Evidence-Based Reviews

Depression and suicide among physicians

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Seeking special treatment

Self-treatment. Physicians may attempt to treat their mood disorder with self-prescribed medications before seeking consultation from a psychiatrist. Others use alcohol or illicit drugs to try to alleviate mood disorder symptoms. Self-diagnosis and treatment are not advisable because it is impossible to be objective. Professional boards and state medical boards discourage or prohibit self-prescribing because of the need for ongoing evaluation and monitoring for adverse reactions.

‘VIP’ treatment. When a physician comes to a colleague for help with a mental health issue, both parties might underestimate the severity of the crisis.24 Weintraub25 reported a case series of 12 “VIP” psychiatric inpatients, 10 of whom he described as “therapeutic failures, “including 2 who committed suicide and 3 who left the hospital against medical advice. He observed that improvement occurred only after patients lost their VIP status/treatment.

In a literature review, Groves et al26 found delays in pursuing diagnostic evaluation and treatment for physician patients. He described risks of VIP treatment (Table 3),26 including the physician’s ability to circumscribe the care regimen to obtain “special treatment, “which can create conflict among care providers and other patients. The ailing physician might have trouble relinquishing control. Care providers might not give physician patients necessary information about the illness or treatment because they make assumptions about the physician’s knowledge or fear causing narcissistic injury. Providers’ identification with their peers, deference to their background, and desire to preserve these patients’ autonomy may lead to interventions that are different from those they would provide to other patients.

Treating physicians might underestimate the patient’s suicide risk and tend to not hospitalize a physician patient who faces an imminent risk of self-harm. Similarly, a physician patient might know what key words to use to deny suicidal ideation or avoid hospitalization. Providers assessing physician patients should provide the same interventions they would give to nonphysician patients with the same history and suicide risk factors. To do otherwise is to risk a fatal outcome.

Physician health programs provide confidential treatment and assistance to physicians with mental illness and/or substance abuse problems. Some programs are affiliated with licensing boards, some are branches of the state medical societies, and others are independent of the licensing agencies. Directories of these programs are available from the Federation of State Physician Health Programs and the Federation of State Medical Boards (see Related Resources). Physician health programs aim to help impaired physicians receive treatment and rehabilitation without censure or licensure revocation, provided they comply with treatment and monitoring requirements.

Table 3

Risks of caring for ‘VIP’ patients

Caregivers, family, and the patient may deny the possibility of alcohol or substance abuse
Caregivers may avoid or poorly handle discussions of death and ‘do not resuscitate’ orders
The patient may suffer from emotional isolation when protected from the normal hospital culture
The patient’s feelings of shame and fear in the sick role can go uncomforted
Caregivers may overlook neuropsychiatric symptoms because they do not wish to ‘insult’ the patient
Staff may neglect or poorly handle the patient’s toileting and hygiene
Ordinary clinical routine may be short-circuited
Caregivers may avoid discussing issues related to the patient’s sexuality
Source: Reference 26

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Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

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