UAB Synopsis, Vol. 28, No. 42, November 9, 2009
Each month UAB Synopsis asks Physician Resource Office Medical Director and UAB Physician Health Officer Sandra L. Frazier, MD, to answer a question about professional well being and health.
Dear Dr. Frazier: I feel depressed, and I have been handling it myself. How can I determine if I need help?
A: Physicians have a number of occupational risks for depression: heavy workload, lack of sleep, poor eating habits, poor physical fitness, exposure to illness, tragedy, and death, and patients who may be demanding or unappreciative. Physicians are subject to a high level of scrutiny by hospitals, health care payment plans, and regulatory agencies. Exposure to death and dying may lead to unresolved grief among physicians.
Although about 12% of physicians have depression — the same percentage as the general population — suicide rates among doctors are higher than in the general population. In male physicians, the rate of suicide is 40% higher than in the general population; the rate in female physicians is 130% higher. Completion rates are high in men and women physicians because they know the lethality of and have access to means of suicide. As many as 400 US physicians take their lives each year.
Women physicians are especially at risk for depression and have a high incidence of completed suicide. Researchers hypothesize that women physicians juggle careers along with the majority of the responsibility for family care. Women have not attained full parity in previously male-dominated professions and are not rewarded by promotion or privilege as often as men. Experts also cite a paucity of empathic opportunities.
Medical students and residents have higher rates of depression than the general population, and they exhibit higher rates of suicidal ideation.
Culture Change
Many physicians try to treat their own depression. They think that if they can function, they do not need help. (Though often they are not functioning at as high a level as they think.) Physicians underutilize mental health care services because of lack of time, lack of confidentiality, and stigma. They fear that admitting a mental illness such as depression will hurt their careers, jeopardize their licensure, or affect their privileges. In fact, seeking help is often the best way to protect your license, privileges, and patients.
We need a culture change in medicine so that physician mental health becomes a higher priority. If we do not feel comfortable coming forward and getting treatment, how can we expect our patients to seek appropriate treatment? Physicians may be well trained but that does not give us immunity to life stressors. The Physician Resource Office is working to change UAB culture so that taking care of yourself is considered a strength.
The office is away from the mainstream medical center (in the John N. Whitaker Building). We do not keep computer records in the UAB system. Whether you have one question or a long-term need, your information and identity are confidential (unless you are actively suicidal).
Recognize Signs and Symptoms
Depression is an illness that requires intervention and treatment, just as diabetes, heart disease, and other illnesses do. However, physicians often miss the signs and symptoms of depression in their patients and in themselves. You may think you are functioning but you may be compromising your efficiency, your ability to work in a team, and, ultimately, patient care.
Look for sleep problems, loss of interest in pleasurable activities, feelings of guilt or worthlessness, decreased energy, impaired concentration, appetite changes, and thoughts of death or suicide.
If you are not sure if you need help, ask yourself if your feelings are affecting your family life or your patient care. Call the Physician Resource Office, and often in a phone conversation we can decide together what steps you should take. We can help, whether you need guidance through the healing process for acute grief, are experiencing situational depression and need short-term assistance, or need long-term medical management and therapy.
Do not ask a friend to prescribe you an antidepressant. There are ethical issues surrounding prescribing for family and friends (www.uabhealth.org/69000/), and to be fully effective, treatment for depression generally should involve a two-pronged approach: medication management and counseling.
Concomitant with our dedication to patient care should be an equal emphasis on our own health and that of our colleagues. Physicians can be seriously ill and not recognize it. Watch out for each other, commit to being supportive, and give permission to speak to each other about what is happening in your lives.
Notice if a colleague undergoes sudden changes such as weight loss or gain, insomnia, or a personality change such as increased irritability. Intervene if you are concerned — it may be exactly what your colleague needs. Ask him or her if he or she is all right, or ask how you can help. If your colleague is not amenable to your suggestions and his or her problem is affecting patient care, report your concerns to a higher level. It helps no one to turn a blind eye.
Call the Physician Resource Office if you need help deciding whether to intervene or what to say to a colleague. A phone conversation likely can help you determine what direction is best.
Services are provided at no cost for any physician — faculty or resident — and students in the School of Medicine. For more information contact Dr. Frazier at 205.731.9799 or visit our Web site at www.uabhealth.org/18393/.
If you have a question for Dr. Frazier, please e-mail uabsynopsis@uabmc.edu.