Stigma and the Ailing Physician: Part 2

Last month I introduced the confounding variable of stigma in symptomatic physicians and how much doctors delay going for help – or even worse, eschew treatment all together! Let me explain some of the consequences of procrastinating and not seeking timely treatment.

First, we have known for some time that early intervention in most psychiatric illnesses affects treatment efficacy and prognosis. This is especially true in depression and underlies the public health imperative of educating citizens about the incidence of depression in our society and the need for prompt diagnosis and treatment. It is sadly ironic that most physicians, especially primary care doctors, know this and are increasingly screening for depression in their patients, but they turn a blind eye to their own symptoms. Although most of them will still respond to first line treatment when they do seek help (or even have a spontaneous remission with no treatment), some won’t. These physicians take longer to get better and may struggle for some time with residual symptoms and will require the expertise of a good psychopharmacologist utilizing combination and augmentation medication strategies along with sophisticated psychotherapy.

Second, practicing medicine when you are not at your best is risky. Errors of commission and omission are a distinct possibility, if not a probability. Cognitive slowing and/or distorted thinking mean you’re not as diagnostically and therapeutically sharp as usual. Multitasking is an essential skill in medicine – and you can’t do this if you’re distracted and can’t concentrate. Memory impairment is a common symptom of depression and it’s hard to follow the patient’s story and ask the right questions if you can’t remember what was said a few minutes earlier. Confident decision making is diminished with depression, so you end up hesitating, deliberating, or doubting your findings and course of action. Prescription writing and staying on top of charting, electronic health records, and billing become onerous.

Third, living with untreated psychiatric symptoms puts vulnerable doctors at risk for a range of medical illnesses, including coronary artery disease, hypertension, diabetes and other endocrine disorders, musculoskeletal maladies, and more. The comorbidity is quite serious. And too commonly, physicians slowly increase what was once social use of alcohol, so that they now become symptomatic drinkers, which can lead to a substance use disorder. A smaller cohort of doctors reverts to street drug usage – marijuana, cocaine – or anesthesiologists and surgeons may begin to divert opiates in the workplace.

And fourth, symptomatic primary care physicians and psychiatrists (or any other group of physicians with a working knowledge of psychotropic medicines) begin to treat their self-diagnoses with antidepressants, tranquilizers, and hypnotics at bedtime. To be fair, this sometimes works and the physician begins to feel better. Some of these doctors will call a psychiatrist at that point and ask her/him to take over the prescription(s). But many won’t and keep treating themselves, which is never a good idea. When self-medicating doesn’t work, those same doctors confuse themselves trying to determine if they are getting worse or developing initiation side-effects. They stop and start medications willy-nilly because they don’t have the objective medical judgment that they use with their patients. Sometimes they can become dangerously toxic from very ill-informed self-medicating.

What about ailing physicians who do recognize that they are ill and go for help like John Q Public (or Jane Q Public)? In my next blog, I will describe how stigma can still be a force to be reckoned with in the doctor-patient relationship.

Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.