Depressed Doctors: When everyone expects you to "heal thyself."

What percentage of doctors suffer from depression?

The same percentage as anybody in any other profession.  Doctors are JUST AS likely to suffer from depression as the population at large.  They're also just as likely to have a seizure disorder, MS, diabetes or anything else.

Being a doctor doesn't mean you're immune.  But when it comes to depression, being a doctor does make a difference.

Compared with the general population - how often do doctors commit suicide?

TWICE AS OFTEN! 
Male physicians are 1.4 times more likely, and female physicians are 2.27 times more likely.

Why?

2 main reasons:

1.  Doctors know how to die - they see it every day.  They know what pills will kill them.  They can write the prescription, fill them, and take all they need to go quietly into the night.

2.  They don't get treatment.  The stigma for mental illness may have gone down for patients - but not for doctors.  Doctors still expect each other to "get over it."  When medical students were anonymously polled - 14% met the diagnosis for depression.  (about average for any population)
 - Here's why they didn't want to seek treatment or tell anyone:

 - 53% thought telling a counselor would be "risky"
 - 62% thought they'd be seen as "less intelligent"
 - 83% thought they'd be seen as "unable to handle responsibilities"
 - 56% thought their opinion would be less respected

Of practicing doctors that were polled:

 - 14% prescribed their own antidepressants (VERY DANGEROUS AND ILLEGAL)
 - 10% feared losing their practice privileges
 - 8% feared losing their medical license

Doctor's know intellectually that depression is an illness just like every other.  But we all went through med school, we know what's expected, and we know that doctors aren't supposed to get depressed.  We are taught that depression is weakness.  If you do feel depressed you should just buckle down and work harder and push on through.  Seeing a counselor or therapist is weak.  Take a pill if you have to - but deal with it on your own.  If you play the depression card - you'll be on the outside looking in.

It was a humbling lecture to hear today.  I sat in a room with 200 of my colleagues, and we talked about how much we care for our depressed patients, yet we continue to hold each other to a "higher" (impossible) standard.  Of all professions - Doctors should be the most understanding.

It was sad to read the studies, and see the results.
The medical community isn't just as bad as everybody else - we're worse.

Defensive Medicine - What Makes Psychiatry Even Harder

When most people think of "Defensive Medicine" they envision what physicians do to cover their backsides rather than really help patients.

I think of being a medical student working in the ER when a drunk patient comes in complaining of chest pain.  My attending physician asks - "what does that patient need?" I answer - "He needs a rally bag, some food and a place to sleep for about 12-18 hours."
She then says - "but you know what we're going to do right?  He's going to get a CBC, CMP, UA, BAL, Chest X-ray and an EKG - and that's just for starters."

And that's how it goes.  We know what's wrong - or least we're pretty sure.  But we have to cover ourselves legally - because what if???

Can a drunk guy with chest pain be having a heart attack?  YES

It's like they say: "Every Hypochondriac eventually dies from something."

My residency director often said: "A man with diseases can have as many as he pleases."

Just because someone uses drugs and has a personality disorder doesn't mean they can't have epilepsy.  Yep - just because someone has pseudoseizures doesn't mean they can't have real seizures too.

And that's why we do it.  Yeah - we don't want to get sued - it's true. 

We would probably be correct and save thousands and millions of dollars if we treated people how we REALLY think they need to be treated.  But we don't get to make that call.

Psychiatrists have it even worse.  I wish I could just look at a depressed patient, or an anxious patient, and give them what they need.  I could give them the medications that are most likely to help them and get them the therapy that is most likely to have a lasting effect - but I have to do more than that.

Every patient I see - I have to look at their medication list and ask myself - "If they took every pill in their medicine cabinet - would they survive?" "If they tried to kill themselves - have I given them the tools to do it?"

I always have to worry about suicide.  Always.

I can't just treat symptoms, or even diseases.  I have to practice defensive medicine - meaning I have to defend the patient from themselves.

It's an impossible task.  I don't control their free will.  I am not their parent or their conscience.  I am merely their psychiatrist.

Yet somehow - when I get that call - the one where some ER doctor tells me that my patient just attempted suicide by overdosing on the pills I gave them - I'll feel responsible.

Maybe I can get used to it.  Is that what makes a good shrink?  Being able to handle things like that?

Maybe that sinking pit of guilt, despair, and regret at having facilitated a patient's suicide goes away?

Maybe it should.

Maybe it shouldn't.