The death by suicide last fall of Bangor orthopedic surgeon Dr. John West reflects a disturbing trend: Physicians may be less likely than other groups to seek and receive the help they need to combat depression and the everyday stresses of life.
According to the American Foundation for Suicide Prevention, death by suicide is about 70 percent more common among male physicians in the United States than among other male professionals and as much as 400 percent higher among female physicians than among women in other professions.
Ann Haas, director of prevention projects for the foundation, said in a recent interview that the high levels of professional stress associated with practicing medicine do not alone account for the disparity.
“We think a big part is low rates of treatment, coupled with the higher than average capacity to kill oneself because of access to medications and other lethal means,” she said. Physicians are especially reluctant to seek treatment for depression, substance abuse and other disorders, she said.
For one thing, licensing and certification boards require doctors to report mental health diagnoses and treatment, and they may be considered professionally “impaired” if they do.
For this and other reasons, she said, there is a deeply rooted culture of concealment and denial of mental health problems in the medical community.
For women in particular, Haas said, the stress of medical practice often proves overwhelming as they struggle to prove themselves in a demanding career that is still dominated by men.
“They’re told, ‘Don’t tell anyone, don’t go get help; it will mar your career,’” Haas said. Although women in the general population are both more likely to suffer from depression than men and more likely to seek treatment, female doctors often suffer depression without seeking help, she said.
According to Dr. Eric Steele, chief medical officer of Brewer-based Eastern Maine Healthcare Systems, doctors are trained to keep their emotions in check, to insulate themselves from pain, and to disguise their personal vulnerabilities.
“Doctors have access to tremendous health care resources, but we’ve been trained not to ask for help,” Steele said.
The problem is compounded by the professional deference with which health care providers may treat colleagues who do seek help, he said.
In recognition of their education and expertise, “we give them more autonomy than is good for them as patients,” Steele said. Reluctance to pry into a colleague’s personal affairs or question professional judgment can lead health care providers to avoid asking tough questions, he said, such as whether a patient is abusing drugs or alcohol or feels in danger of suicide.
Physicians also struggle with the same day-to-day realities as other people, Steele said. Like many members of the post-war baby boom generation, he said, “our kids are moving out, our physical stamina is changing, our relationships are changing. It turns out these things affect us, too.”
Haas said there is growing recognition within the medical community that the issue of physician depression and suicide must be addressed. Some medical schools offer anonymous screening and counseling to their students, residents and faculty, she said, and some states are considering revisions to their licensing and certifica-tion regulations.
The goal is to “break down barriers to treatment,” she said, “and to send the message that the culture is changing.”
When American Foundation for Suicide Prevention medical director Paula Clayton spoke to physicians at Maine Medical Center in Portland after West’s suicide last fall, the event was well-attended by doctors from across the state. The foundation remains in close contact with a number of physicians and their families in Maine, Haas said.
Concern about depression and suicide in the medical community is not new.
A 2003 article in the Journal of the American Medical Association found that depression and suicide among physicians is made worse by a culture that imposes punitive barriers to treatment and discrimination in professional advancement.
“As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students,” the authors concluded.
The Medical Professionals Assistance Program, offered through the Maine Medical Association, coordinates treatment for physicians and other health care providers at risk of professional impairment due to substance abuse, mental health problems or other conditions.
Clinical director Margaret Palmer said everyone who enters the program is screened for depression.
“Physicians maintain an image of themselves that is always strong, always correct,” she said. “They’re the last to want to reveal any vulnerability.”
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