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NEW YORK – The adage that physicians are the worst patients has more than a grain of truth to it when it comes to mental health issues, psychiatrists said at a workshop on physician mental health presented at the American Psychiatric Association’s Institute on Psychiatric Services.
"Why is it so hard for doctors to seek help?" asked Dr. Michael Myers, of the department of psychiatry and behavioral sciences at the State University of New York in Brooklyn.
The stigma of mental illness as perceived by physicians themselves is often a barrier to seeking mental health services. In addition, there is often stigma within the helping professions, and an institutional denial that even physicians might be subject to the thousand natural shocks that other humans are heir to, Dr. Myers said.
"Not all doctors are comfortable looking after other physicians, and it makes them a little squeamish," he said.
Many patients also are ambivalent about being treated by a physician with health issues, making the impaired physician even more leery about getting help, he added.
Stigma reinforces denial and delay in getting help, compounds symptoms, increases refractoriness to treatment, and contributes to strains in personal relationships. Stigma also affects medication adherence, because physicians might think they know better than anyone else what drugs they need.
"Stigma kills," Dr. Myers said, noting that deeply depressed physicians or those who feel very isolated and alienated have increased symptoms of melancholia, guilt, shame, cognitive distortion, and suicidality that can lead to suicidal actions.
Additionally, some physicians with depression or bipolar disorder might have comorbid cocaine, opiate, or alcohol dependence, increasing their risk for death from unintentional overdose or from a cascade of problems associated with substance abuse, such as marital breakups, economic threats to their practices, or scrutiny from medical boards.
At-risk physicians also might hesitate to seek care because they don’t want to impose on others, they have a tendency toward self-reliance, or they are too wrapped up in their work to pay attention to their own needs. Physicians also might worry that breaches in confidentiality could harm their careers, Dr. Myers said.
Code of Conduct
Dr. Linda M. Worley noted that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited facilities to have a code of conduct defining acceptable behavior and specifying which behaviors are disruptive and inappropriate, and to have a process or action plan for managing disruptive staff members.
She teaches a distressed physicians’ course at Vanderbilt University in Nashville, Tenn., where she is an adjunct clinical professor of medicine. A maximum of six physicians take the 6-month CME course at one time; many are there as condition of their continued employment. There are four faculty members, including a physician, social worker, psychologist, and addiction/assessment counselor. One observer is also allowed for each session, but the rules specify that he or she must take part in the exercises.
Physicians who are referred to the course are first interviewed by telephone to make sure that the program is a good fit and that the participants are not currently substance abusers, and course staff also conduct collateral interviews to determine the mental health needs of prospective participants.
The participants engage in an initial 3-day session at Vanderbilt and have three subsequent 1-day sessions over the ensuing 6 months.
"It’s a transformative learning experience. This is an opportunity to critically reflect on their life events, and that helps them to change their beliefs and their behaviors," Dr. Worley said.
The techniques employed include intellectual didactics, peer group exercises, emotional awareness training, and helping participants identify triggers of their inappropriate behaviors.
Early Intervention
Many of the challenges that Dr. Worley and her colleagues address in experienced physicians also confront physicians in training, noted Dr. Mai-Lan Rogoff, an associate professor of psychiatry and associate dean of student affairs at the University of Massachusetts in Worcester.
Medical school wellness programs are primarily aimed at preventing burnout, a problem more common among students than alcohol, substance abuse, or suicidality, Dr. Rogoff said.
She defined burnout as a triad of components as measured by the Maslach Burnout Inventory, a rating instrument developed by Christina Maslach, Ph.D., professor of psychology at the University of California at Berkeley.
Burnout is a combination of emotional exhaustion (feelings of being emotionally overextended and exhausted by your work), depersonalization (feelings of being a cog in a machine, having an unfeeling response toward those who receive your services), and having a low sense of personal accomplishment.
Burnout is associated with a variety of negative outcomes, Dr. Rogoff noted, including loss of empathy, substance abuse, and suicidal ideation.
"There are personal and environmental risks for burnout that are known and described in burnout in various settings. The interesting thing is that if you look at medical students and medical school, both sets of risk factors exist there," she said.
"On a personal level, you’ve got perfectionism, low resilience, negative focus, and all those issues, and environmentally one of the risk factors for burnout is unclear or impossible requirements or excessive workloads. This is the way most medical students feel," she added.
Medical students also acutely feel that there is a lack of time and a lack of control over their own circumstances, and that they face major consequences from mistakes and often have to deal with angry, upset, or ungrateful patients.
Medical school wellness programs address both the personal and environmental risk factors for burnout, with an emphasis on the latter. In addition to making counseling and therapy services readily available to students, wellness programs such as that in place at the University of Massachusetts focus on providing students with an increased sense of institutional support and peer support through group and team activities and exercises.
Although there are no objective data showing that such wellness programs work, "there’s absolutely no question that students like these programs," Dr. Rogoff said.
Dr. Myers, Dr. Worley, and Dr. Rogoff all reported having no relevant conflicts of interest.
NEW YORK – The adage that physicians are the worst patients has more than a grain of truth to it when it comes to mental health issues, psychiatrists said at a workshop on physician mental health presented at the American Psychiatric Association’s Institute on Psychiatric Services.
"Why is it so hard for doctors to seek help?" asked Dr. Michael Myers, of the department of psychiatry and behavioral sciences at the State University of New York in Brooklyn.
The stigma of mental illness as perceived by physicians themselves is often a barrier to seeking mental health services. In addition, there is often stigma within the helping professions, and an institutional denial that even physicians might be subject to the thousand natural shocks that other humans are heir to, Dr. Myers said.
"Not all doctors are comfortable looking after other physicians, and it makes them a little squeamish," he said.
Many patients also are ambivalent about being treated by a physician with health issues, making the impaired physician even more leery about getting help, he added.
Stigma reinforces denial and delay in getting help, compounds symptoms, increases refractoriness to treatment, and contributes to strains in personal relationships. Stigma also affects medication adherence, because physicians might think they know better than anyone else what drugs they need.
"Stigma kills," Dr. Myers said, noting that deeply depressed physicians or those who feel very isolated and alienated have increased symptoms of melancholia, guilt, shame, cognitive distortion, and suicidality that can lead to suicidal actions.
Additionally, some physicians with depression or bipolar disorder might have comorbid cocaine, opiate, or alcohol dependence, increasing their risk for death from unintentional overdose or from a cascade of problems associated with substance abuse, such as marital breakups, economic threats to their practices, or scrutiny from medical boards.
At-risk physicians also might hesitate to seek care because they don’t want to impose on others, they have a tendency toward self-reliance, or they are too wrapped up in their work to pay attention to their own needs. Physicians also might worry that breaches in confidentiality could harm their careers, Dr. Myers said.
Code of Conduct
Dr. Linda M. Worley noted that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited facilities to have a code of conduct defining acceptable behavior and specifying which behaviors are disruptive and inappropriate, and to have a process or action plan for managing disruptive staff members.
She teaches a distressed physicians’ course at Vanderbilt University in Nashville, Tenn., where she is an adjunct clinical professor of medicine. A maximum of six physicians take the 6-month CME course at one time; many are there as condition of their continued employment. There are four faculty members, including a physician, social worker, psychologist, and addiction/assessment counselor. One observer is also allowed for each session, but the rules specify that he or she must take part in the exercises.
Physicians who are referred to the course are first interviewed by telephone to make sure that the program is a good fit and that the participants are not currently substance abusers, and course staff also conduct collateral interviews to determine the mental health needs of prospective participants.
The participants engage in an initial 3-day session at Vanderbilt and have three subsequent 1-day sessions over the ensuing 6 months.
"It’s a transformative learning experience. This is an opportunity to critically reflect on their life events, and that helps them to change their beliefs and their behaviors," Dr. Worley said.
The techniques employed include intellectual didactics, peer group exercises, emotional awareness training, and helping participants identify triggers of their inappropriate behaviors.
Early Intervention
Many of the challenges that Dr. Worley and her colleagues address in experienced physicians also confront physicians in training, noted Dr. Mai-Lan Rogoff, an associate professor of psychiatry and associate dean of student affairs at the University of Massachusetts in Worcester.
Medical school wellness programs are primarily aimed at preventing burnout, a problem more common among students than alcohol, substance abuse, or suicidality, Dr. Rogoff said.
She defined burnout as a triad of components as measured by the Maslach Burnout Inventory, a rating instrument developed by Christina Maslach, Ph.D., professor of psychology at the University of California at Berkeley.
Burnout is a combination of emotional exhaustion (feelings of being emotionally overextended and exhausted by your work), depersonalization (feelings of being a cog in a machine, having an unfeeling response toward those who receive your services), and having a low sense of personal accomplishment.
Burnout is associated with a variety of negative outcomes, Dr. Rogoff noted, including loss of empathy, substance abuse, and suicidal ideation.
"There are personal and environmental risks for burnout that are known and described in burnout in various settings. The interesting thing is that if you look at medical students and medical school, both sets of risk factors exist there," she said.
"On a personal level, you’ve got perfectionism, low resilience, negative focus, and all those issues, and environmentally one of the risk factors for burnout is unclear or impossible requirements or excessive workloads. This is the way most medical students feel," she added.
Medical students also acutely feel that there is a lack of time and a lack of control over their own circumstances, and that they face major consequences from mistakes and often have to deal with angry, upset, or ungrateful patients.
Medical school wellness programs address both the personal and environmental risk factors for burnout, with an emphasis on the latter. In addition to making counseling and therapy services readily available to students, wellness programs such as that in place at the University of Massachusetts focus on providing students with an increased sense of institutional support and peer support through group and team activities and exercises.
Although there are no objective data showing that such wellness programs work, "there’s absolutely no question that students like these programs," Dr. Rogoff said.
Dr. Myers, Dr. Worley, and Dr. Rogoff all reported having no relevant conflicts of interest.
NEW YORK – The adage that physicians are the worst patients has more than a grain of truth to it when it comes to mental health issues, psychiatrists said at a workshop on physician mental health presented at the American Psychiatric Association’s Institute on Psychiatric Services.
"Why is it so hard for doctors to seek help?" asked Dr. Michael Myers, of the department of psychiatry and behavioral sciences at the State University of New York in Brooklyn.
The stigma of mental illness as perceived by physicians themselves is often a barrier to seeking mental health services. In addition, there is often stigma within the helping professions, and an institutional denial that even physicians might be subject to the thousand natural shocks that other humans are heir to, Dr. Myers said.
"Not all doctors are comfortable looking after other physicians, and it makes them a little squeamish," he said.
Many patients also are ambivalent about being treated by a physician with health issues, making the impaired physician even more leery about getting help, he added.
Stigma reinforces denial and delay in getting help, compounds symptoms, increases refractoriness to treatment, and contributes to strains in personal relationships. Stigma also affects medication adherence, because physicians might think they know better than anyone else what drugs they need.
"Stigma kills," Dr. Myers said, noting that deeply depressed physicians or those who feel very isolated and alienated have increased symptoms of melancholia, guilt, shame, cognitive distortion, and suicidality that can lead to suicidal actions.
Additionally, some physicians with depression or bipolar disorder might have comorbid cocaine, opiate, or alcohol dependence, increasing their risk for death from unintentional overdose or from a cascade of problems associated with substance abuse, such as marital breakups, economic threats to their practices, or scrutiny from medical boards.
At-risk physicians also might hesitate to seek care because they don’t want to impose on others, they have a tendency toward self-reliance, or they are too wrapped up in their work to pay attention to their own needs. Physicians also might worry that breaches in confidentiality could harm their careers, Dr. Myers said.
Code of Conduct
Dr. Linda M. Worley noted that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited facilities to have a code of conduct defining acceptable behavior and specifying which behaviors are disruptive and inappropriate, and to have a process or action plan for managing disruptive staff members.
She teaches a distressed physicians’ course at Vanderbilt University in Nashville, Tenn., where she is an adjunct clinical professor of medicine. A maximum of six physicians take the 6-month CME course at one time; many are there as condition of their continued employment. There are four faculty members, including a physician, social worker, psychologist, and addiction/assessment counselor. One observer is also allowed for each session, but the rules specify that he or she must take part in the exercises.
Physicians who are referred to the course are first interviewed by telephone to make sure that the program is a good fit and that the participants are not currently substance abusers, and course staff also conduct collateral interviews to determine the mental health needs of prospective participants.
The participants engage in an initial 3-day session at Vanderbilt and have three subsequent 1-day sessions over the ensuing 6 months.
"It’s a transformative learning experience. This is an opportunity to critically reflect on their life events, and that helps them to change their beliefs and their behaviors," Dr. Worley said.
The techniques employed include intellectual didactics, peer group exercises, emotional awareness training, and helping participants identify triggers of their inappropriate behaviors.
Early Intervention
Many of the challenges that Dr. Worley and her colleagues address in experienced physicians also confront physicians in training, noted Dr. Mai-Lan Rogoff, an associate professor of psychiatry and associate dean of student affairs at the University of Massachusetts in Worcester.
Medical school wellness programs are primarily aimed at preventing burnout, a problem more common among students than alcohol, substance abuse, or suicidality, Dr. Rogoff said.
She defined burnout as a triad of components as measured by the Maslach Burnout Inventory, a rating instrument developed by Christina Maslach, Ph.D., professor of psychology at the University of California at Berkeley.
Burnout is a combination of emotional exhaustion (feelings of being emotionally overextended and exhausted by your work), depersonalization (feelings of being a cog in a machine, having an unfeeling response toward those who receive your services), and having a low sense of personal accomplishment.
Burnout is associated with a variety of negative outcomes, Dr. Rogoff noted, including loss of empathy, substance abuse, and suicidal ideation.
"There are personal and environmental risks for burnout that are known and described in burnout in various settings. The interesting thing is that if you look at medical students and medical school, both sets of risk factors exist there," she said.
"On a personal level, you’ve got perfectionism, low resilience, negative focus, and all those issues, and environmentally one of the risk factors for burnout is unclear or impossible requirements or excessive workloads. This is the way most medical students feel," she added.
Medical students also acutely feel that there is a lack of time and a lack of control over their own circumstances, and that they face major consequences from mistakes and often have to deal with angry, upset, or ungrateful patients.
Medical school wellness programs address both the personal and environmental risk factors for burnout, with an emphasis on the latter. In addition to making counseling and therapy services readily available to students, wellness programs such as that in place at the University of Massachusetts focus on providing students with an increased sense of institutional support and peer support through group and team activities and exercises.
Although there are no objective data showing that such wellness programs work, "there’s absolutely no question that students like these programs," Dr. Rogoff said.
Dr. Myers, Dr. Worley, and Dr. Rogoff all reported having no relevant conflicts of interest.
AT THE AMERICAN PSYCHIATRIC ASSOCIATION'S INSTITUTE ON PSYCHIATRIC SERVICES
