12 May 2008

Doctors and suicide know-how

A study has highlighted a grim, rarely talked-about problem: that the medical know-how doctors learn in order to save lives makes them especially good at ending their own.

It seems that knowing too much really can be bad for your health – especially if you're a doctor. A study has shown the grim, rarely talked-about twist that medical know-how doctors learn to save lives - it makes them especially good at ending their own.

The problem is exacerbated by the fact that some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado – meaning that many fear admitting they have a psychiatric problem as this could be fatal to their careers. So they suffer in silence.

Johannesburg-based psychiatrist, Dr Frans Korb says that while this could be as much of a problem in South Africa as the rest of the world, he is unaware of any statistics available to prove this. He could however, confirm that in his experience, doctors do indeed suffer from depression just as often as us 'ordinary' folk do.

"A medical doctor is under huge amounts of stress daily. They work long hours on very little sleep and this stress is often what leads to depression," says Korb.

But surely a doctor, who is trained to recognise the symptoms of depression and stress, would be able to identify the problem and seek the appropriate help? Apparently, it's not that simple.

Doctors' pride prevents them seeking help
"Doctors are trained to save lives and help people, it's in their personality to do. So when they get sick and thus become the patient, the roles are reversed and this is incredibly difficult for many of them to accept," he says, and adds that this often leads to them not seeking the help they need.

Dr Glenn Siegel, who runs a suburban Chicago program that treats doctors with drug abuse, depression and other psychiatric problems shares the same view and says, "Depressed doctors frequently decide to self-medicate, but don't seek psychotherapy that could help them deal with underlying issues.

"It's not a safe topic to be as open about in that profession because you're responsible for the well-being of others," Siegel says. "If you're admitting something like that, you're saying maybe you're not fit to do your job."

Dr Robert Lehmberg, an Arkansas surgeon who has battled with depression, says, "You just would rather take a risk with your health than your career. It's not like you get a second chance with it."

Many docs deeply embarrassed by 'problem'
A psychiatrist in the New York area who asked to remain unidentified said he had suicidal thoughts every day for several years. But in medical school in the 1980s, he says he was so embarrassed about seeking help for depression that he went to a pay phone instead of his dorm to call a therapist.

As the stigma persists, he said he didn't want his name used to avoid hurting his family and relationships with colleagues and patients.

Some studies have suggested depression is more common among doctors, especially women physicians, and that the high demands of a job dealing with life-and-death issues makes them prone.

'Docs at no more risk than anyone else'
But Dr Erika Frank, a specialist in research on physician health, questions this reasoning and says she worries that singling out physicians risks 'pathologising' a profession whose members generally "have it awfully good."

"I think the situation gets portrayed as far more grave than it really is for physicians compared to anyone else in the world," Frank said.

There could be reasons why the stigma would be worse for doctors, "but you can come up with just as many reasons why physicians would be better equipped to acknowledge mental illness," she said. "We've all done psychiatric training. We all know bad mental health outcomes happen to good people," she said.

Medical knowledge dangerous to suicidal docs

Doctors have easy access to prescription drugs and a precise knowledge of how the body works - and they know exactly the amount of a drug needed for an overdose to stop breathing and halt the heart.

Physician suicide a huge problem
According to the American Medical Association, physician suicide is 'an endemic catastrophe' which led them to pledge to work in order to prevent the problem. But the suicides have persisted.

In an attempt to address this, the American Foundation for Suicide Prevention has launched an educational campaign in hopes of making troubled doctors more willing to seek help. The American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of antidepressant pills, paid for the program. It includes a documentary titled 'Struggling in Silence'.

"It really has been swept under the carpet," said Dr Paula Clayton, the suicide foundation's medical director. The foundation says 300 to 400 doctors commit suicide each year based on estimates from research, but that more studies are needed to get a more precise count.

Another estimate of 250 yearly comes from an online article by Dr Louise Andrew and in American Medical News, an AMA publication. But a spokesman said the AMA doesn't track doctor suicides because accurate numbers aren't available.

Statistics unreliable and often unavailable
Suicide figures in broader society are not completely reliable because suicide is often not given as the cause of death. The overall US suicide rate among men is four times higher than in women - about 23 per 100 000 versus about six per 100 000 in women, according to the most recent government data.

But among doctors, suicide rates are about equal for men and women. A 28-state study from 1984 - 95 found women doctors were more than twice as likely as women in the general population to kill themselves.

Men were more than 70 percent more likely inside the medical profession than overall to commit suicide. One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr Frank.

Studies into problem often flawed
A study in Denmark, published in 2007, found more suicides in doctors than among more than 20 other professions, including nurses, factory workers, elementary school teachers, corporate managers and architects.

Some studies have been based on newspaper obituaries, which are 'flawed at best' because suicide often isn't listed as a cause of death, said Dr Morton Silverman, a University of Chicago suicide expert.

New Jersey physician Ron Brown suffered from depression and killed himself in 2002. His widow, Mumtaz Bari-Brown, said she believes the stigma kept her husband from getting help in time to save his life. As a boy, Brown had been told his father died of a heart attack, not the real cause of suicide, the widow said.

"We have to stop the hiding and the ignorance and recognise it as a disease like high blood pressure or diabetes," said Bari-Brown, who also is featured in the new documentary.

Doctors need support, assurances
Dr G. Richard Smith, Lehmberg's doctor and director of the University of Arkansas for Medical Sciences' psychiatric research institute, said doctors need assurance they won't risk their jobs if they seek psychiatric help.

Smith succeeded in getting changes to questions on medical license applications in Arkansas that he believes will help. The old application asked doctors if they were being treated for mental illness or ever had been. A 'yes' answer required a psychiatrist's note declaring they were fit to practice medicine. Now, they need only disclose mental health treatment that was advised or required by medical authorities

The previous form didn't keep doctors with psychiatric problems from practicing, Smith said. But it did keep 'doctors who needed treatment from getting the treatment that they needed.' – (Sapa)

May 2008

Read more:
Men more prone to suicide
Blood test to diagnose depression


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Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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