A physician who feels hopeless and worthless and complains of pain
Dr. D, age 33, complains of worsening depression, pain and muscle tension, and suicidal ideation. How would you treat a physician−colleague?
Next, the treatment team introduced progressive relaxation. Again, the simplicity of this process of tensing and relaxing groups of muscles was met with disbelief. Our therapist explained that voluntarily producing muscle tension facilitates the relaxation response of both the mind and the body. The mind first commands the muscles to do what it does easily— “tense”; then is asked to elicit what is more difficult—“relax.” Repetition of the simple commands “tense—relax” in the arms, legs, back, abdomen, shoulders, neck, and face establishes a calming rhythm, again increasing the sense of control.22 We strongly encouraged daily practice of this exercise and Dr. D committed to the mindful breathing and relaxation exercise.
OUTCOME Recovery, maintenance
Dr. D and his psychotherapist address his anger, all-or-nothing thinking, and loneliness. Grief over his failed marriage was identified, giving them an opportunity to explore this loss and past, perceived losses of his parents’ affection in the context of the therapeutic relationship. Supportive therapy promoted ways to fulfill his ideal self.
Treatment lasted 2 years. Dr. D’s prior depressive episode indicates a need for maintenance medication. The antidepressant is continued and, with help from supportive psychotherapy, stress management, 8 weeks away from work, and the life changes mentioned above, our patient has not had a relapse.
Bottom Line
Depression and thoughts of suicide are common among physicians. Grant time off from work and reassure the physician that he (she) is entitled to seek medical treatment without repercussions. Adapt the type of psychotherapy to the physician’s specific concerns. Because physicians are at particular risk for loss of the ideal self, first consider person-centered therapy.
Related Resources
• Vanderbilt Center for Professional Health. www.mc.vanderbilt.edu/cph.
• Federation of State Physician Health Programs, Inc. www.fsphp.org.
Drug Brand Names
Clonazepam • Klonopin Fluvoxamine • Luvox Zolpidem • Ambien
AcknowledgementThe authors wish to acknowledge the contribution of Rachel Sieke, BS, Research Assistant, Department of Psychiatry, University of Toledo Medical Center, Toledo, Ohio.
Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
