Addressing Physician Depression: Why Physicians Rarely Seek Help

Posted on November 2, 2010 by VITAL WorkLife

 

With many healthcare organizations feeliStock_000009504484_XXXLargeing overwhelmed with the task of addressing the relatively few doctors that engage in disruptive—and potentially dangerous—behavior, can they really be expected to help doctors without performance problems address their personal anxiety and depression issues? The short answer is yes—and here’s why.

Often dismissed as “the common cold of mental health,” depression is a highly treatable condition that often goes untreated among medical professionals. Physicians are used to dealing with stress; it’s part of their training regimen. The people attracted to medicine often have oversize egos, confidence in their ability to handle any and all problems, and a fear that admitting a need for help could threaten their professional reputations.

Combine that personality type with the stress of practicing medicine today and it’s small wonder that the rate of suicide among physicians is 40% higher for male physicians and 140% higher for female physicians than among the general population. That’s a tragic consequence of failing to treat a highly treatable disease when the symptoms first emerge.

  • Untreated depression among your medical staff could also be taking a serious financial toll:
    A 2009 study by Blue Cross/Blue Shield of Tennessee estimated that depression, anxiety and emotional diseases were the fifth costliest of all disease categories in the workforce.
  • An overview of the literature on anxiety disorders found the estimated annual cost in the United States to be between $42.3 billion and $46.6 billion, of which 75% was attributed to indirect costs such as lost productivity.

Healthcare organizations may be paying an additional cost in terms of patient retention and outcomes. While a depressed doctor may not be angry or disruptive, a withdrawn, morose or preoccupied doctor is unlikely to give patients a sense of satisfaction or confidence in that doctor’s recommendations. More critically, they may not be delivering optimal care, which could lead to adverse events or errors.

If your organization isn’t actively encouraging your physicians to seek counseling or help as needed, chances are the majority of your troubled staff will attempt to self-treat or self-medicate their problems away—or not get treatment at all. In a 2010 survey of medical students experiencing depression:

  • 30% reported stigma as an explicit barrier to seeking mental health services
  • 37% identified lack of confidentiality
  • 24% cited fear of documentation on their student records.

For practicing physicians, stigma and confidentiality are issues, especially in states where there are licensure implications related to mental health issues. Furthermore, some physicians who have experienced depression have reported that they have had a difficult time when they have sought help, in some cases due to collegiality or reluctance on the part of their providers to acknowledge that there was an issue at all.

Given most physicians’ natural disinclination to seek help, what are your organizational options for addressing this issue?

Helping Physicians Address Depression:
Services and Programs

While many healthcare organizations offer Employee Assistance Programs (EAPs), few physicians take advantage of them. “Doctors face pressures unique to their profession,” explains Dr. Alan Rosenstein, medical director for VITAL WorkLife . “They don’t believe that services designed for the general public will meet their specific needs. They want to talk to somebody who’s walked in their shoes and understands the pressures of practicing medicine.”

This is why VITAL WorkLife designed an EAP specifically for physicians and their families. Available 24 hours a day, The Physician Wellness Resources offers confidential counseling, coaching and support—by telephone or in person. Physicians can call to talk one-on-one with a physician peer coach outside their organization, or even outside their geographic region, at a time and place that’s convenient for them, as well as with qualified mental and behavioral health professionals.

If a physician is self-referred for depression, a VITAL WorkLife senior consultant will work with him or her to assess their condition, evaluate various modalities of treatment and develop an action plan. Confidentiality is assured around all issues other than where VITAL WORKLIFE is required by law to report to the institution and/or licensing board.

The Physician Wellness Resources also includes a wide range of support services that can prevent or reduce stress in a physician’s life, ranging from marriage and individual counseling, to financial and legal services, to concierge services designed to maximize the quantity and quality of a physician’s personal time.

“Our hope is that physicians who take advantage of the full range of services offered by their Physician Wellness Resources benefit will avoid the cycle of stress and burnout that often leads to depression,” notes Rosenstein.

A Comprehensive Solution
For Healthcare Organizations

In addition to the Physician Wellness Resources, VITAL WorkLife offers two companion services which can assist and support medical executives and healthcare organizations:

  • Training, workshops and consulting services around the challenges faced by healthcare organizations. One way many organizations are working to create a culture of physician wellness is by forming Physician Wellness Committees (see article below), which VITAL WorkLife can assist with and support.
  • A comprehensive intervention program designed to help healthcare organizations intervene compassionately and effectively with physicians exhibiting dysfunctional behaviors (which may have underlying causes such as substance abuse and severe depression).

A VITAL WorkLife intervention typically begins with a comprehensive assessment of the impaired physician from a variety of angles. This is conducted using a multi-disciplinary team selected for their expertise in several areas. Once an assessment has been made and an action plan developed, VITAL WorkLife provides the services, referrals, monitoring and, where appropriate, reporting as required by state law.

“Our preference would be to have doctors refer themselves for help,” notes Rosenstein. “We’d rather be helping doctors improve their satisfaction with their practices and family life than helping doctors resurrect their reputations and careers after engaging in disruptive behavior.”

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