Physicians challenged to deal with their own problems
If someone were depressed, had suicidal thoughts or a substance abuse problem, he or she would probably be advised to seek help from a physician.
What happens if a physician needs help?
If a physician has any of these problems, it may be harder to acknowledge, identify and treat. Doctors may have higher rates of depression, suicide and substance abuse than the general public, and the varied causes mean that it’s often difficult for them to adhere to the proverb “Physician, heal thyself.”
Dr. John Jackson came to Fort Worth in 1979, a few years after finishing his medical training in Dallas. After being in the area a few years, he and a friend began noticing that another friend, also a physician, was having problems with self-medicating.
“We didn’t know what to do,” Jackson said.
Jackson and his friend approached the local physician health and rehabilitation committee through the Tarrant County Medical Society. The chair of the committee met with their medicating colleague and encouraged him to seek treatment. Their colleague got help, was rehabilitated and returned to his practice in good health.
Many of the reasons physicians suffer from depression and other mental illnesses are the same as for the general public: There are genetic links, as well as the impact of stress and a lack of access to health care. (Ironically, some studies have shown many physicians donÂ’t have primary care providers themselves, and their schedules often stand in the way of seeking appointments.)
The stresses placed on physicians are often much different than on a member of the general public, however. The unique impact of their careers is what has prompted state medical associations and boards to offer them assistance in recognizing their issues, treating and rehabilitating them so that patients can be safely treated.
Jackson, who is now the chair of the Texas Medical AssociationÂ’s physician health and rehabilitation committee, became interested in the topics when his friend needed help. Jackson also saw his father, also a physician, struggle from a drug problem and become rehabilitated.
“They don’t just come back; they come to a monitored system,” Jackson said, thanks to support from physician committees that can dictate a physician to go through counseling, random drug screenings and regular meetings with supervisors or other groups.
Practicing medicine on a daily basis means dealing with an overwhelmingly diverse amount of work related to being a physician, from procedures to paperwork, as well as trying to balance a personal life, said Dr. Alan Podawiltz, a psychiatrist at the University of North Texas Health Science Center.
“They’ve been told you can’t know everything, but they haven’t been taught you can’t do everything,” he said.
ItÂ’s no surprise many physicians are subject to irregular schedules, bad diets, a lack of exercise and little down time with family and friends, said Podawiltz, chair of the department of psychiatry, behavioral health and neuroscience at the Health Science Center. Add in the emotional stresses of dealing with patients and thinking about their health constantly, and itÂ’s easy to see where a physicianÂ’s own health would fall by the wayside.
“They become so committed outside themselves that they forget to be committed inside,” he said.
Hospitals are required by the Joint Commission to have some kind of program to deal with what are frequently called “disruptive” or “physician health” issues, ranging from temper-tantrum-throwing doctors to those drowning in stress. It is hard to ask a physician if he or she is feeling well because of the lingering stigmas against mental illnesses of any kind, Podawiltz said.
It is far better for a physician to voluntarily step forward and ask for help than to be called forward for some sort of a review, said George Pearson, senior vice president for medical staff affairs at Texas Health Resources.
“We have an obligation, but they have an obligation as well,” Pearson said, explaining that physicians have a responsibility to their patients and also to the licensing board to be able to treat those patients without any impairment.
Whether help comes through an institutionÂ’s committee or through a local medical society or association, what is important is that physicians feel that it is acceptable to ask for help, Pearson said.
About 80 to 90 percent of physicians who go through treatment for a problem and then are followed through a physician health committee for several years avoid relapse, Jackson said, because they have a strong professional network to keep an eye on them and provide support. Physicians also have a lot to lose if they are noncompliant with treatment and monitoring. If their license is revoked, then their entire career can disappear.
“It’s not that doctors are better at recovery; it’s that doctors have a much more structured environment for them to return to,” he said.
While some may be uneasy with having a recovering alcoholic or drug addict practicing medicine again, Jackson said the best business decision is to rehabilitate physicians and return them to the work force. With such high treatment success rates, the physicians can generally be relied upon to practice medicine competently, and discarding doctors who may have had a temporary slip-up means discarding lots of knowledge and needed services.
“I started to become educated a little bit about substance abuse disorders and became a believer in that this is a disease process, not merely a moral failing, and people who had these problems could receive help and could return,” he said.
Contact Bassett at ebassett@bizpress.net
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To find help or report an impaired physician:
The Tarrant County Medical Society has a physician health and rehabilitation committee for physicians who may have a substance abuse problem, psychiatric disorder or anything else that is impairing their work. There are regular meetings to support local physicians, and more information can be found by contacting the TCMS at 817-732-2825.
The Texas Medical AssociationÂ’s physician health and rehabilitation committee has a 24-hour hotline that anyone can call if believe a physician may be impaired. The number is 1-800-880-1640.
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Physician suicide rate higher than general publicÂ’s
BY ELIZABETH BASSETT
Fort Worth Business Press
ItÂ’s well known that physicians suffer the same issues as the general public, but whatÂ’s still being studied is how prevalent things like suicide, substance abuse, depression and other mental illnesses are in this small population.
One commonly referenced article was published in the New England Journal of Medicine in 2005 by Dr. Eva Schernhammer, an instructor at Harvard Medical School. Schernhammer looked at other studies herself, and she found there was some substance to the general impression that physicians face issues more than the general public.
Schernhammer pointed out that differences between physicians and the general population can begin as early as medical school. Female medical students commit suicide as frequently as male students, and of people the same age in the general public, men commit suicide more frequently.
The high incidence of women physicians committing suicide is a topic of several studies. A 2004 meta-analysis paper in the American Journal of Psychiatry found female physiciansÂ’ suicide rate can be three- to fourfold that of women in the general public. Male physicians also commit suicide more frequently than the general public; itÂ’s about 70 percent more likely among male doctors than other professionals, according to information from the American Foundation for Suicide Prevention, which has workshops and programs to specifically address physician suicide.
There are also significantly more successful suicides among physicians because of their knowledge of drugs and the human body, said George Pearson, senior vice president of medical staff affairs and physician relations for Texas Health Resources. There are fewer unsuccessful suicide attempts among female physicians than completed suicides, which isnÂ’t seen in the general public with women, where only about one in 10 or one in 15 attempts are successful, according to SchernhammerÂ’s study.
“If their intent truly is to end their life, they are quite knowledgeable about how to do that,” Pearson said.
Suicide can sometimes come after a physician has grappled with substance abuse. About 10 to 12 percent of physician struggle with drug or alcohol at some point in their life, said Dr. John Jackson, chair of the Texas Medical AssociationÂ’s physician health and rehabilitation committee. ItÂ’s the same percentage that faces substance abuse in the general public, he said. About 73 percent of the cases referred to the TMA committee are for drug and alcohol dependence.
“Lots of people may drink or drug a bit and then stop,” Jackson said, noting that the substance abuse may be temporary and resolve without the physician seeking help or many people finding out about the problem.
Studies have linked drug abuse to certain specialties that have ready access to powerful drugs, like anesthesiologists, psychiatrists and emergency room physicians, Schernhammer reports.
Both suicide and substance abuse can result from mental health problems. About 6 percent of cases seen by the TMA committee on physician health and
rehabilitation are for depression and another 11 percent for other psychiatric illnesses. The Federation of State Physician Health Programs assists physicians in rehabilitation and treatment for substance abuse problems, working relationship problems and psychiatric illnesses. Dr. Luis Sanchez, president of the Federation, said physicians often have problems admitting their problems.
“We’re taught from medical school on to keep our mouths shut,” he said.
Much of the reluctance to speak up could come from the perceived threat of losing oneÂ’s medical license, Sanchez said. State medical boards are responsible for ensuring physicians are fully competent to practice and stopping those who are impaired from possibly hurting patients. State physician health programs can be through state medical associations or societies and are dedicated to supporting physicians.
Physicians may think that if they admit they have a problem, they will automatically lose their license. However, Sanchez said, if they come forward through a health program and seek treatment and follow through, then here isnÂ’t necessarily a reason for the board to make any restrictions, he said.
“It’s different sorts of missions, but they [the medical boards] rely on us to assist them,” he said.
Jackson said that health committees can report a physician to the board if he or she is noncompliant with treatment, however.
“We don’t do that for any reason except to get the right thing done,” he said.
Contact Bassett at ebassett@bizpress.net
