad how doctors with depression are treated by
their own and by the public! The PHP encourages doctors with difficulties to
self-refer but punishes them for doing so. Changes need to be made!"
One
neurologist described the problem:
No other
profession has the degree of intrusion with regard to healthcare that doctors
have to suffer from. In residency, a resident friend of mine became depressed.
She made the mistake of doing the correct thing and asking for medical care.
This almost destroyed her future. I was the one who had to take random blood
samples from her. It was humiliating and wrong. We both learned our lesson. The
boards, licensing, and privilege questions are wrong. We are human and should
be able to ask for medical care if needed. We doctors instead are subjected to a
witch hunt with a 200-year-old attitude. Any other profession would be up in
arms screaming discrimination; we take it.
Another
clinician noted:
I believe
that doctors and all healthcare professionals should be able to get the care
that they need without censure. It appears heartless to me that a physician can
recommend to a client the care needed, but that the way the system is set up,
deny that same physician the care he/she requires. There is no health without
mental health.
A
psychiatrist advised, "I recommend psychotherapy, at least once a week.
Eventually, I recommend time-limited antidepressant medication if it enhances
psychotherapy; otherwise, avoid psychotropics."
An
ophthalmologist who sought treatment for addiction said:
I am 7
months from completing a 5-year contract with my state's PHP. I am a bipolar
recovering alcoholic. I am unable to recredential with health plans owing to a
board order suspending my license. I have a stay of suspension, provided that I
am compliant with the dictates of my monitoring contract. I couldn't be where I
am mentally or physically without their help. Onerous, yes, but a lifesaver in
my case.
One
psychiatrist described why so many physicians are having a hard time:
The
number-one cause of burnout in physicians in my opinion is the loss of autonomy
and the host of abuses foisted upon them by the system. Take the incredible
burden, the responsibility, and the stress of being in charge of other people's
lives, and combine that with the utter disrespect and contempt with which
doctors are treated, and what do you get?
Combine the conflict between the professional and ethical duty to do your best for your patient and being forced to do otherwise by businessmen so that they can profit, and the outcome is inevitable. The EMR is not only crazy-making but also offensive to a professional. Add to that work conditions that are intolerable and are forced upon the doctor by others. Many physicians experience an utter lack of control over their work....
Combine the conflict between the professional and ethical duty to do your best for your patient and being forced to do otherwise by businessmen so that they can profit, and the outcome is inevitable. The EMR is not only crazy-making but also offensive to a professional. Add to that work conditions that are intolerable and are forced upon the doctor by others. Many physicians experience an utter lack of control over their work....
"Most
of the depression in medicine is caused by a lack of control," noted a
cardiothoracic surgeon, who continued:
You can't
control your schedule, your income, or your hours; you can't pick your
patients, and patients can't pick you; and the people who designed this hell
have given themselves a 35-fold pay increase while doctors' pay has barely
doubled (since 1970). Imagine how many of the stressors that currently plague
physicians might be relieved if they had received a 35-fold pay increase? As a
physician, you could have a truly private practice, determining who to see, and
even who to charge. You could hire your own staff, operating room assistants,
nurses, etc. How much less stressful would your life be if you could pick the
material, drugs, sutures, gloves, and other equipment your practice requires to
meet your specific requirements?
Still,
respondents noted that there are still ways to be happy as a physician.
"[T]here are plenty of physicians who have lives filled with joy,"
said an internist, who noted further:’’
Happiness is
fleeting, as the etymology of the word ascribes (happen). Depending on the
field you decide to specialize in, there will be varying constraints on your
scope of practice. But being an internal medicine guy with a Navy flight
background and some tough times therein, I found that a fellowship in
wilderness medicine helped to rejuvenate me, and that international and
disaster/humanitarian medicine fulfilled me. And teaching, my old profession
before med school, was something I needed to incorporate into my career again
to bring back that joy of work.''
Africa Center for Clin Gov Research &
Patient Safety
@ HRI West Africa
Group - HRI WA
Consultants in
Clinical Governance Implementation
Publisher: Health and
Medical Journals
8 Amaku Street Housing
Estate, Calabar
Cross River State, Nigeria
Cross River State, Nigeria
Phone No.
+234 (0) 8063600642
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