December 8, 2014
You Can Keep Your Doctor…If He Doesn’t Kill Himself
By Michael D. Shaw
As the ACA (Obamacare) enters its comic relief phase, with the Jon Gruber videos; the “now you tell me” confessions of Democratic lawmakers who say that the bill should not have been passed; and the truly unwanted resurrection of Kathy Sebelius, maybe it’s time to get serious once again. In health care, it can’t get any more serious than physician suicide.
Official estimates put the annual toll of American physicians who die at their own hand as high as 400. But, given the stigma of suicide—especially among doctors—this figure is probably low. Indeed, what are the chances that a physician, fully trained in drugs and dosing, would die of an “accidental overdose”? Of course, such cases, using this favored method of physician suicide, are much easier to cover-up than firearms, the runner-up method.
Quite sadly, but also quite understandably, doctors exceed the suicide completion rate of the general public by more than a factor of two. After all, they do have greater knowledge of these matters, and have ready access to all sorts of dangerous substances. Notably, in all populations, suicide is usually the result of untreated or inadequately treated depression, coupled with knowledge of and access to lethal means.
So, what about depression in physicians? Studies based on confidential questionnaires find that 12% of male and 18% of female doctors are depressed. Given the unconscionable mess that is American health care, one wonders why the percentage isn’t even higher. How is it not depressing to assume massive student debt, to then face long hours; assembly line medical office practices; the realization that at best, you are working for the insurance industry; and the constant threat of litigation?
Fifth-generation physician Louise B. Andrew MD JD, called “the godmother of wellness in emergency medicine,” is the founder of MD Mentor, offering personalized litigation stress support for health professionals. Here are some key points from Dr. Andrew’s essay entitled “Medical Malpractice Stress Management: A Necessary Skill for Practicing Physicians”:
Why are allegations of malpractice so uniquely stressful to physicians? Because the tactics employed by both sides, and indeed the judicial process itself, are uniquely designed to pressure defendants to settle cases. And settling a case of alleged malpractice is a body blow to a professional who has spent a lifetime dedicated to helping others.
Almost all physicians are by nature perfectionists, compulsive, and self-neglecting. We chose this profession because we are action oriented, take-charge types, who want to be appreciated for making a positive impact on people’s lives in their most vulnerable moments. A charge of negligence strikes at the core of our self-image, our self-esteem, and at our beliefs about the value of our life’s work.
Adding insult to injury, a legal claim forces us to defend ourselves in a system in which we have little to no control, where processes are painfully slow and where the results may bear little relation to our efforts, yet can potentially have a permanent impact on our ability to practice. Regardless of the eventual outcome, sued physicians almost always have physical and/or emotional reactions to the claim.
The suicide note of a Texas emergency physician, written the day after he settled a malpractice case, read, “I hope that my death will shed light on the problem of dishonest expert testimony.”
Rarely discussed is that a host of problems arise when doctors wish to be treated for depression. HIPAA confidentiality seems to disappear, and such physicians are often subject to repetitive and intrusive examinations, licensure restrictions, discriminatory employment decisions, practice restrictions, hospital privilege limitations, and increased supervision. As a result, few seek treatment, and most of those who do are advised not to pursue it.
Insider blogs are full of litigation and just plain medical practice horror stories, that—as they say—would make a grown man cry. Don’t be surprised if you see much more on the topic of physician suicide in the coming months. I promise you…future historians will not be kind when describing how we ruined our health care system, following the advent of Medicare in 1965. Thanks, Lyndon!