Doctors are human too. We experience the joys, losses, loves, disappointments, births and deaths of other humans. We also suffer with poor mental health, addiction, burnout, and suicide like anyone else. Unlike everyone else, we seem to suffer more with these difficulties than the general public. And, tragically 300-400 of physicians die by suicide every year in the US alone. This article discusses physician mental health stigma and explores ways to overcome this unnecessary barrier to getting help.
I feel fortunate in writing this as an unlicensed physician. I don’t have a regulator who can take away my license to practice.
So, unlike Dr Seema Jilani MD, the writer of this excellent article on Why So Many Doctors Treat Their Mental Health in Secret, I feel able to write without my palms sweating.
We salute Dr Jilani’s bravery for taking on this loaded topic and writing about it so sensitively and bravely.
Dr Jilani describes the grueling experiences of medical school, residency, and medical practice. She notes that:
Despite the grueling experiences, the medical profession often stigmatizes physicians who seek mental health care and erects barriers to such care. As of last spring, medical boards in 37 U.S. 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 unhelpful.
Ticking those boxes can 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 or “protecting patients”.
The UK General Medical Council which regulates all doctors with a licence to practice has a similar requirement to self-declare one’s own health issues.
This is a double-edged sword: if you declare something you risk a system overreaction. If you don’t, and the system finds out then you are likely seen as unprofessional, dishonest, and worst of all “lacking insight”.
These regulator questions have a frightening effect on doctors. 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. Furthermore, 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.
We argue that these intrusive questions actually increase physician mental health stigma by linking it to shame, underperformance, and risk to patients.
We physicians can also be our own worst enemies. We have stubbornly high negative attitudes towards mental illness, the mentally ill, and those who treat them – our long-suffering psychiatry colleagues. Psychiatry has long been maligned as the Cinderella specialty, and in part resultantly suffers a chronic recruitment deficit.
If we doctors — with all our knowledge of the biopsychosocial underpinnings of mental illness, and the advances in genetics and neuroscience leaving no doubt that mental illness is largely neurological – are still riddled with stigma, then how can our mentally ill and addicted colleagues be expected to be treated with compassion and understanding?
While we recognize the diversity in physician personality types, we all know certain colleagues who have, shall we say, a compassion deficit when it comes to the mentally ill, more so when those are colleagues.
Some were born like that, and some acquired it through years in medicine. We are not here to judge.
Concerningly, compassion fatigue is also a sign of burnout. Finding it hard to care about our patients who rely on us, in many cases for their lives, is a red flag.
Those colleagues with acquired compassion deficiency may wish to explore whether they are indeed burned out, and if so, do something about it.
For those born that way, just look at the neuroscience of mental illness and addiction. These are not lifestyle choices, weakness, lack of grit, or moral failing. They are recognized conditions. And criticism and lack of understanding ain’t helping anybody.
Demonstrating stigmatized attitudes towards physicians with mental health conditions and burnout only makes it more likely for doctors to hide their difficulties. All doctors know that presenting late with a condition worsens the prognosis.
So, by showing physician mental health stigma, we are actually doing a disservice to our colleagues.
We at Physicians Anonymous do wish to encourage all physicians to look after each other and themselves. Talk in confidence, either in person or remotely via our groups. Share in safety. You are not alone in struggling with the incredible demands of being a doctor. Even when everyone else seems impervious to strain, very few are truly like that beneath the water.
You are safe here and we are glad to have you. Welcome to Physicians Anonymous!