Read a few articles the last couple of days, first by Dinah Miller in the most recent issue of Clinical Psychiatry News:
“The American Psychiatric Association has made it a priority to address physician burnout and mental health., APA Trustee-at-Large noted: “State PHPs are an essential resource for physicians, but there is a tremendous diversity in quality and approach. It is critical that these programs include attention to mental health problems as well as addiction, and that they support individual physicians’ treatment and journey toward well-being. They need to be accessible, private, and high quality, and they should be staffed by excellent psychiatrists and other mental health professionals.”
PHPs provide a much-needed and wanted service. But if the goal is to provide mental health and substance abuse services to physicians who are struggling – to prevent physicians from burning out, leaving medicine, and dying of suicide – then any whiff of corruption and any fear of professional repercussions become a reason not to use these services. If they are to be helpful, physicians must feel safe using them.”
Yeah, she goes on to note how states are basically penalizing physicians who come to the State Medical Boards voluntarily for mental health or addiction issues. Really, wonderful to read this, how the very people who are to be protecting the public while being an alleged responsible resource for struggling doctors are screwing everybody over at the end of the day. Oh, and this crap about the APA has made it a priority?
Gee, saying so after decades of bad press by colleagues who belong to that organization and are causing harm to patients and colleagues?! Hmm, let’s get to that in the next article read in the most recent issue of the APA newsletter, Psychiatric New.
“We easily become emotionally and physically exhausted from excessive clinical obligations, documentation, insurance company phone calls, teaching, learning, research, and so on. There never seems to be enough time in the day to also be with family and friends or to just relax. Many of us can feel less than accomplished in our work, not achieving everything we think we should be achieving—usually resulting in our “buckling down” to work harder because, of course, for many physicians, lack of achievement feels personal. Others become withdrawn, cynical, and “go through the motions” at work to get to the end of the day. Still others develop psychiatric disorders, including mood disorders, substance abuse, and/or suicidality. Sadly, this is a trend seen in students and residents alike.
A key finding from my research for organized medicine is the need to invest in educational interventions to help with stress and burnout that can be incorporated into medical school education, residency didactics, and physician continuing education. As things stand now, we lack the skills to handle these complex issues, so there is a need for more research and more time dedicated to wellness training in our profession.”
It is a well written column, but, it is just dishonest and disingenuous of the APA to put this in their newsletter and then be behind the garbage being dumped on those who, in my opinion, are foolish enough to think that coming forward and admitting to problems will be received supportively and responsibly. Frankly, I say it again and again, why do people belong to organizations that are not providing supportive deeds that match their hollow words of concern and caring?
Anyway, the last column also from the above last issue of Psych News, was about preventing physicians from suicide, which to me is very related to Burnout issues.
I can’t locate the article from PsychNews.org as of this writing, but will link Dr Myers’ own site and maybe readers can find it later, it is titled “Preventing Physicians from Dying by Suicide: We all have a Role to Play”.
I’ll type out the main paragraph, and appreciate this is a long one:
“Stigma attached to mental illness is rampant in the house of medicine. I argue that it is even higher than in the general public, and that is shamefully high. Make no mistake, stigma kills. Medical training and its everyday practice are demanding and rigorous. Physicians have to be on top of their game–smart, able to think clearly, decisive, energetic, in good spirits, and empathic. All or most of these qualities are affected by psychiatric illnesses, and this is very scary for doctors to experience. But instead of going to their doctor to get help, even if they have one, most physicians try to fight it, carry on, and prevail. What comes next though is worse; they feel “less than”, “pathetic”, inadequate, deeply ashamed, and chillingly alone. More often than not, they remain tight=lipped. Any progressive, nonjudgmental beliefs they one embraced about mental illness go flying out the window. They are filled with self loathing that they no longer belong in the hallowed halls of medicine and feel they are either a weight on or embarrassment to the profession. Armed with medical knowledge about sure-fire ways of dying , it is not a stretch to imagine what comes next.”
Yes, that sums it up for me. And really, getting back to burnout in psychiatry and the bullshit that is the real APA message at the end of the day, where is the alleged interest and effort to return to complete bio-psycho-social etiologies and treatment interventions that psychiatrists can and should provide? It ain’t there, folks, and frankly, while I try not to use the F-word too much, it really is the only way to say it here: the APA is not only fucking uninvested and clueless if not maliciously complicit, they put physicians at risk by never wavering from their agenda of “PILLS, PILLS, PILLS”, and it is in all their literature and conferences at the end of the day.
Well, read the links, feel free to share others I have not noted, and most importantly, be careful what you share with colleagues. I’ll end with this admission, during my bout with a C5-7 herniated discs issue last year, I did have the Orthopedic physicians provide me small but repeated low dose diazepam Rxs I used 2-3 times a week for sleep, total of 4 Rxs for 15 ten mg tabs. When I had to go to a new PCP after changing insurance coverage because Blue Cross/ Blue Shield raised my premium yet again to an amount LARGER than my monthly mortgage payment, I noted this freely as I inquired if I could have a prescription for 1 time Lorazepam 1mg tabs for some sleepless nights. A prescription I have written numerous times for patients I am wary to prescribe controlled substances, but at least will give them a benefit of doubt for their alleged struggles with insomnia I know firsthand is difficult.
What does this colleague do in response, as my physician for care? He brings up my Rx history in the Maryland Prescription Drug Monitoring system, which I am in and amazingly accurately documented, and then puts this in my face to note I was on a benzo. Gee, what part of I told him so and who wrote them did he miss?!
So, being front and center of being accused and then told controlled substances are not an option by him, I have moved on. Not to seek out benzos from others, but, to learn that being 100% candid and direct seems to be received as a problem.
What’s next for us, colleagues, spontaneous combustion incidents???
The best picture I could find, Hope it fits…