Monday, January 30, 2006

Perhaps We can All Work Towards This

How do you deal with all that happens and not get depressed?

This comes up a lot, usually from the friends not in the medical field. It goes hand in hand with questions like “Have you ever killed somebody?”

So I took some time off from actively killing someone and it occurred to me that, considering the circumstances, it is unlikely that many physicians don’t get depressed and that more don’t eventually commit suicide. So why don’t many more doctors get depressed?

Depression is a common syndrome affecting a large proportion of the constituency. One would think that all that pain and suffering witnessed on the job would induce depression even in Richard Simmons, Not to mention the experience of being an intern. Not to mention being MY intern.

Here’s the answer: They do get depressed, often, in deadly ways, and more commonly than the general population.

Most of the research of depression rates in physicians points to higher rates than the general population but predisposing risk factors which are the same as those in the general population. Surprising, as one would think that physicians are more prone to depression due to the nature of their profession. But this is not, and is, the case.

My only thought is that the rewards of medicine compensate somehow or that it becomes a “job”, and as a defense mechanism loses its magnitude in the eye of the practitioner.

There are some aspects of “the job” which do predispose physicians to depression, but they're not the ones you may have guessed. From an article published in the NEJM on physician depression and suicide:
Another way to view the problem is that the professional burden carried by doctors leads to social isolation and an increased probability of undergoing phases of disturbances in their social networks. It has also been noted that physicians tend to neglect their own need for psychiatric, emotional, or medical help and are more critical than most people of both others and themselves. They are more likely to blame themselves for their own illnesses. And they are apparently more susceptible to depression caused by adverse life events, such as the death of a relative, divorce, or the loss of a job.

There are few interventions in place to help prevent suicide among physicians. Such safeguards might include the provision of discreet and confidential access to psychotherapy and open discussion of the stress encountered in a medical career. The barriers that may prevent physicians from seeking help for mental disorders (such as the threat of losing their medical licenses) must also be addressed. In time, perhaps these and other measures will help doctors to do what they do best: save lives, beginning with their own.
From JAMA: Cross-sectional rates of depression (15%-30%) are higher in medical students and residents than in the general population.

It gets worse, medical personnel are more successful at suicide, which led to a consensus statement released in JAMA in 2003. Among the issues addressed was the difficulty that physicians face when trying to obtain help for mental health disorders:
Thirty-five percent of physicians do not have a regular source of health care, which is associated with less use of preventive medical services supporting the observation that the medical profession does not encourage physicians to admit health vulnerabilities or seek help.

It is reasonable to infer that physicians' concern about disclosure of mental health records is widespread, although studies are lacking. Breaches of confidentiality also are believed to harm openness between the physician (as patient) and the treating clinician and may result in needless disclosures to coworkers. Those concerns, coupled with professional attitudes that broadly discourage admission of health vulnerabilities, are likely the driving forces behind physicians' disinclination to seek mental health care.
Wonder what they were discussing? (From the same consensus statement)
The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians in seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement.
I know two physicians who committed suicide. And have heard of many more medical students who’ve succeeded as well.

If you are a medical professional and would like help you can find more information here:


Blogger incidental findings said...

You've touched on one of the greatest problems with physician wellbeing. It is actually professionally dangerous to get help.

6:26 PM  
Anonymous Health Blog said...

It is reasonable to infer that physicians' concern about disclosure of mental health records is widespread, although studies are lacking.

12:20 AM  
Anonymous Brice said...

Thanks so much for this post, pretty helpful data.
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12:33 AM  

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