Physician Staffing Blog

Lifestyle

Dealing with Physician Depression and Related Issues

April 30, 2018

By Debra Wood, contributor

Mood disorders and other mental health conditions are common in the U.S. population; about 18.3 percent of adults had a mental illness in 2016, according to the National Institute of Mental Health.

Unfortunately, physicians are not exempt from these conditions.

“Depression is very common among physicians, at least as high as the general population, and probably, it’s starting to be more,” said Louise B. Andrew, MD, JD, medical-legal, risk management and trial consultant and litigation stress counselor in Victoria, British Columbia, Canada.

In the worst cases, untreated physician depression can even lead to suicide. But greater awareness, preventive measures and appropriate treatments can make a difference.

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PTSD in physicians

Physicians often experience traumas and tragedies. Patients die despite one’s best efforts, and daily stressors occur during the practice of medicine. All of these things can lead to post-traumatic stress disorder (PTSD) in physicians.

A 2014 study published in the Journal of Medical Practice Management reported emergency physicians, those practicing in underserved areas, residents, doctors who have been sued for malpractice and those indirectly exposed to trauma are most likely to develop PTSD.

While many hospitals and practices may offer the opportunity for debriefing and counseling after adverse incidents, physicians may not always take advantage of these services, or may continue to suffer the after-effects in silence.

Anxiety in physicians

Physicians also may experience anxiety, ranging from temporary anxious thoughts to a full-blown anxiety disorder that interferes with daily life.

Heather Fork, MD, CPCC, career coach and owner and founder of the Doctor’s Crossing, recommends taking some concentrated time to understand and address any worries and anxiety you may be feeling.

In one of her blogs, she suggested physicians write down anxious thoughts and then assess how likely that thought is to happen and if there is anything that can be done to mitigate the threat. She also suggests taking slow, deep breaths and focusing on the present.

Change could be an answer for some

Tom Davis, MD, FAAFP, principal of Tom Davis Consulting in St Louis, said that depression, anxiety and burnout often result when the physician has a “poor fit” with his or her job. Health care has become more corporate, with a focus on productivity, making it hard for “emotional givers” to perform assembly-line patient visits.

Physician burnout is a different issue. It is an occupational stress syndrome, Andrew explained, and it does not lead to depression.

Recognition is the first step in combatting depression. Davis said that physicians should recognize that depression or anxiety are not their fault, but rather the fault of a system which “puts them on a treadmill cranking out data” and being measured by patient satisfaction scores.

Another proactive thing that Davis recommends is getting at least eight hours of sleep daily.

Next, he suggests changing the situation, learning to say “no” to performing more nonclinical work” and considering other options.

“Go part-time if you have to, but do something—nothing is going to get better if you don’t make a change,” said Davis, adding, “Fall back on the three principles of motivation: autonomy, mastery, purpose.”

Once the changes have been made and the physician is feeling better, Davis recommends mentoring colleagues and students.

“The only strategy left is for individual clinicians to take control of their own mental health by practicing medicine in a way sustainable for them,” Davis said.

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Challenges of depression treatment

Physicians routinely diagnose and treat patients dealing with mood disorders, but they are less likely to recognize their own depression.

Additionally, when the doctor is the one with a mood or other disorder, treatment can become far more complicated than for people in other professions. Physicians often fear seeking treatment will lead to the loss of their medical license, which Andrew said can happen.

Yet physician depression is readily treatable.

Some physicians will seek treatment in another city under an assumed name, Andrew said. Others live in a state of being miserable, because they are afraid.

Physicians appear to try self-medication, which Andrew said is not illegal but not a good practice. Some physicians have tried it with disastrous results.

“It may take many different trials of medication to get what works for you,” Andrew said. “If it doesn’t work [at first], you might come to the conclusion nothing will work for you.”

Andrew recommends seeking care from a psychiatrist or mental health facility and paying cash, so the insurance company is not involved.

Beware of physician health programs

While physician health programs (PHPs) have been established and operate with the expectation of helping physicians, they may not be the right choice.

“I would not send anyone to a physician health program,” Andrew said.

Physicians referred to a PHP will be drug tested, and even evidence of a single glass of wine could be considered an alcohol-use problem, Andrew said. The doctor at that point will be referred to a specific treatment center and kept there up to 90 days, which could cost $100,000 up front, Andrew explained. If a physician leaves, the center reports it to the board of medicine, and he or she is disciplined, including the possible loss of the medical license.

Florida recently passed legislation (HB 229) to require the Department of Health to establish terms and conditions of the impaired practitioner programs by contract. It also requires the department to refer practitioners to consultants and revises grounds for refusing to issue or renew a health professional’s license.

Louisiana’s Senate has unanimously passed a Physician’s Bill of Rights (SB286), which will grant physician’s rights against improper investigations and to provide due process.

Andrew recommends caution with such programs and to seek care elsewhere.

Whatever you do, don’t ignore the problem. A physician’s mental health and well-being cannot be overlooked.

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