Saturday, May 15

Do punitive rules force doctors to hide their mental health problems? | US Health


Dr Mary Dinh, 31, described her medical training during the pandemic as a harrowing experience. Constantly fearing she would take the virus home for lack of PPE, she wore an N95 mask until it disintegrated and saw 13 patients die in one day at her Pennsylvania hospital. Dinh was desperate to see an unprecedented death, her colleagues are battling depression, and a fellow resident attempts suicide.

“Residency is already one of the most difficult and challenging times in a doctor’s life,” Dinh said, referring to the three or four years of training after medical school. “Add a pandemic to that, a shortage of doctors, and the residents are essentially slave labor for the hospital.”

Dinh says her program fostered a culture in which residents were unable to seek mental health care while maintaining the demands of workweeks longer than 80 hours. He turned to older doctors who advised him to get out of town, pay cash, and use a pseudonym if he needed to speak to someone. “It’s almost like a really shady deal just to get mental health care and some support,” Dinh said. “I am not doing anything illegal.”

He found a therapist almost two hours away. “It was incredibly helpful and rejuvenating,” Dinh said. But his work environment was so unbearable that a month ago, Dinh left the program.

One year after the pandemic, doctors struggle with the occupational hazards of working in medicine, including trauma, death and lack of sleep. The Covid-19 virus has only added to the exhaustion that doctors already faced before the pandemic. A 2018 literature review of 10 years of research published in peer-reviewed journals it showed that physician suicide was twice the rate in the general population. From 28 to 40 per 100,000, the loss was greater than the military.

Most of the general public can seek mental health care without worrying that their careers are at risk. This is not the case for doctors. In most states, once a doctor seeks help for mental health issues, including anxiety, post-traumatic stress disorder (PTSD), or addiction, they are required to report their condition on the application for a state medical license. .

Honestly answering mental health-related screening questions can raise red flags, putting a doctor’s license at risk. After a decade of debt averages in education and medical schools $ 215,900, doctors are afraid of jeopardizing their livelihood.

Interviews with physicians reveal the extraordinary steps some will take to avoid being linked to a mental health diagnosis. They will travel to an out-of-state pharmacy to obtain medications, pay cash to see a therapist or psychiatrist so that health insurance billing is not linked to mental illness, and strategically discuss their struggles with only those they trust.

State medical boards are responsible for licensing, investigating, and disciplining a physician.

But Dr. Pamela Wible, a family physician, researcher, and founder of Ideal Medical Care who started a hotline in 2012 for doctors who need confidential help, says they go too far, violating a doctor’s privacy and discriminating against them for seeking help under the Americans with Disabilities Act. Act. “The tone in these apps is punitive,” Wible said. “They have a total intolerance to allow the doctor to be human.”

Along with co-investigator Arianna Palermini, a medical student, Wible studied each state’s medical license applications, rate your approach to mental health screening questions. Some, like Michigan and Nevada, got an A for not asking questions about mental health or limiting them to their current disability. Florida, Alaska and Washington were among those who earned an F for questions that span a doctor’s entire medical history rather than their current mental health status.

Wible says there is a difference between disabled doctors who are unable to care for the patient and those who need support to cope with the daily dangers of working in medicine or who are going through a difficult time in their lives such as divorce or anxiety postpartum. “They [medical boards] they do not segment or stratify physicians. It’s pretty much a one-size-fits-all solution for anyone who deviates from their expectations, ”said Wible.

Dr. Stephanie Colantonio, 32, a California pediatrician, struggled with the stress of medical school and residency, stress that manifested as abdominal pain and migraines. He approached a social worker who connected Colantonio to a therapy service.

The deadly coronavirus pandemic has only added to the stress faced by doctors in the US.
The deadly coronavirus pandemic has only added to the stress faced by doctors in the US. Photography: Étienne Laurent / EPA

When it came time to apply for her medical license in California, Colantonio remembers feeling relieved that she hadn’t used any psychiatric medications. “There’s nothing wrong with that, but I felt like, ‘Okay, I have nothing to report other than going to therapy,’ ‘Colantonio said.

Sarah, who requested that her last name be withheld out of fear of retaliation, is a Wisconsin-based physician who has been diagnosed with ADHD and depression. Take Ritalin, a prescription medication for ADHD. “It calms me down and allows me to focus,” he said. But it is also a controlled substance due to its addictive nature when abused.

If Sarah applied for a medical license in a state like Alaska, you would need to disclose that you have ADHD, that you take a controlled substance for ADHD, and send a letter from your treating physician verifying that you can safely practice medicine.

Through a trusted friend, Sarah found an Arizona-based psychiatrist who accepts cash to avoid documentation. Although her doctor is a 26-hour drive from her, he says it’s worth it. He also sees a virtual therapist in Virginia who he pays via PayPal and knows that there is still a risk that he can be traced. There is nothing you can do about Ritalin, which is tracked statewide through prescription drug monitoring programs.

“There is a very, very big difference between having mental health problems and impaired mental health problems,” Sarah said. “And because we don’t allow people to feel like a normal human being in medicine, people feel like they have to hide it under the rug.”

Studies keep in mind that untreated mental health symptoms can lead to disease worsening and suicide.

But Mayo Clinic Proceedings found that 40% of doctors They were reluctant to get help for a mental health condition because of the impact it can have on their medical license. To address the problem, the American Medical Association adopted a new policy in 2018 that encouraged state licensing boards to focus screening questions on the physician’s current disability rather than prior medical history.

Wible reflected on the death of Dr. Lorna Breen, medical director of the emergency department at a New York City hospital who died by suicide in the early days of the pandemic. “Imagine Lorna Breen having to sneak out of town, pay cash, and use a fake name to get mental health care, how well would that go?” Wible said. “That is an impossible scenario.”

Arizona-based freelance psychiatrist Dr. Lisa Goldman understands the complications physicians face when trying to seek mental health care. Your practice does not accept insurance. “Without a license, it is basically like a crippled horse. The game is over, ”Goldman said.

Goldman believes that the doctors, nurses and other healthcare workers he treats are not a danger to the public, they simply want to alleviate his symptoms. “They don’t want to be in a bad mood. They don’t want to be irritable. They don’t want to get mad at their families, ”he said.

For now, Dinh is taking time to recover from his residency experience and spend time with family. “If you create a medical community that is afraid to seek mental help, then you create a culture that shames the doctors who are suffering,” Dinh said. “We need to completely abolish the myth that doctors are superhuman and can endure human rights violations in the workplace.”


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