Dealing with Physician Depression and Related Issues
April 30, 2018
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.
physicians are not exempt from these conditions.
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
In the worst cases, untreated physician
depression can even lead to suicide. But greater awareness, preventive measures
and appropriate treatments can make a difference.
LEARN more about your physician
career options with Merritt Hawkins.
PTSD in 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.
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
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.
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.
burnout is a different issue. It is an occupational stress syndrome, Andrew
explained, and it does not lead to depression.
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
proactive thing that Davis recommends is getting at least eight hours of sleep
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,
Once the changes have been made and the
physician is feeling better, Davis recommends mentoring colleagues and
“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.
a new practice environment with Merritt Hawkins’ physician
Challenges of depression treatment
routinely diagnose and treat patients dealing with mood disorders, but they are
less likely to recognize their own depression.
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.
depression is readily treatable.
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.
appear to try self-medication, which Andrew said is not illegal but not a good
practice. Some physicians have tried it with disastrous results.
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.”
recommends seeking care from a psychiatrist or mental health facility and
paying cash, so the insurance company is not involved.
Beware of physician health
physician health programs (PHPs) have been established and operate with the
expectation of helping physicians, they may not be the right choice.
would not send anyone to a physician health program,” Andrew said.
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.
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.
Senate has unanimously passed a Physician’s Bill of Rights (SB286), which will
grant physician’s rights against improper investigations and to provide due
recommends caution with such programs and to seek care elsewhere.
you do, don’t ignore the problem. A physician’s mental health and well-being
cannot be overlooked.
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and Maintain a Healthy Work–Life Balance
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