Destigmatize: Local doctors push to break the stigma on physician mental health
Editor’s note: This story includes the mention of suicide and its impact on a community. If you or someone you know is suicidal, you can reach the national suicide hotline at 800-273-8255.
About 400 doctors die by suicide in the United States each year. That’s the size of a medical school’s graduating class.
Dr. Steven Reid, 68, said those 400 physicians translate to roughly 1 million U.S. patients who lose their doctors annually.
Yet the retired neurosurgeon said the general public doesn't recognize this problem. Reid started Doctor Lifeline, a nonprofit organization that works to uncover and resolve the circumstances causing the high rate of physician suicide, in 2018 as a project for his retirement. Losing seven colleagues and his father to suicide, he said he felt he had a unique perspective.
“If you randomly were to look into an exam room in a doctor's office anywhere in the country, the doctor is about twice as likely to die by suicide than the patient in front of him or her,” Reid said.
Reid said there’s a culture in medicine that expects perfection from doctors. There’s a belief that if a doctor takes time off from their practice, they’re dumping their responsibilities onto their colleagues, he said.
Throughout Reid’s training, from internship to his graduation from the neurosurgery residency program, he said he took only one day of sick leave. In terms of mental illnesses, speaking about being depressed or burnt out is “taboo in the culture,” Reid said.
Doctor Lifeline is looking to change that culture.
“I think depression needs to be recognized and destigmatized,” he said. “I think that there shouldn't be any cultural cost for a young physician to say, ‘Hey, I'm really depressed.’”
But the reality is there are many reasons those in the medical field decline to share their mental health issues. Reid said the fear of a documented illness influencing their licensing, referrals and ability to get insurance causes some to suppress the truth.
Dr. Mariam Rahmani, 40, said people should treat mental health care like regular health care. The psychiatrist said licensing for physicians to practice shouldn't ask “do you have any mental health conditions that impair your ability to work?” but instead should ask “do you have any health conditions?”
Health includes mental health, Rahmani said.
“The implicit message is that physical illnesses are different than mental illnesses,” she said. “I think some of the stigma was perpetuated by those medical licensing questions.”
Competitive. That’s one word to describe the medical field. Rahmani said it puts pressure on a lot of people. When she attended medical school, she said the grading scale consisted of the plus-minus system, However, many institutions today have switched to a pass-fail system. She said this is significantly better.
When you're competitive, you compare yourself to those around you, she said. And unfortunately, Rahmani said the addition of a mental illness exacerbates imposter syndrome.
“I think there also is a lot of fear that they might be discriminated against,” she said. “Discrimination, retaliation and not getting opportunities because others might underestimate their ability because of having a mental illness.”
Most of those who enter medicine do so because “they feel that they have a mission to help their fellow man,” Reid said. He said there is a mismatch between what people going into medicine expect and what it’s become.
He said this creates tremendous emotional dissonance as their occupational expectations are not met.
“They find themselves in this kind of industrial assembly line that modern medicine has become, where the main function of the doctor is to check the right box and to make money for the corporation that they are employed by,” Reid said.
Rahmani echoed a similar statement, saying insurance companies ask her to change prescriptions so the company can pay less, rather than trusting her clinical expertise. She said her primary concern is the patient — not herself or the insurance company.
So deeply rooted in their practices, doctors' own woes are so often forgotten.
According to the Missouri State Medical Association, a quarter or more of physicians have no primary care provider.
Rahmani said some insurance companies only cover doctors’ psychiatric treatment at the hospital where they’re employed. She said this raises concerns about privacy and confidentiality, making physicians, medical students and other healthcare providers reluctant to get help. Some institutions even limit free counseling sessions through their employee assistance program, making the resource ineffective, she said.
This leaves a looming sense of helplessness, Reid said.
“I think physicians find themselves in situations that are just emotionally untenable, egregious situations where they feel that there's no other alternative,” he said.
Due to the effects of COVID-19, Reid said there is already a prominent physician shortage.
Reid said there needs to be detoxification of the environments where physicians practice; physicians should be allowed to be physicians.
“I think if the public doesn't wake up and recognize that things must change, we're going to find that we are going to be severely lacking physicians,” Reid said.