I’ve been marinating on this one for a while. And 3.5 months into sabbatical, I think I have it. While the AMA and other governing bodies in medicine have been running around in circles lighting their heads on fire, I have the answer to address the “how to address the mental health needs of physicians” issue.
Just kidding. I’m nowhere near that good.
I don’t have a solution, but I can lay out in simple terms what the very real competing issues are and not be bitter about it. Then, collectively, there has to be a win-win scenario in here. After all, we’ve put the Hubble Telescope into orbit to see into the farthest reaches of the galaxy. We’ve eradicated polio (if not for the anti-vaxers). We’ve invented Crystal Pepsi. We can handle this one, too.
Physicians still have to answer pointed questions in many states to the effect of “do you have or have you had any mental health condition requiring treatment?” It’s one thing to be impaired and unable to perform. It’s a whole different matter to be appropriately treated and productive. Why treat it different from any medical condition? You wouldn’t be concerned if your doctor had asthma. Why would you be concerned if they took an SSRI for anxiety or depression? You would be concerned (or should be) if your doctor was recovering from a stroke. Uncontrolled mental health problems would be similar. The issue is still stigma. All mental health issues get lumped into the same category. Health problems are still seen as different. Let’s face it. Until we really look at “mental health” as “health”, this won’t change. This is an issue inside and outside of the profession. No solution offered by me. Tincture of time? I don’t know.
Medicine (and nursing) is in a small subset of professions where individuals with mental health problems can impact outcomes on a both immediate and delayed scale. I won’t list all of them here. It’s not too hard to see how someone with an uncontrolled, severe problem could be a threat to safety to patient outcomes. Anyone reasonable would argue that safeguards should be in place to protect patients in these instances.
Much like the general population, that’s not the majority of health care professionals. Here are the players at the table. This may be a bit over simplified, but I think it illustrates the point well enough.
-Patients/the public. This group has a simple NEED in concept. They need to be protected from dangerous health care professionals (HCP), whatever the definition and the root cause of the problem. If a HCP is a danger to the public, there needs to be a transparent process and place for the public to have this type of information. At times, the health care profession has been cloaked in secrecy. This is undeniable. In the axiom of “do no harm”, the public has to be afforded this safeguard.
-State licensing boards. They are the “switchboard” so to speak. They are tasked with ensuring someone is “fit” to practice. If mental health is continued to be perceived through outdated, punitive models, physicians are not likely to report, nor are they likely to seek help. If they don’t ask about physician “fitness” at all, the public is at risk. And legally, I would hate to be this group. Again, I am not sure how public the information is that they put out. If you protect physician privacy, the accusation is that of not being transparent enough. (By the way, you could lump healthcare organizations, hospitals, and any organization heavily involved in credentialing in this group, too. I just don’t feel like writing all day.)
-Physicians. The HCPs. We tell our patients to take mental health seriously, yet frequently deny our own. Stressed out, depressed, burnt out physicians don’t serve anyone particularly well. And like the general public, we need HELP. The vast majority can be treated successfully IF we have avenues to pursue treatment and don’t jeopardize our careers by just seeking help.
This seems complicated. There are seemingly competing interests at play. The governing medical bodies are calling for action. Physicians are calling more attention to their own mental health and burn out. We do need health care organizations and hospitals (the employers) to actually acknowledge that this us an issue worth addressing and to actually do something. More than making noise, the governing bodies like the AAP would be better suited to apply actual pressure on these organizations (that seem to be propagating burn out as they chew people up and spit them out) rather than issue position statements (which the governing bodies excel at doing; they LOVE to issue position statements).
Sarcasm aside, I think in all of this, there is a win-win in here somewhere. I don’t have enough expertise in the medical-legal arena by myself to delineate each step. But it has to be doable. Here’s why: No one single entity has to be defeated. The only thing that truly has to be defeated is seeing mental health as a separate type of health issue. It isn’t. It’s a health issue, nothing more, nothing less. Beaten up, stressed out, anxiety ridden HCPs are not weak people. Rather, they likely got to that point because they exhausted their compassion, their empathy, and they just need assistance in finding new and healthier ways to cope and get support. This should sound like a similar refrain for the general public. Until that switch is made, we aren’t going anywhere in the big picture, folks.
Once we get there, I think there is a win-win in here. I think the needs of the public, the licensing board, and the individual physicians can all be met. Each party has a need that IS NOT RELIANT on someone else having their need squashed. It will require a change in what is reported to the public and how. It will require a change in how licensing boards perceive mental health, ask about it, and support those of us that are still productive people. And it will take physicians recognizing that our patients do have needs that need to be protected. But we also need to have access to the same care without fear of retribution.
None of this is mutually exclusive. From my own experience, I feared being treated for anxiety and panic attacks. I feared that if found out, that it would impact my ability to practice. I feared that seeking treatment would negatively impact me. I’m not 100% sure that there’s not some negative ramification of acknowledging it now, and that I’m only “safe” because I’m not in that environment now. I don’t know if I would ever convince myself to go back to that cauldron. It just seems silly not to say something now, for those that still have a skin in this game. All this needs is the recognition of, “yes, this is a problem worth fixing” and then the will to do so. We need less grandstanding statements from the AMA and the AAP (however well-intentioned) and more tangible action to actually help. We don’t need a list of stress mitigation techniques to help reduce stress once in a stressful situation. If I see one more list about the need to meditate, I’m going to vomit blood out of my eyes. Like those with addressable mental health issues, we need actual help. We’ve handled more difficult things, so please, pass me the Crystal Pepsi.