Seeking Support Among Peers
Although many doctors talk to family and friends, the most common form of professional support is complaining among peers online and at work. "My friends and I would take online PHQ-9 [Patient Health Questionnaire] tests that showed we were severely depressed, and we would laugh and go back to work," states Dr Shola Shade Ezeokoli.
Some depressed physicians actually seek appropriate care with their primary physician, psychiatrist, or therapist. To keep appointments off of their official medical record, some use fake names, pay cash, and pursue treatment out of town to prevent medical board investigations and avoid local colleagues (because of confidentiality concerns). Selective serotonin reuptake inhibitors (SSRIs) appear to be the most popular prescribed medication for physician depression.
"During one part of my internship," shares Dr Joel Cooper, "I found out that at least 75% of my fellow residents were on SSRIs or other antidepressants just to get through it, because it was so horrible. Depression, or a constantly depressed state, is more or less the norm in medical school and throughout one's residency. It's truly a wonder that more doctors don't die by suicide as they go through this lengthy, rigorous, and often heartless process."
One reason doctors go underground for treatment is to avoid being referred to a physician health program (PHP). "My medical director suggested I self-refer to the PHP here," Adam says, "so I called (and didn't give my name) and was shocked by how unhelpful they were. They described the process, which would delay returning to work. I'd be forced to comply with years of monitoring and pay for multiple evaluations and random drug screens. (Even though I don't have a substance problem.) I may be mentally ill, but I'm not crazy! It seemed punitive and geared toward addicted docs, with nothing to offer everybody else."[3]
Owing to the punitive nature of physician treatment programs, such as PHPs, and the prevalence of intrusive mental health questions on physician licensing, hospital privilege, and insurance credentialing applications, many doctors avoid seeking needed care.
Physician Self-destruction
Physician self-harm can take the form of self-destructive thinking patterns, addictions, and even suicide. Drinking after work is popular among depressed physicians and can quickly escalate into a dangerous routine. A doctor named Paula stated[4]:
Recently I recognized the signs and it startled me—if one glass of wine calms the entangled fallout at the end of a day of difficult patients, families and unrealistic expectations around life expectancy, disease outcome, and cultural entitlement, then two does it better! Beginning to anticipate that 'glass-of-friend' awaiting me at the end of a 'document-this-right-or-get-prosecuted' day, I abruptly set it all aside for hot tea and orange juice. Honestly, it freaked me out how easily it happened that alcohol soothed and asked no questions—and how smoothly I justified it. If you don't think it can happen to you...
Self-harm behaviors may also include having affairs, keeping scalpels on hand, stockpiling pills, or buying a gun. Some docs stop looking both ways before crossing the street in what can be termed an "accidentally on purpose" suicide attempt. Those who fail self-harm as their primary treatment strategy for depression may eventually turn to self-care and then seek professional help with a physician.
Others maintain suicide back-up plans for comfort. "I have been actively suicidal over the past 7 years more times than I can count," claims a doctor called Mike. "In a strange way, it has become one of the few comforting constant areas/states where I feel I exert some degree of control and autonomy. What I think I experience when it comes to my profession goes beyond 'clinical depression.' It's the depletion of one's humanity."
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Cite this: Pamela L. Wible. Doctors and Depression: Suffering in Silence - Medscape - May 11, 2017.
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